A Clinical Study Of The Cardiovascular System Functionin Patients With Gout By Ultrasonography

Objective: The cardiovascular system function in patients with goutwere detected by ultrasonography to (1) investigate the arterial stiffness ofpatients with gout, as well as other risk factors associated with atheroscleroticplaque; (2) study the cardiac function changes of patients with gout,comparing the wave intensity (WI) ultrasound technique with conventionalechocardiography to evaluate early systolic and diastolic function of heart.Methods: This study included a pure gout group [27 patients withoutmetabolic syndrome (MetS)], a gout with MetS group (33 patients) and acontrol group (30 healthy subjects) between August 2010 and September 2011.All of the subjects underwent grayscale ultrasound, wave intensity (WI),echocardiography and clinical and laboratory examinations. Carotidintima-media thickness (IMT) and the presence of plaques were evaluated bygrayscale ultrasonography. The WI parameters evaluated the arterial stiffnesswere negative area (NA), stiffness parameter (β), Peterson’s pressure modulus(Ep), arterial compliance (AC), augmentation index (AI), local pulse wavevelocity derived fromβand WI, respectively (PWVβand PWV-WI). Thecardiac function changes of subjects were instantaneous accelerating waveintensity (W1), instantaneous deceleration wave intensity (W2), left ventricularejection fraction (LVEF), fractional shortening (FS), mean fractionalshortening (mFS), mitral early diastolic inflow velocity (E) and itsdeceleration time (EDT), mitral late diastolic inflow velocity (A), earlydiastolic peak velocities (Ve) and late diastolic peak velocities (Va) of septal and lateral mitral annulus on tissue doppler imaging (TDI), the mean valuesof Ve and Va were recorded as e′and a′, respectively; besides these, the ratiosof E/A, e′/a′and E/e′were also calculated.Other echocardiographic parameters were left atrial end-systolicdiameter (LASD), interventricular septum and left ventricular posterior wallend-diastolic thickness, respectively (IVSDT and PWDT ), left ventricularmass index (LVMI), left ventricular end-diastolic diameter and volume(LVEDD and LVEDV) and stroke volume (SV) measured on 2-dimensional(2D) and M-mode echocardiography, as appropriate.Results:1. 2D grayscale ultrasonography of right common carotid artery(RCCA) : The carotid IMT in the gout with MetS group was significantlythicker than that in the control group (P <0.05). Atheromatous plaques weremore frequently in the gout patients without MetS (8 cases, 29.6%) than thosein controls (2 cases, 6.7%) (P <0.05) , beside these, there were no significantdifferences between the gout with MetS group (7cases, 21.2%) and the puregout and control groups. Logistic regression analysis showed that age (OR:1.13, 95% CI: 1.04-1.23) and smoking status (OR: 2.08, 95% CI: 0.98-4.39)were independent risk factors for the presence of plaques in gout subjects.2. The arterial stiffness parameters of the RCCA on WI: The stiffnessindexβwas higher in the gout with MetS group than that in the pure goutgroup (P <0.05). The Ep, PWVβand PWV-WI in the gout with MetS groupwere distinctively higher than those in the pure gout and control groups (all P<0.05). Moreover, the values of NA were significantly lower in controls thanthose in the patients with gout (P =0.016 and P =0.004 for the pure gout andgout with MetS groups, respectively). 3. The systolic and diastolic function parameters on WI: W1in thepatients with gout and MetS was significantly higher than controls, and W2inthe pure gout group was notably lower than that in the gout with MetS groupexclusively (P <0.01). However, W1and W2were insignificant between thepure gout patients and controls (P >0.05).4. The conventional echocardiographic data of subjects: IVSDT andPWDT were thicker, LVMI and LASD were higher in the gout with MetSgroup than those in the pure gout and control groups (P <0.05). Comparingwith the pure gout patients and controls, the e′and e′/a′were distinctivelylower and the E/e′was remarkably higher in the gout with MetS group (P<0.05). However, there were no significant differences in age, LVEDD,LVEDV, SV, EF, FS, mFS, E, E/A, EDT and a′(all P >0.05).5. There were positive correlations between E/e′andβ, Ep, PWVβandPWV-WI (r values were 0.369, 0.444, 0.327 and 0.337, respectively, all P<0.01) in gout patients; besides these, the positive correlations were also inLVMI withβand Ep (r values were 0.384 and 0.476, respectively, all P <0.01)in these patients; there were significant positive correlations between LVMIand E/e′(r =0.567, P =0.000).Conclusion:1. The WI ultrasound technique was sensitive to assessing arterialstiffness and the gout with MetS group had higher arterial stiffness parametersthan those in the pure gout and control groups, indicating the lower elasticityand more severe impairment of the vasculature in the patients with gout andMetS. The parameter of NA was more sensitive to evaluating the increasedarterial stiffness in the pure gout patients.2. W1was more sensitive than LVEF and FS to assess the changes of left ventricular systolic function of patients with gout.3. The parameters of e′, e′/a′and E/e′on TDI were more sensitive thanW2and E/A to evaluate the early diastolic disfunction.4. The gout with MetS group had structure abnormality of left ventricularand left atrium and remodeling of left ventricular.