| Background and Purpose:The prevalence of gout in China is increasing year by year.Gout increases the risk of death from cardiovascular disease,and it is a potential risk factor for heart failure and a poor prognostic factor.Increasing evidence suggests that gout may have a direct negative effect on cardiac function,further contributing to clinical heart failure.Genetic factors play an important role in the occurrence of gout,and many studies have suggested that gout has a certain genetic tendency.However,whether family history of gout further reduces left ventricular systolic and diastolic function in patients with primary gout has not been clearly reported.Echocardiography plays an irreplaceable role in the evaluation of left ventricular systolic and diastolic function.This study aimed investigate the effects of family history of gout on left ventricular systolic function and diastolic function in patients with primary gout by echocardiography and two-dimensional speckle tracking echocardiography.Methods:329 male patients with primary gout who visited the Department of Rheumatology and Immunology of the First Affiliated Hospital of Chengdu Medical College from September 2020 to July 2022 were selected.According to the exclusion criteria and inclusion criteria,a total of 244 male patients with primary gout were included.During the same period(September 2020 to July 2022),a control group was recruited from the physical examination center of our hospital,all of which were male too.Primary gout patients were divided into familial primary gout group(78 cases)and sporadic primary gout group(166 cases)according to the family history of gout.Indicators of left ventricular systolic function and diastolic function were measured via routine echocardiography,including Left ventricular end-diastolic volume,LVEDV),Left ventricular end-systolic volume(LVESV),Left atrial volume index(LAVI),Stroke volume(Stroke volume,SV),early peak mitral diastolic velocity(E)peak late mitral diastolic velocity(A)(E/A),mean early diastolic motion velocity of the mitral annulus septum and lateral wall(e’)and E/e ’.Two-dimensional gravimetric dynamic images of the apical four-chamber view,two-chamber view and three-chamber view,as well as the basal section,middle section and apical section of the left ventricular short axis were collected and stored continuously for 3 cardiac cycles.The data of left ventricular systolic function,including Global longitudinal strain(GLS)and Global circle strain(GCS),were analyzed using two-dimensional speckle tracking echocardiography.Family history and clinical data of the patients,including age,disease duration,Body mass index,Serum creatinine,Serum uric acid(SUA),Cystatin C,Serum beta-2microglobulin,Serum Triglyceride,Total cholesterol,High density lipoprotein cholesterol,and Low density lipoprotein cholesterol were collected.Compared echocardiogram parameters of the familial primary gout group and sporadic primary gout group,the correlation between family history of gout and left ventricular systolic function and diastolic function indexes was analyzed.Further the Receiver operating characteristic curve was drawn to investigate the predictive effect of family history and SUA on grade 2 and above left ventricular diastolic dysfunction in patients with primary gout.Result:1.The levels of SUA,TG,TC and LDLC in patients with familial primary gout were significantly higher than those in patients with sporadic primary gout.[SUA(540±101 vs.461±89,P<0.001),Serum Triglyceride(2.37±1.13 vs.2.03±1.24,P=0.042),Total cholesterol(4.83±0.90 vs.4.38±0.99,P=0.001),Low density lipoprotein cholesterol(2.98±0.84 vs.2.65±0.82,P<0.001)]2.The left ventricular systolic function parameters GLS and GCS were higher than in patients with familial primary gout,and lower SV and LVEF than those with sporadic primary gout.Meanwhile,left ventricular diastolic function parameters E/A and e ’in patients with familial primary gout were significantly lower than those in patients with sporadic primary gout,while LAVI and E/e’ were significantly higher than those in patients with sporadic primary gout.[GLS(-17.33±1.22 vs.-19.07±1.25,P<0.001),GCS(-24.77±1.24 vs.-30.79±4.41,P<0.001),SV(50.1 ± 4.7 vs.57.9 ± 8.4,P=0.008),LVEF(59.1±3.5 vs.62.7±3.8,P<0.001),E/A(1.07±0.41 vs.1.22±0.33,P=0.001),e’(7.9±1.2 vs.10.2±2.3,P<0.001),LAVI(31.5±4.6 vs.28.8±4.6,P<0.001),E/e’(10.0±3.3 vs.7.9±2.1,P<0.001)]3.The proportion of grade 2 and above left ventricular diastolic insufficiency in patients with familial primary gout was significantly higher than that in patients with sporadic primary gout(41.0% vs.10.2%).4.Indicators of left ventricular systolic function(GLS,GCS,LVEF)and diastolic function(LAVI,E/A,e ’,E/e ’)were significantly correlated with family history of gout,even after adjusting for age,BMI,course of disease,confounding variables of Serum creatinine,Serum uric acid(SUA),Cystatin C,Serum beta-2 microglobulin,Serum Triglyceride,Total cholesterol and Low density lipoprotein cholesterol(P < 0.01).5.Family history of gout could predict grade 2 and above left ventricular diastolic dysfunction in patients with primary gout,and the area under ROC curve was 0.714(OR=6.43,[95%CI: 3.28--12.60]).Combined with SUA,the area under ROC curve was 0.872.Conclusions:In patients with primary gout,patients with a family history of gout had worse left ventricular systolic and diastolic function than those without a family history of gout;family history of gout in patients with primary gout was closely related to left ventricular systolic and diastolic function indicators;and family history of gout predicted left ventricular diastolic dysfunction in patients with primary gout.By asking patients with gout to have a family history of gout,echocardiography and two-dimensional spot tracking examination as early as possible are helpful for clinical early judgment and prevention of cardiac complications in patients with primary gout,and provide a basis for clinical decision-making. |
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