Assessment Of Diastolic Left Ventricular Energy Loss And Vortex By Ultrsonic Vector Flow Mapping In Patients With Liver Cirrhosis

ObjectTo assess the left ventricular energy loss and the charcateristic of vortex during ventricular diastole phases by vector flow mapping in patients with different degrees of liver cirrhosis,and to investigate the relationship between left ventricular cardiac fluid dynamics and left ventricular diastolic function in patients with cirrhosis,which may help early reveal the clinical value of LVEL and vortex parameters for more precise evaluation of left ventricular diastolic function.MethodsEigty-two patients with liver cirrhosis were enrolled as observation group,and divided into two groups of ascite group(ASC,n=39)and without ascite group(NASC,n=43).Forty adults were employed as control group matched with gender and age.The following parameters were obtained by two-dimensional conventional ultrasound measurement: left ventricular posterior wall thickness(LVPW),interventricular septal thickness(IVS);left ventricular end diastolic volume(LVEDV)Left ventricular end systolic volume(LVESV),leftventricular ejection fraction(LVEF),stroke volume(SV),cardiac output(CO),Left atrial volume index(LAVI);peak transmitral valve flow velocity in early diastole(E),peak transmitral valve flow velocity in late diastole(A),peak mitral annulus velocity in early diastole(e),peak mitral annulus velocity in late diastole(a),isovolumetric relaxation time(IVRT),e and were taken the average value of septal and lateral sides,E/A and E/e were calculated.The left ventricular energy loss(LVEL),left ventricular vortex circulation(LVVC),and left ventricular vortex area(LVVA)at isovolumic relaxation,rapid filling,slowing filling,atrial systole phases during ventricular diastole were derived by the analysis of vector flow mapping with a dedicated vector flow mapping workstation.The comparison of the differences of the above parameters between three groups,and the correlation analysis between them and conventional diastolic function parameters were performed.Results1 Comparison of conventional two-dimensional ultrasound parametersCompared with the control group,the LAVI of the NASC group increased significantly,and the difference was statistically significant(P<0.01).There was no significant difference in LVPW,IVS,LVEDV,LVESV,SV,CO and LVEF between the NASC group and the control group(P>0.05).).Compared with the control group,LVEDV,LVESV,SV,CO and LAVI were increased in the ASC group,the difference was statistically significant(P<0.05 or P<0.01).There was no significant difference in LVPW,IVS and LVEF between the ASC group and the control group.(P>0.05).Compared with the NASC group,the LVEDV,SV,CO,and LAVI in the ASC group increased significantly(P<0.05 or P<0.01).There was no significant difference in LVPW,IVS,LVESV,and LVEF between the ASCgroup and the NASC group.P>0.05).2 Comparison of conventional doppler ultrasound parametersCompared with the control group,the difference in the NASC group was significantly higher(P<0.05).There was no significant difference in the A,E/A,e,a,e/a,E/e,and IVRT between the NASC group and the control group.Significance(P>0.05);Compared with the control group,E,A,E/e increased,IVRT decreased in ASC group,the difference was statistically significant(P<0.05 or P<0.01);E/A,e,a,e/ between ASC group and control group a difference was not statistically significant(P>0.05).Compared with the NASC group,the E and A in the ASC group increased,the difference was statistically significant(P<0.05).There was no significant difference in E/A,e,a,e/a,E/e,and IVRT between the ASC group and the NASC group.Significance(P>0.05).3 Comparison of left ventricular energy loss and vortex parameters at different diastolic phasesCompared with the control group,the LVEL at isovolumic relaxation and rapid filling phases,the LVVC and LVVA at slowing filling phases in the NASC group were increased,the difference was statistically significant(P<0.05 or P<0.01),and the LVVC and LVVA at rapid filling phase,The LVELat slowing filling phase,The LVEL,LVVC and LVVA at atrial systole phase in the NASC group were relatively increased,and the difference was not statistically significant(P>0.05).Compared with the control group,the LVEL at isovolumic relaxation phase,the LVEL and LVVC at rapid filling phase,the LVEL,LVVC and LVVA at slow filling and atrial systole phases in the ASC group were allincreased,the difference was statistically significant(P<0.05 or P<0.01).The LVVA during at rapid filling phase in the ASC group was increased,and the difference was not statistically significant(P>0.05).Compared with the NASC group,the LVEL at rapid filling phase,the LVEL and LVVC at slow filling and atrial systole phases in the ASC group were increased,the difference was statistically significant(P<0.05 or P<0.01),the LVEL at isovolumic relaxation phase,the LVVC and LVVA at rapid filling phase,the LVVA at slowing filling and atrial systole phases in the ASC group were relatively increased,and the difference was not statistically significant(P>0.05).The LVVC and LVVA at isovolumic relaxation in the three groups were zero,the difference was not statistically significant(P>0.05).4 Correlation analysis between diastolic left ventricular energy loss and vortex parameters and conventional diastolic function parameters4.1 Correlation between LVEL,LVVC and LVVA at rapid filling and atrial systole phases and corresponding doppler ultrasound parametersIn the control group,the LVEL,LVVC and LVVA at rapid filling phase were positively correlated with E(r=0.668,0.442,0.351;P<0.05).The LVEL at atrial systole phase was positively correlated with A and a(r=0.398,0.422;P<0.05).In the NASC group,the LVEL at the rapid filling and atrial systole phases were positively correlated with E and A(r=0.681,0.624;P<0.05).The LVEL,LVVC and LVVA at rapid filling phase were positively correlated with e(r=0.434,0.423,0.388;P<0.05).LVEL and LVVC at atrial systolic phase were positively correlated with a(r=0.473,0.327;P<0.05).In the ASC group,the LVEL,LVVC and LVVA at the rapid filling phasewere positively correlated with E(r=0.719,0.635,0.591;P<0.05).LVEL and LVVC at atrial systole phase were positively correlated with A(r=0.556,0.434;P<0.05).The LVELat atrial systolic phase was positively correlated with a(r=0.383,P<0.05).4.2 Correlation analysis of LVEL,LVVC,LVVA at diastolic phase and E/AIn the control group,the LVEL at the rapid filling and slowing filling phase,the LVVC and at the slowing filling phase were positively correlated with E/A(r=0.535,0.385,0.323;P<0.05).In the NASC group,the LVEL at isovolumic relaxation,rapid filling and atrial systolic phases,the LVVA at slowing filling phase was negatively or positively correlated with E/A(r=-0.515,0.532,-0.584,0.309;P<0.05).In the ASC group,the LVEL at rapid filling and atrial systole phase,the LVVC and LVVA at rapid filling phase were positively or negatively correlated with E/A(r=-0.486,-0.342,0.389,0.429;P<0.05).4.3 Correlation analysis of LVEL,LVVC,LVVA at diastolic phases and E/eIn the NASC group,the LVEL at rapid filling phase,the LVVA in the slowing filling was positively or negatively correlated with E/e(r=0.331,-0.385).In the ASC group,the LVEL at the rapid filling phase,LVVC and LVVA at atrial systole phase were positively correlated with E/e(r=0.344,0.443,0.395;P<0.05).Conclusion1.VFM could evaluate left ventricular energy loss and vortex changes in patients with cirrhosis,which was a non-invasive,simple and inexpensive inspection technique to evaluate the cardiac fluid dynamics changes.2.The changes of left ventricular energy loss and vortex in patients with cirrhosis reflected the abnormal changes of left ventricular hemodynamics during diastolic period in patients with cirrhosis.3.The changes of left ventricular energy loss and vortex during diastolic period were more obvious in patients with ascites compared to without ascites,which reflected the difference of left ventricular blood fluid dynamics changes between ascites and without ascites in patients with cirrhosis,ang may help reveal the relationship between changes in left ventricular blood fluid dynamics changes and severity of the disease.4.The left ventricular energy loss and vottex in the subgroup cirrhosis and normal group changed during the cardiac diastolic cycle,which reflected the different characteristics of left ventricular energy loss and vortex during the cardiac cycle in patients with cirrhosis and normal individuals,ang may help reveal possible variation of the left ventricular energy loss and vortex during the cardiac diastolic cycle.5.The left ventricular energy loss and vortex parameters in patients with cirrhosis were related to the parameters of left ventricular conventional diastolic function,which reflected the relationship between left ventricular fluid dynamics and diastolic function in patients with cirrhosis,and the changes of left ventricular energy loss and vortex in patients with cirrhosis may help reveal early changes in left ventricular diastolic function.