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Vector flow mapping analysis of left ventricular vortex performance in type 2 diabetic patients with early chronic
Xiaoxue Chen1,2, Fang Qiu3, Wei Wang4
1Department of Ultrasound, First Hospital of Qinhuangdao, Hebei Medical University, No.258, Wenhua Road, Qinhuangdao, 066000, Hebei, China.
Insights
Type 2 diabetes and early chronic kidney disease (CKD) alter left ventricular (LV) vortex dynamics. Vector flow mapping (VFM) reveals abnormal LV vortices, particularly with poor glycemic control, suggesting potential for early diastolic dysfunction detection.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Diabetes mellitus is a primary driver of chronic kidney disease (CKD).
- Early-stage CKD is associated with increased diastolic dysfunction.
- Intracardiac vortex dynamics offer novel insights into cardiac function.
Purpose of the Study:
- To visualize and analyze left ventricular (LV) vortex characteristics in type 2 diabetic patients with early CKD using vector flow mapping (VFM).
- To investigate the relationship between LV vortex parameters, glycemia, and LV filling in this patient population.
Main Methods:
- A cross-sectional study involving 67 controls and 89 type 2 diabetic patients with CKD stages 2-3a.
- Transthoracic echocardiography with VFM to assess LV anterior vortex (E-vortex, A-vortex, S-vortex) in the apical long-axis view.
- Correlation analysis to examine relationships between vortex characteristics, glycemia, and LV filling parameters (E/A ratio).
Main Results:
- Patients with type 2 diabetes and early CKD exhibited smaller E-vortex area and weaker circulation compared to controls.
- These patients showed a larger A-vortex area and more intense circulation.
- Poorly controlled hyperglycemia was associated with stronger A-vortex and S-vortex, and a longer S-vortex duration.
- Glycemia and E/A ratio correlated significantly with A-vortex and S-vortex features, respectively.
Conclusions:
- Vector flow mapping (VFM) detected abnormal left ventricular (LV) vortex patterns in type 2 diabetic patients with early CKD.
- These abnormalities were more pronounced in individuals with suboptimal glycemic control.
- LV vortex analysis may serve as a valuable biomarker for identifying and potentially managing hyperglycemia-induced diastolic dysfunction in early CKD.
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.
