Assessment Of Intra-ventricular Fluid Dynamic Changes Of Left Ventricle Using Ultrasonic Vector Flow Mapping In Patients With Type 2 Diabetes Mellitus

Objective: To evaluate the intra-ventricular fluid dynamics of left ventricle in patients with type 2 diabetes(D2M)mellitus during diastolic period and isovolumetric contraction phase(IVC),and to explore the clinical value of left intra-ventricular energy loss(EL)assessment of left ventricle using ultrasonic vector flow mapping for quantitatively evaluation of left ventricular diastolic dysfunction and the potential changes of hemodynamic during IVC.Methods: Sixty two patients with D2 M were selected randomly as case group and thirty nine normal adults were employed as control group.Dynamic images of standard two-dimensional cardiac views with gray-scale and spectral Doppler and apical 3 chambers(AP3c)view with color Doppler flow during three completed cardiac cycles were acquired for the measurement of general parameters of left ventricle and left atrium,diastolic and systolic function of left ventricle.The AP3 c color Doppler flow images were analyzed further using an off-line dedicated workstation to acquire the left intra-ventricular EL parameters during diastolic phases and IVC,and vortex circulation(Cir)and vortex area and the position of vortex center(vortex-X and vortex-Y)during IVC and diastolic phases identified based on the time-flow curve(T-F curve)of left ventricular inflow tract and the open-close of valve.Diastolic phase and IVC of left ventricle were divided into the isovolumic relaxation phase(P1),early diastolic phase(P2),rapid filling phase(P3),slow filling phase(P4),atria contract period(P5)and isovolumetric contraction phase(P6).The EL parameters of each phase(Pn-EL,n=1~6)and vortex parameters of IVC were recorded simultaneously.The difference of general parameters and vortex parameters in IVC and EL value of each diastolic and IVC phases werecompared.The correlation between EL and the general function parameters of relaxation and contraction,and vortex parameters of left ventricle between two groups were analyzed.Results: 1 Comparison of the left ventricular general functional parameters: Compared to the normal group,A,E/e,E peak deceleration time(EDT),isovolumic relaxation time(IRT),isovolumetric contraction time(ICT)and Tei index of D2 M group were higher,and E/A,e,e/a were lower with statistical significance(p<0.05).The E of D2 M group were lower than that of normal group,while a and pre-ejection time(PET)was higher with no statistical significance(p>0.05).2 Comparison of the EL parameters during diastolic phase(P1~P5): Compared to those of normal group,the EL in D2 M group of the phases were higher with statistical significance in P1,P2,P4,P5phases(p<0.05),while no statistical significant difference in P3 phase(p>0.05).3 Comparison of the vortical parameters and EL parameter during IVC:Compared to those of normal group,the P6-EL and circulation of D2 M group were higher with statistical significance(p<0.05).The X axis of vortex central position(vortex-X)and Y axis of vortex central position(vortex-Y)and vortex area of D2 M group were lower with statistical significance(p<0.05),while no statistical significant difference of vortex area(p>0.05).4 Correlation analysis between vortical parameters and time parameters of left ventricle during IVC:There were all no significant correlation between circulation or vortex-Y and ICT or PET(p>0.05).5 Correlation analysis between EL of each phase and general functional parameters: In D2 M group,the significant positive correlation between P3-EL and E,E/A were observed separately(p<0.01),and there were positive correlation between P3-EL and e,e/a,E/e(p<0.05);There were significant positive correlation between P5-EL and A,a(p<0.01),and significant negative correlation between P5-EL and E/A,e/a(p<0.01).In normal group,there was a significant positive correlation between P3-EL and E(p<0.01),and positive correlation between P3-EL and E/A,e(p<0.05).Therewas positive correlation between P5-EL and A,a(p<0.05),and negative correlation between P5-EL and E/A(p<0.05).There was no correlation between P6-EL and ICT or PET(p>0.05).6 Correlation analysis between P6-EL and vortex parameters during IVC: There was a significant positive correlation between P6-EL and vortex circulation in both above two groups(p<0.01).A significant negative correlation was demonstrated between P6-EL and Vortex-Y in D2 M group(p<0.05),but there was no significant negative correlation between P6-EL and Vortex-Y in normal group(p>0.05).No significant correlation was found between P6-EL and vortex-X or Area in both two groups(p>0.05).Conclusions: The significant vertical parameter and EL changes of left intra-ventricular fluid dynamics of left ventricle are demonstrated during diastolic phase and isovolumetric contraction period in patients with D2 M and there is a close correlation between EL parameters and left ventricular diastolic functional parameters of left ventricle,indicate that vortical parameters and EL could be used as quantitative indexes for evaluation of the diastolic dysfunction of patients with D2 M.There is a disordered flow pattern also during pre-ejection phase of patients with D2 M and the higher energy loss during diastole period and IVC,and might lead to the insufficiency of kinetic energy at the time of injection of left ventricle.