Division of Cardiology, Chang Gung Memorial Hospital, No. 6, West Chia-Pu Road, Putz, Chiayi Hsien, Taiwan 613, Republic of China.
Rheumatology (Oxford). 2014 May;53(5):867-74. doi: 10.1093/rheumatology/ket444. Epub 2014 Jan 9.
The aim of the present study was to investigate the effect of gout on left ventricular (LV) diastolic function and left atrial volume (LAV).
A total of 173 patients were divided into four groups: control (n = 35), asymptomatic hyperuricaemia (n = 30), gouty arthritis without tophi (n = 58) and gouty tophi (n = 50). Patients underwent a comprehensive Doppler echocardiography examination to evaluate LV volume, systolic and diastolic function and LAV and function.
Serum uric acid levels were not significantly different in the asymptomatic hyperuricaemia, gouty arthritis without tophi and gouty tophi groups. However, the ratio of the transmitral and myocardial peak early diastolic velocities (E/e') and LAV index (LAVi) progressively increased from the control group to the gouty tophi group. The tophi group had significantly higher E/e' [10.5 (s.d. 3.2) vs 8.6 (s.d. 2.1), P = 0.008] and larger maximal, pre-contraction and minimal LAVi [29.6 ml/m(2) (s.d. 9.9) vs 20.1 ml/m(2) (s.d. 4.8); 19.1 ml/m(2) (s.d. 8.5) vs 11.5 ml/m(2) (s.d. 3.4); 9.6 ml/m(2) (s.d. 4.2) vs 6.1 ml/m(2) (s.d. 2.2); all P < 0.001] than the control group. By binary logistic analysis, maximal LAVi was an independent predictor for the development of tophi in gout patients, with an odds ratio of 1.068 (95% CI 1.02, 1.118; P = 0.005).
The severity of gout had a significant effect on LV diastolic dysfunction and LA enlargement in gout patients. Additionally, a high maximal LAVi predicted the development of tophi and may be a predictor of adverse cardiovascular events related to LA and LV remodelling in this clinical setting.
本研究旨在探讨痛风对左心室（LV）舒张功能和左心房容积（LAV）的影响。
共纳入 173 例患者，分为四组：对照组（n = 35）、无症状高尿酸血症（n = 30）、无痛风石的痛风性关节炎（n = 58）和痛风石（n = 50）。所有患者均接受全面的多普勒超声心动图检查，以评估 LV 容量、收缩和舒张功能以及 LAV 和功能。
无症状高尿酸血症、无痛风石的痛风性关节炎和痛风石组患者的血尿酸水平无显著差异。然而，从对照组到痛风石组，二尖瓣和心肌峰值早期舒张速度（E/e'）和 LAV 指数（LAVi）的比值逐渐增加。痛风石组的 E/e'显著升高[10.5（s.d. 3.2）比 8.6（s.d. 2.1），P = 0.008]，最大、收缩前和最小 LAVi 也更大[29.6 ml/m²（s.d. 9.9）比 20.1 ml/m²（s.d. 4.8）；19.1 ml/m²（s.d. 8.5）比 11.5 ml/m²（s.d. 3.4）；9.6 ml/m²（s.d. 4.2）比 6.1 ml/m²（s.d. 2.2）；均 P < 0.001]。二元逻辑分析显示，最大 LAVi 是痛风患者发生痛风石的独立预测因子，优势比为 1.068（95%CI 1.02，1.118；P = 0.005）。
痛风的严重程度对痛风患者的 LV 舒张功能和 LA 增大有显著影响。此外，高最大 LAVi 预测痛风石的发生，可能是预测该临床情况下与 LA 和 LV 重构相关不良心血管事件的一个指标。
