2 型糖尿病合并早期慢性肾脏病患者左心室涡流性能的向量流映射分析。
Vector flow mapping analysis of left ventricular vortex performance in type 2 diabetic patients with early chronic kidney disease.
机构信息
Department of Ultrasound, First Hospital of Qinhuangdao, Hebei Medical University, No.258, Wenhua Road, Qinhuangdao, 066000, Hebei, China.
Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio- cerebrovascular Disease, No. 215, Hepingxi Road, Shijiazhuang, 050000, Hebei, China.
出版信息
BMC Cardiovasc Disord. 2023 Sep 1;23(1):434. doi: 10.1186/s12872-023-03474-7.
BACKGROUND
Diabetes is the leading cause of chronic kidney disease (CKD) and contributes to an elevated incidence of diastolic dysfunction in the early stages of CKD. Intracardiac vortex is a novel hemodynamic index for perceiving cardiac status. Here, we visualized left ventricular (LV) vortex characteristics using vector flow mapping (VFM) in type 2 diabetic patients with early CKD.
METHODS
This cross-sectional study included 67 controls and 89 type 2 diabetic patients with stages 2-3a CKD. All subjects underwent transthoracic echocardiographic examination. LV anterior vortex during early diastole (E-vortex), atrial contraction (A-vortex) and systole (S-vortex) were assessed using VFM in the apical long-axis view. Its relation to glycemia or LV filling echocardiographic parameters were further analyzed using correlation analysis.
RESULTS
Type 2 diabetic patients with early CKD had a small area (439.94 ± 132.37 mm vs. 381.66 ± 136.85 mm, P = 0.008) and weak circulation (0.0226 ± 0.0079 m/s vs. 0.0195 ± 0.0070 m/s, P = 0.013) of E-vortex, but a large area (281.52 ± 137.27 mm vs. 514.83 ± 160.33 mm, P ˂ 0.001) and intense circulation (0.0149 ± 0.0069 m/s vs. 0.0250 ± 0.0067 m/s, P < 0.001) of A-vortex compared to controls. CKD patients with poorly controlled hyperglycemia had stronger A-vortex (area: 479.06 ± 146.78 mm vs. 559.96 ± 159.27 mm, P = 0.015; circulation: 0.0221 ± 0.0058 m/s vs. 0.0275 ± 0.0064 m/s, P < 0.001) and S-vortex (area: 524.21 ± 165.52 mm vs. 607.87 ± 185.33 mm, P = 0.029; circulation: 0.0174 ± 0.0072 m/s vs. 0.0213 ± 0.0074 m/s, P = 0.015), and a longer relative duration of S-vortex (0.7436 ± 0.0772 vs. 0.7845 ± 0.0752, P = 0.013) than those who had well-controlled hyperglycemia. Glycemia, and E/A (a LV filling parameter) were respectively found to had close correlation to the features of A-vortex and S-vortex (all P < 0.05).
CONCLUSIONS
Abnormal LV vortices were detected in type 2 diabetic patients with early CKD using VFM, especially in those who neglected hyperglycemic control. LV vortex might be a promising parameter to slow or halt the hyperglycemia-induced diastolic dysfunction in early CKD.
背景
糖尿病是慢性肾脏病（CKD）的主要病因，并导致 CKD 早期舒张功能障碍的发生率升高。心腔内涡流是一种感知心脏状况的新型血流动力学指标。在这里，我们使用二维斑点追踪技术（2DSTE）在患有 2 型糖尿病和早期 CKD 的患者中可视化左心室（LV）涡流特征。
方法
本横断面研究纳入了 67 名对照者和 89 名患有 2-3a 期 CKD 的 2 型糖尿病患者。所有患者均接受了经胸超声心动图检查。使用心尖长轴切面的向量血流图（VFM）评估舒张早期（E-vortex）、心房收缩（A-vortex）和收缩期（S-vortex）的 LV 前向涡流。使用相关分析进一步分析其与血糖或 LV 充盈超声心动图参数的关系。
结果
患有早期 CKD 的 2 型糖尿病患者的 E-vortex 面积较小（439.94±132.37 mm 比 381.66±136.85 mm，P=0.008），循环较弱（0.0226±0.0079 m/s 比 0.0195±0.0070 m/s，P=0.013），而 A-vortex 面积较大（281.52±137.27 mm 比 514.83±160.33 mm，P ˂0.001），循环较强（0.0149±0.0069 m/s 比 0.0250±0.0067 m/s，P＜0.001）。血糖控制不佳的 CKD 患者 A-vortex 较强（面积：479.06±146.78 mm 比 559.96±159.27 mm，P=0.015；循环：0.0221±0.0058 m/s 比 0.0275±0.0064 m/s，P＜0.001）和 S-vortex 较强（面积：524.21±165.52 mm 比 607.87±185.33 mm，P=0.029；循环：0.0174±0.0072 m/s 比 0.0213±0.0074 m/s，P=0.015），并且 S-vortex 的相对持续时间较长（0.7436±0.0772 比 0.7845±0.0752，P=0.013）。与血糖控制良好的患者相比，这些患者的血糖水平和 E/A（LV 充盈参数）与 A-vortex 和 S-vortex 的特征密切相关（均 P＜0.05）。
结论
使用 VFM 在患有早期 CKD 的 2 型糖尿病患者中检测到异常的 LV 涡流，尤其是在忽视高血糖控制的患者中。LV 涡流可能是一种很有前途的参数，可以减缓或阻止早期 CKD 中高血糖引起的舒张功能障碍。
Zotero 插件