Quantitative Evaluation Of Left Ventricular Global Myocardial Work By Pressure-Strain Loops Technology In Patients With Hyperuricemia

Objective:To quantitatively evaluate the changes of the left ventricular myocardial work in patients with different disease progressions of hyperuricemia(HUA)by noninvasively left ventricular pressure-strain loop(PSL)and to explore the correlation between the degree of left ventricular myocardial damage and the level of uric acid and inflammatory response factors in patients with HUA.Methods:Seventy-three patients(case group)Who were diagnosed HUA in Henan Provincial People’Hospital from March 2021 to May 2022 were selected.According to the 2015 American College of Rheumatology/European Union Against Rheumatism Gout Classification Standard and clinical symptoms and laboratory indicators,they were scored and divided into gout group 34 cases(score≥8 points)and asymptomatic HUA group 39 cases,another 32 healthy volunteers matched by age and sex were selected(control group).Secondary HUA(caused by malignant tumors or oral medications,etc.),autoimmune diseases such as systemic lupus erythematosus,rheumatoid arthritis,abnormal renal function caused by gout,diabetes,hypertension,congenital heart disease,valvular heart disease,cardiomyopathy and other heart diseases and poor image quality are excluded.1.Collection of general clinical data and laboratory indicators:Heart rate,systolic and diastolic blood pressure,height,body weight and body mass index(BMI)were measured and collected for all study participants all study subjects.Asymptomatic HUA and gout course,imaging data,clinical symptoms,etc.were collected.Asymptomatic HUA and gout course,imaging data,clinical symptoms,etc.were collected.On the morning of the ultrasound examination,fasting blood was drawn to measure the serum uric acid level of the subjects,and the total cholesterol,triglycerides,low-density lipoprotein and CRP,TNF-α,ESR,IL-1,IL-6 and other inflammatory response factors were collected.2.Conventional echocardiography parameter acquisition:GE Vivid E95 ultrasound diagnostic instrument is equipped with M5S-D probe(1.4～4.6MHz).The patient takes the left position,connects to the electrocardiogram,and after the person is calmly breathing and the heart rate is stable,LAD,LVEDd,LVEDs,IVSD,LVPWD,LVEF.Pulse Doppler was used to measure the peak flow velocity of early mitral valve(E)and late diastolic(A),and tissue Doppler was used to measure the early peak velocity of mitral annular diastolic at the left ventricular lateral wall and ventricular septum,and the average values e’,E/A,E/e’were calculated.3.Collection of left ventricular myocardial work parameters:Collect dynamic images of five cardiac cycles of apical four-chamber heart,three-chamber heart and two-chamber heart.The Echo PAC 203workstation was used to perform offline analysis of the imported images,and the non-invasive left ventricular pressure-strain loop technique was used to obtain the GLS,GWI,GCW,GWW,GWE.Results:1.Compared with the control group,the levels of SUA,CRP and IL-6 in the asymptomatic HUA group and the gout group were significantly increased(all P<0.05),and the levels of SUA,CRP and IL-6in the gout group were higher than those in the asymptomatic HUA group(all P<0.05).There were no significant differences in age,sex,heart rate,BMI,systolic blood pressure,diastolic blood pressure,hyperlipidemia ratio,disease course,and some inflammatory response factors(TNF-α,ESR,IL-1)between the three groups(all P>0.05).2.Compared with the control group,E/e’was increased in the asymptomatic HUA group(P<0.05),and the LAD and E/e’increased in the gout group(all P<0.05).The gout group E/e’was higher than the asymptomatic HUA group(P<0.05).There were no significant differences in LVEDd,LVEDs,LVEF,IVSD,LVPWD and E/A between the three groups(all P>0.05).3.Compared with the control group,GWI and GCW,GLS were reduced in the asymptomatic HUA group(all P<0.05)and GWI,GCW,GWE and GLS were reduced in the gout group(all P<0.05).GWI,GCW,GWE and GLS were lower in the gout group than those in the asymptomatic HUA group(all P<0.05),and there was no significant difference in GWW between the three groups(P>0.05).4.In patients with HUA,GWI,GCW,GWE and SUA were negatively correlated(r/r_s=-0.790,-0.730,-0.457,all P<0.001),and negatively correlated with inflammatory response factors(CRP,IL-6)(r/r_s=-0.591,-0.529,-0.315,all P<0.05),(r/r_s=-0.779,-0.730,-0.489,all P<0.001).E/e’was positively correlated with SUA,CRP and IL-6(r=0.693,0.463,0.688,all P<0.001).Conclusion:1)Patients with HUA have different degrees of left ventricular systolic and diastolic dysfunction when the left ventricular ejection fraction is still normal,manifested as decreased GWI,GCW,GWE and elevated E/e,the degree of left ventricular systolic and diastolic dysfunction gradually increases with the increase of serum uric acid and inflammatory response factors.2)Pressure-strain loop technology(PSL)can quantitatively evaluate the work changes of left ventricular myocardium in HUA patients under different conditions,reduce GWI and GCW in the asymptomatic HUA group,and reduce GWI、GCW and GWE in the gout group,so as to provides a quantitative basis for clinical understanding of his cardiac impairment and further formulation of corresponding treatment plans.