血流向量成像技术评价2型糖尿病患者舒张期左心室内相对压

Evaluation of diastolic left ventricular relative pressure in patients with type 2 diabetes mellitus by vector flow mapping

目的:应用血流向量成像(VFM)技术的相对压成像(RPI)评价2型糖尿病(T2DM)患者舒张期左室内压力分布,并探讨影响舒张期左室内压力分布的临床危险因素。方法:选取2020年8月至2021年7月阜外华中心血管病医院就诊的T2DM患者30例和对照组30例。所有入选对象均行常规超声心动图检查,采用VFM技术的RPI测量等容舒张期(IR)、快速充盈期(RF)、心房收缩期(AC)、等容收缩期(IC)和快速射血期(RE)的左室内压力差(IVPD)和左室内压力梯度(IVPG)。测量二尖瓣口舒张早期峰值速度(E)、舒张晚期峰值速度(A),计算E/A。组织多普勒测量二尖瓣环室间隔侧和侧壁舒张期早期峰值速度平均值(e′),计算E/e′。并分析IVPD与这些参数的相关性。结果:①与对照组比较,T2DM组E/A、e′、IVPD-IR、IVPG-IR、IVPD-RF、IVPG-RF、IVPD-AC、IVPG-AC显著减低,E/e′显著增加(均P<0.05)。②IVPD-IR、IVPD-RF、IVPD-AC与E/A呈正相关(r=0.309,P<0.05;r=0.274,P<0.05;r=0.273,P<0.05);IVPD-IR、IVPD-RF、IVPD-AC与E/e′呈负相关(r=-0.587,P<0.05;r=-0.273,P<0.05;r=-0.415,P<0.05);IVPD-IR、IVPD-AC与e′呈正相关(r=0.451,P<0.05;r=0.431,P<0.05)。③多因素线性回归分析结果得出糖化血红蛋白(HbA 1c)是影响IVPD-IR、IVPD-RF、IVPD-AC的独立危险因素(β=-0.417,P<0.05;β=-0.451,P<0.05;β=-0.460,P<0.05)。结论:RPI技术能够定量评价T2DM患者舒张期左室压力分布。HbA 1c是影响T2DM患者IVPD-IR、IVPD-RF、IVPD-AC的独立危险因素。

Objective To evaluate the distribution of diastolic left ventricular pressure in patients with type 2 diabetes mellitus(T2DM)by relative pressure imaging(RPI)based on vector flow mapping(VFM),and to explore the clinical risk factors for the diastolic left ventricular pressure distribution.Methods Thirty patients with T2DM and thirty normal controls were included from August 2020 to July 2021 in Fuwai Central China Cardiovascular Hospital.All selected subjects underwent conventional echocardiography.Left intraventricular pressure difference(IVPD)and left intraventricular pressure gradient(IVPG)were measured using RPI of VFM in isovolumic relaxation(IR),rapid filling(RF),atrial contraction(AC),isovolumic contraction(IC)and rapid ejection(RE)phases.The relationships between IVPD with other parameters were analyzed.Results①Compared with the control group,E/A,e′,IVPD-IR,IVPG-IR,IVPD-RF,IVPG-RF,IVPD-AC,and IVPG-AC were significantly lower and E/e′was significantly greater in the T2DM group(P<0.05).②IVPD-IR,IVPD-RF,and IVPD-AC were positively correlated with E/A(r=0.309,P<0.05;r=0.274,P<0.05;r=0.273,P<0.05).IVPD-IR,IVPD-RF,and IVPD-AC were negatively correlated with E/e′(r=-0.587,P<0.05;r=-0.273,P<0.05;r=-0.415,P<0.05).IVPD-IR and IVPD-AC were positively correlated with e′(r=0.451,P<0.05;r=0.431,P<0.05).③Multivariable linear regression analysis showed that hemoglobin A1c(HbA1c)was an independent risk factor affecting IVPD-IR,IVPD-RF,and IVPD-AC(β=-0.417,P<0.05;β=-0.451,P<0.05;β=-0.460,P<0.05).Conclusions RPI of VFM can quantitatively evaluate diastolic left ventricular pressure distribution in patients with T2DM.HbA1c is an independent risk factor affecting IVPD-IR,IVPD-RF,and IVPD-AC.