Assessment Of Left Ventricular Diastolic Function In Patients With Sjogren’s Syndrome By Real-time Three-plane Quantitative Tissue Velocity Imaging And Strain Rate Imaging

Objective:Assessment of left ventricular diastolic function by Real time three-plane quantitative tissue velocity imaging and strain rate imaging according to measure movement velocity of left ventricular wall and myocardial strain and strain rate in patients with Sjogren’s syndrome, evaluate left ventricular diastolic function of Sjogren’s syndrome patients of different types. Investigate the feasibility of this technology for the assessment of left ventricular diastolic function of Sjogren’s syndrome patients with different subgroups.Materials and methodsStudy object:choose 27 patients, All were recruited from the patients diagnostic of Sjogren’s syndrome in department of rheumatism and immunology in the first affiliated hospital of Kunming medical university were selected from June 2014 to February 2015. A diagnosis of Sjogren’s syndrome was assigned according to the USA-European consensus classification consensus on Classification Standards for Sjogren’s syndrome criteria in 2002. Then according to whether to merge rheumatoid arthritis or not, divide them into two subgroups —primary Sjogren’s syndrome patients (primary group) and secondary Sjogren’s syndrome group (secondary group), with 15 cases in the primary group and 12 in the secondary group. Exclusion criteria:1) various CHDs, serious valvular heart disease, coronary heart disease, primary hypertension and other heart diseases; 2) metabolic diseases: diabetes and abnormal blood lipid metabolism patients; 3) the quality of the three-plane imaging is too poor that can’t be analyzed.Research method:All the subjects were examined in a calm state, All patients were accepted the examination of two-dimensional gray-scale images from the parasternal long-axis view by using GE G9 Dimension M3S probe. Use M- mode to measure left ventricular ejection fraction (LVEF). Pulsed wave Doppler (PW) was used to measure the indexes of mitral valve flow pattern as early diastolic flow velocity (Ep) and late diastolic peak velocity (Ap), and the Ep/Ap ratio was calculated. Use the 4V probe to get the RT-3PE figure of the apical four-chamber view, and adopt the technology of RT-3PEQTVI and RT-3PE SRI to obtain and store the figure, Then early diastolic peak velocity(Ve), late diastolic peak velocity(Va), early diastolic peak strain rate(SRe), late diastolic peak strain rate(SRa)of each segment myocardial were measured off-line, and Ve/Va, mVe, mVa SRe/SRa were calculated. Use the statistical software of SPSS 17.0 to comparatively analyze the various diastolic peaks and strain peaks of Sjogren’s syndrome patients in different groups.Result:1. There were no statistically significant differences between Sjogren’s syndrome patients and controls group in the heart structure, traditional parameters of LV systolic function. (P>0.05).2. Use Pulsed wave Doppler (PW) to measure the indexes of mitral valve flow pattern and calculate Ep/Ap. It has found that there were no statistically significant differences between Sjogren’s syndrome patients and controls group (P>0.05)3. Using the technology of RT-3PEQTVI:3.1 Compared with the controls group:Ve of the left ventricular basal section in primary group were decreased. Except for that, there is no significantly decrease in the rest 11 segments, but Ve/Va, mVe, mVe/mVa of the left ventricular basal and middle section were decreased, Va and mVa were increase; the Ve, Ve/Va, mVe, mVe/mVa of the left ventricular basal and middle section in secondary group were decreased, and their Va and mVa were raised (P<0.05).3.2 Comparing with the primary group:the Ve, Ve/Va, mVe, mVe/mVa of the left ventricular basal and middle section in secondary group were decreased, and their Va and mVa were raised(P<0.05).4. The use of RT-3PE SRI technology:4.1 Comparing with the controls group:there were no significant changes in the SRe, SRa and SRe/SRa of the left ventricular basal and middle section in primary group(P>0.05),but SRe and SRe/SRa decreased in secondary group(P<0.05).4.2 Comparing with the primary group:except for the SRa in the 12 segments of the secondary group, which had no significant changes. But the SRe and SRe/SRa were significant decreased(P<0.05).Conclusion:1. The left ventricular diastolic dysfunction of Sjogren’s syndrome Patients happend earlier than the systolic dysfunction and the shape change of the left ventricle.2. Pulsed wave Doppler (PW) was used to measure the indexes of mitral valve flow pattern as early diastolic flow velocity (Ep) and late diastolic peak velocity (Ap), and the Ep/Ap ratio was calculated. Which evaluation index shows that the left ventricular diastolic function is not sensitive.3. The technology of RT-3PE QTVI and RT-3PE SRI evaluating left ventricular diastolic function of Sjogren’s syndrome patients is prior and better than the simple method of Ep/Ap.4. In the technology of RT-3PE SRI SRe, SRe/SRa can both be treated as the index of left ventricular diastolic dysfunction. In the technology of RT-3PE QTVI, Ve, Va, Ve/Va, mVe, mVa, mVe/mVa can all be treated as the index of left ventricular diastolic dysfunction.5. Comparing the technologies of RT-3PE QTVI and RT-3PE SRI, the index of Ve of RT-3PE QTVI is more sensitive, it also improved that technology of RT-3PE QTVI is better than RT-3PE SRI.