Evaluation Of Left Ventricular Diastolic Function In Patients With Primary Sjogren’s Syndrome Using Ultrasonic Vector Flow Mapping Combined With Two-dimensional Speckle Tracking

Objective:We set out to evaluate the changes of diastole energy loss(EL)and global longitudinal strain rate(GLSR)of left ventricular in patients with primary Sjogren’s syndrome(PSS)using ultrasonic vector flow mapping(VFM)combined with two-dimensional speckle tracking(2D-STI),thus to explore the changes of left ventricular diastolic hemodynamics and myocardial mechanics in PSS patients,then revealing left ventricular diastolic dysfunction(LVDD)of PSS patients at early stages.Methods:Fifty-two PSS patients(PSS group)and 35 healthy participants(control group)were enrolled in this study.We performed vector flow mapping via transthoracice echocardiography on all the participants to obtain the following parameters:left ventricular geometric parameters:left ventricular end-diastolic diameter(LVEDD)and end-diastolic left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST);Left ventricular global function parameters:Tei index,isovolumic relaxation time(IVRT),E,A,Em and Am.And left ventricular mass(LVM),left ventricular mass index(LVMI),the ratio of E/A,Em/Am and E/Em were calculated.The left ventricular ejection fraction(LVEF)was measured by Simpson biplane method.The average total energy loss(ELt),basal level segmental energy loss(ELb),middle level segmental energyloss(ELm)and apical level segmental energy loss(ELa)of isovolumic relaxation(IVR),rapid filling(RF),slow filling(SF)and atrial systolic(AS)phases and early diastolic global longitudinal strain rate(GLSRe),atrial systolic global longitudinal strain rate(GLSRa)were obtained by offline analysis with workstation.The difference between the two groups was compared and correlation was analyzed between the ELt,GLSRe,GLSRa parameters and left ventricular global function parameters such as Tei index,IVRT,E,A,E/A,Em,Am,Em/Am,E/Em.Results:1.Left ventricular geometric parameters:all the configuration parameters were staying within normal range,but in PSS group,IVST,LVPWT,LVM and LVMI were higher than those in control group and LVEDD was lower than those in control group(all P>0.05).2.Left ventricular function parameters:LVEF of PSS group and control group were staying within normal range,but LVEF of PSS group was lower than that of control group(P>0.05);in PSS group,Em and Em/Am were lower than those in control group,E/Em,Tei index and IVRT were higher than those in control group(all P<0.05);E,A and Am in PSS group were higher than those of control group and E/A was lower than comparing with the control group,but the above difference was not statistically significant(all P>0.05).3.Left ventricular diastolic EL parameters:Compared with the control group,ELt,ELb,ELm and ELa in IVR and AS phase in PSS group were significantly higher(all P<0.05);ELt and ETa in RF stage were significantly higher comparing with the control group(all P<0.05);ETa in SF stage was significantly higher comparing with the control group(P<0.05);there was no significant difference among other parameters.4.Left ventricular diastolic GLSR parameters:in PSS group,GLSRe and GLSRa were all lower comparing with the control group(all P<0.05).5.Linear correlation analysis:IVR-ELt is positively correlated with E,E/A,E/Em(r=0.285～0.392,all P<0.05)and negatively correlated with IVRT and Tei index(r=-0.400～-0.493,all P<0.05):AS-ELt is negatively correlated with Tei index(r=-0.324,P<0.05);GLSRa is negatively correlated with Am,IVRT(r=-0.400～-0.493,all P<0.05);and there was no significant correlation between other indexes.Conclusion:1.In PSS group,the damage of left ventricular diastolic function preceded the remodeling of left ventricular structure.2.In PSS group,the diastolic EL and GLSR of left ventricular changed significantly,which reflected the changes of left ventricular hemodynamics and myocardial mechanical state in diastolic period.3.There is a linear correlation between EL,GLSR parameters and traditional left ventricular diastolic function parameters.The combination of left ventricular hemodynamic parameters and myocardial mechanical parameters with traditional diastolic function parameters may be more systematic and comprehensive to evaluate early left ventricular diastolic function in patients with PSS.