超声血流向量成像对痛风患者左心室能量损耗的初步评价

目的应用超声血流向量成像（VFM）技术初步评价痛风患者左心室能量损耗并探讨其临床应用价值。 方法选取2019年12月至2020年6月在四川省人民医院确诊的痛风患者45例为痛风组，同期收集四川省人民医院体检的健康志愿者40例为对照组。根据病程将痛风患者分为长病程组（24例）和短病程组（21例）。同时根据年龄将痛风患者分为中年痛风组（22例）和青年痛风组（23例），将对照组分为中年对照组（20例）和青年对照组（20例）。所有研究对象均行经胸超声心动图获取常规超声心动图数据。采用VFM工作站离线分析1个心动周期7个时相（P1~P7）的平均能量损耗（EL），7个时相分别为等容舒张期（P1）、舒张早期（P2）、舒张中期（P3）、舒张晚期（P4）、等容收缩期（P5）、收缩早期（P6）、收缩晚期（P7）。分析比较痛风组与对照组以及各亚组间各时相校正后的能量损耗值（ELc）的差异，以及各时相ELc与常规超声心动图参数、ELc与痛风患者年龄和病程之间的相关性。 结果痛风组ELcP3、ELcP6、ELcP7均大于对照组（P均＜0.05）。长病程组年龄、E/e、ELcP4、ELcP5大于短病程组（P均＜0.05）。中年痛风组E/e、ELcP3大于中年对照组（P均＜0.05），青年痛风组ELcP3、ELcP6大于青年对照组（P均＜0.05）。舒张期参数：E/e与ELcP2、ELcP4呈正相关（r=0.306、0.405，P均＜0.01），E/A与ELcP4呈负相关（r=-0.364，P＜0.01），E/A与ELcP2呈正相关（r=0.409，P＜0.01）；收缩期参数：LVEF与ELcP6呈正相关（r=0.306，P＜0.01）；年龄与ELcP4、ELcP5呈正相关（r=0.622、0.671，P均＜0.01）；病程与ELcP4、ELcP5、ELcP7呈正相关（r=0.433、0.465、0.300，P均＜0.01）。 结论VFM技术可定量评估痛风患者左心室流场状态，痛风患者存在左心室早期轻度舒张及收缩功能受损，且受损程度与病程及年龄相关。超声心腔内流体能量损耗参数有望成为检测痛风患者早期左心室舒张及收缩功能异常的新方法。

Evaluation of left ventricular energy loss in gout patients using ultrasonic vector flow mapping

ObjectiveTo evaluate the clinical value of ultrasonic vector flow mapping (VFM) in the evaluation of left ventricular energy loss in gout patients. MethodsHospitalized gout patients (gout group, n=45) and healthy people who had underwent physical examination (control group, n=40) at Sichuan Provincial People's Hospital from December 2019 to June 2020 were enrolled. Based on the course of gout, gout patients were divided into either a long-course subgroup (n=24) or a short-course subgroup (n=21). According to their age, both gout patients and control people were divided into either an aged subgroup (n=22 for gout patients and n=20 for controls) or a young subgroup (n=23 for gout patients and n=20 for controls). All subjects underwent transthoracic echocardiographic examination, and conventional echocardiographic parameters were derived. By using a dedicated VFM workstation, the average energy loss (EL) was obtained offline in seven phases (P1-P7): isovolumic diastole (P1), early diastole (P2), mid-diastole (P3), late diastole (P4), isovolumic systole (P5), early systole (P6), and late systole (P7). The differences in the parameters were statistically analyzed between the gout group and control group, and between each subgroup. The correlation between traditional cardiac function parameters and corrected EL (ELc), and the correlation of ELc with age and the course of gout were also statistically analyzed. ResultsELcP3, ELcP6, and ELcP7 in the gout group were statistically higher than those of the control group (P＜0.05). Age, E/e, ELcP4, and ELcP5 in the long-course subgroup were statistically higher than those of the short-course subgroup (P＜0.05). E/e and ELcP3 in the aged gout subgroup were statistically higher than those of the aged control subgroup (P＜0.05), while ELcP3 and ELcP6 of the young gout subgroup were statistically higher than those of the young control subgroup (P＜0.05). Correlation analysis of diastolic parameters showed that ELcP2 and ELcP4 had a positive correlation with E/e (r=0.306 and 0.405, respectively; P＜0.01), and that ELcP4 had a negative correlation with E/A (r=-0.364, P＜0.01). Besides, there was a positive correlation between diastolic ELcP2 and E/A (r=0.409, P＜0.01). Correlation analysis of systolic parameters showed that there was a positive correlation between ELcP6 and LVEF (r=0.306, P＜0.01). ELcP4 and ELcP5A had a positive correlation with age (r=0.622 and 0.671, respectively; P＜0.01), and ELcP4, ELcP5, and ELcP7 had a positive correlation with the disease course (r=0.433, 0.465, and 0.300, respectively; P＜0.01). ConclusionVFM can quantitatively evaluate left ventricular blood flow field of gout patients. Early mild left ventricular diastolic and systolic dysfunction have occurred in gout patients, and the severity of dysfunction might be related with age and the course of gout. Ultrasound quantitative evaluation of intracardiac blood fluid energy loss parameters is expected to be a new method to detect early left ventricular diastolic and systolic dysfunction in gout patients.