Lin Jing-Chi, Lin Chun-Liang, Chen Mien-Cheng, Chang Pey-Jium, Chang Shih-Tai, Chung Chang-Min, Pan Kuo-Li
Division of Allergy and Immunology and Rheumatology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
Arthritis Res Ther. 2015 Nov 14;17:323. doi: 10.1186/s13075-015-0842-8.
Gout is a common metabolic disorder characterized by hyperuricemia and chronic inflammation. Previous studies show that hyperuricemia accelerates the occurrence and worsening of cardiovascular disease due to LV remodeling. However, it is still unclear whether hyperuricemia is the sole contributor to organic heart remodeling in patients with gout. In addition, there is a paucity of data regarding the association between LV diastolic function and gout. The objective of this study was to investigate the effects of gout on LV diastolic function.
A total of 173 patients were divided into tertiles based on the following serum uric acid (UA) levels: (1) serum UA ≤ 6.5 mg/dL (n = 54), (2) serum UA >6.5 to ≤8.5 mg/dL (n = 59), and (3) serum UA > 8.5 mg/dL (n = 60).Patients underwent a comprehensive Doppler-echocardiography examination to evaluate LV volume, systolic and diastolic function, and left atrial (LA) volume.
LV diastolic parameters, including diastolic peak early transmitral flow velocity (E), late transmitral flow velocity (A), E/A, peak early diastolic mitral annular velocity (Em), late diastolic annular velocity (Am), Em/Am, E/Em, maximal LA volume index (LAVi) and prevalence of moderate to severe LV diastolic dysfunction were not significantly different between the three groups. Among the population being studied, 108 individuals received a gout diagnosis. Gout patients had greater LV end-systolic dimensions (27.08 ± 4.38 mm, p = 0.006), higher LV mass index (107.18 ± 29.51 g/m2, p < 0.001), higher E/Em (10.07 ± 2.91, p = 0.008), and larger maximal LAVi (16.96 ± 7.39 mL/m2, p < 0.001) than patients without gout. The prevalence of moderate to severe LV diastolic dysfunction was higher in patients with gout (23%, p = 0.02).
Gout, not hyperuricemia alone, is associated with LV diastolic dysfunction and LA volume enlargement.
痛风是一种常见的代谢紊乱疾病，其特征为高尿酸血症和慢性炎症。既往研究表明，由于左心室重塑，高尿酸血症会加速心血管疾病的发生和恶化。然而，高尿酸血症是否是痛风患者心脏器质性重塑的唯一促成因素仍不清楚。此外，关于左心室舒张功能与痛风之间关联的数据也很匮乏。本研究的目的是探讨痛风对左心室舒张功能的影响。
根据血清尿酸（UA）水平将173例患者分为三分位数组：（1）血清UA≤6.5mg/dL（n = 54），（2）血清UA>6.5至≤8.5mg/dL（n = 59），以及（3）血清UA>8.5mg/dL（n = 60）。患者接受了全面的多普勒超声心动图检查，以评估左心室容积、收缩和舒张功能以及左心房（LA）容积。
三组之间的左心室舒张参数，包括舒张期二尖瓣血流早期峰值流速（E）、晚期二尖瓣血流流速（A）、E/A、舒张早期二尖瓣环峰值流速（Em）、舒张晚期二尖瓣环流速（Am）、Em/Am、E/Em、最大左心房容积指数（LAVi）以及中度至重度左心室舒张功能障碍的患病率均无显著差异。在研究人群中，108人被诊断为痛风。痛风患者的左心室收缩末期内径更大（27.08±4.38mm，p = 0.006），左心室质量指数更高（107.18±29.51g/m2，p<0.001），E/Em更高（10.07±2.91，p = 0.008），最大LAVi更大（16.96±7.39mL/m2，p<0.001）。痛风患者中度至重度左心室舒张功能障碍的患病率更高（23%，p = 0.02）。
痛风而非单纯的高尿酸血症与左心室舒张功能障碍和左心房容积增大有关。
