Dataset Information

Vector flow mapping analysis of left ventricular vortex performance in type 2 diabetic patients with early chronic kidney disease.

ABSTRACT:

Background

Diabetes is the leading cause of chronic kidney disease (CKD) and contributes to an elevated incidence of diastolic dysfunction in the early stages of CKD. Intracardiac vortex is a novel hemodynamic index for perceiving cardiac status. Here, we visualized left ventricular (LV) vortex characteristics using vector flow mapping (VFM) in type 2 diabetic patients with early CKD.

Methods

This cross-sectional study included 67 controls and 89 type 2 diabetic patients with stages 2-3a CKD. All subjects underwent transthoracic echocardiographic examination. LV anterior vortex during early diastole (E-vortex), atrial contraction (A-vortex) and systole (S-vortex) were assessed using VFM in the apical long-axis view. Its relation to glycemia or LV filling echocardiographic parameters were further analyzed using correlation analysis.

Results

Type 2 diabetic patients with early CKD had a small area (439.94 ± 132.37 mm² vs. 381.66 ± 136.85 mm², P = 0.008) and weak circulation (0.0226 ± 0.0079 m²/s vs. 0.0195 ± 0.0070 m²/s, P = 0.013) of E-vortex, but a large area (281.52 ± 137.27 mm² vs. 514.83 ± 160.33 mm², P ˂ 0.001) and intense circulation (0.0149 ± 0.0069 m²/s vs. 0.0250 ± 0.0067 m²/s, P < 0.001) of A-vortex compared to controls. CKD patients with poorly controlled hyperglycemia had stronger A-vortex (area: 479.06 ± 146.78 mm² vs. 559.96 ± 159.27 mm², P = 0.015; circulation: 0.0221 ± 0.0058 m²/s vs. 0.0275 ± 0.0064 m²/s, P < 0.001) and S-vortex (area: 524.21 ± 165.52 mm² vs. 607.87 ± 185.33 mm², P = 0.029; circulation: 0.0174 ± 0.0072 m²/s vs. 0.0213 ± 0.0074 m²/s, P = 0.015), and a longer relative duration of S-vortex (0.7436 ± 0.0772 vs. 0.7845 ± 0.0752, P = 0.013) than those who had well-controlled hyperglycemia. Glycemia, and E/A (a LV filling parameter) were respectively found to had close correlation to the features of A-vortex and S-vortex (all P < 0.05).

Conclusions

Abnormal LV vortices were detected in type 2 diabetic patients with early CKD using VFM, especially in those who neglected hyperglycemic control. LV vortex might be a promising parameter to slow or halt the hyperglycemia-induced diastolic dysfunction in early CKD.

SUBMITTER: Chen X

PROVIDER: S-EPMC10474629 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Vector flow mapping analysis of left ventricular vortex performance in type 2 diabetic patients with early chronic kidney disease.

Chen Xiaoxue X Qiu Fang F Wang Wei W Qi Zhengqin Z Lyu Damin D Xue Kun K Sun Lijuan L Song Degang D

BMC cardiovascular disorders 20230901 1

<h4>Background</h4>Diabetes is the leading cause of chronic kidney disease (CKD) and contributes to an elevated incidence of diastolic dysfunction in the early stages of CKD. Intracardiac vortex is a novel hemodynamic index for perceiving cardiac status. Here, we visualized left ventricular (LV) vortex characteristics using vector flow mapping (VFM) in type 2 diabetic patients with early CKD.<h4>Methods</h4>This cross-sectional study included 67 controls and 89 type 2 diabetic patients with stag ...[more]

PMID: 37658336

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Project description:ObjectivesThe aims of this study were to: 1) assess the feasibility of left ventricular (LV) vortex flow analysis using contrast echocardiography (CE); and 2) characterize and quantify LV vortex flow in normal subjects and patients with LV systolic dysfunction.BackgroundVortices that form during LV filling have specific geometry and anatomical locations that are critical determinants of directed blood flow during ejection. Therefore, it is clinically relevant to assess the vortex flow patterns to better understand the LV function.MethodsTwenty-five patients (10 normal and 15 patients with abnormal LV systolic function) underwent CE with intravenous contrast agent, Definity (Bristol-Myers Squibb Medical Imaging, Inc., North Billerica, Massachusetts). The velocity vector and vorticity were estimated by particle image velocimetry. Average vortex parameters including vortex depth, transverse position, length, width, and sphericity index were measured. Vortex pulsatility parameters including relative strength, vortex relative strength, and vortex pulsation correlation were also estimated.ResultsVortex depth and vortex length were significantly lower in the abnormal LV function group (0.443 +/- 0.04 vs. 0.482 +/- 0.06, p < 0.05; 0.366 +/- 0.06 vs. 0.467 +/- 0.05, p < 0.01, respectively). Vortex width was greater (0.209 +/- 0.05 vs. 0.128 +/- 0.06, p < 0.01) and sphericity index was lower (1.86 +/- 0.5 vs. 3.66 +/- 0.6, p < 0.001) in the abnormal LV function group. Relative strength (1.13 +/- 0.4 vs. 2.10 +/- 0.8, p < 0.001), vortex relative strength (0.57 +/- 0.2 vs. 1.19 +/- 0.5, p < 0.001), and vortex pulsation correlation (0.63 +/- 0.2 vs. 1.31 +/- 0.5, p < 0.001) were significantly lower in the abnormal LV function group.ConclusionsIt was feasible to quantify LV vorticity arrangement by CE using particle image velocimetry in normal subjects and those with LV systolic dysfunction, and the vorticity imaging by CE may serve as a novel approach to depict vortex, the principal quantity to assess the flow structure.

Project description:BackgroundThe influence of hemodialysis (HD) on hydromechanics of the left ventricle has not been reported. This study evaluated the left ventricular summation of energy loss (EL-SUM), average energy loss (EL-AVE), and wall shear stress (WSS) before and after HD using vector flow mapping (VFM) in patients with end-stage renal disease (ESRD).MethodsWe prospectively recruited 40 patients receiving long-term HD and excluded those with structural cardiac disease. Echocardiography was performed before and within 24 hours after HD. Conventional echocardiographic parameters, summation, and average energy loss (EL-SUM, EL-AVE, EL-base, EL-mid and EL-apex), and WSS in each segment were compared.ResultsA total of 40 patients with uremia were recruited. After HD, left ventricular EL-AVE-total, and EL-SUM-total decreased significantly in the early diastolic [29.43 (18.76 to 46.28) vs. 17.70 (10.76 to 95.60) N/(m2·s) and 12 (6 to 17) vs. 5 (3 to 11) e-2 J; P<0.001, respectively], mid-diastolic [17.07 (10.38 to 24.35) vs. 10.29 (5.86 to 16.30) N/(m2·s) and 7 (3 to 10) vs. 4 (2 to 6) e-2 J; P<0.001, respectively], and early systolic [17.82 (12.79 to 24.77) vs.14.90 (10.23 to 19.05) N/(m2·s) P=0.011 and 8 (5 to 11) vs. 5 (4 to 8) e-2 J, P=0.002, respectively] phases. It was revealed that HD did not change EL-AVE-total and EL-SUM-total in the late diastolic and late systolic phases. The EL-AVE decreased after HD in the left ventricular (LV) basal [50.70 (24.19 to 77.92) vs. 26.00 (11.50 to 47.68) N/(m2·s); P<0.001] and mid [15.52 (8.88 to 20.90) vs. 9.47 (6.41 to 14.21) N/(m2·s); P=0.001] segments during the early diastolic phase; in the LV basal [18.64 (10.33 to 29.80) vs. 10.25 (6.98 to 19.43) N/(m2·s); P<0.001), mid (15.70 (9.93 to 23.08) vs. 9.99 (6.03 to 16.25) N/(m2·s); P<0.001), and apical [9.78 (4.06 to 15.77) vs. 4.52 (3.14 to 10.36) N/(m2·s); P=0.001) segments during the mid-diastolic phase; in the LV mid [14.34 (8.34 to 23.88) vs. 9.36 (6.48 to 17.05) N/(m2·s); P=0.013] and apex [11.25 (6.37 to 21.88) vs. 6.60 (5.33 to 12.17) N/(m2·s); P=0.016] segments during the late diastolic phase; and in the apical [10.28 (6.05 to 17.01) vs. 7.59 (3.73 to 13.20) N/(m2·s) P=0.025] segment during the early systolic phase. After HD, WSS significantly reduced in the mid-diastolic [0.51 (0.32 to 0.69) vs. 0.38 (0.30 to 0.46) Pa, P=0.001] and early systolic [0.60 (0.45 to 0.81) vs. 0.57 (0.42 to 0.68) Pa, P=0.029] phases. There was no change in WSS during the early diastolic, late diastolic, and late systolic phases.ConclusionsAfter HD, EL and WSS of LV decrease during the systolic and diastolic phases. The VFM can reflect the LV hemodynamics in patients undergoing HD under different fluid loads.

Dataset Information

Vector flow mapping analysis of left ventricular vortex performance in type 2 diabetic patients with early chronic kidney disease.

Background

Methods

Results

Conclusions

Publications

Vector flow mapping analysis of left ventricular vortex performance in type 2 diabetic patients with early chronic kidney disease.

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