Skip to main content

Advertisement

SpringerLink
Log in

Ultrasonographic measurement of carotid artery resistive index and diastolic function of the heart in gout patients

  • Original Article - Imaging
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

The aim of the study was to establish the functional disorder in the blood circulation of gout patients with a method that shows early damage of the heart and vascular structures. A total of 117 patients were examined cross-sectionally by a complex multimodal ultrasonography and were divided into four groups: 37 healthy controls, 24 asymptomatic hyperuricemia, 36 gout without tophi and 20 gouty tophi. With pulsed Doppler, common carotid artery resistive index (CCARI) and parameters of the transmitral blood flow were determined: the ratio between maximal early and late flow velocities (E/A ratio) and deceleration time (DT). With tissue Doppler imaging, mitral annular peak velocity (Em) was obtained. In the examined ultrasonographic parameters between healthy controls and the three patient groups, there was a statistically significant difference (p < 0.001). Comparing asymptomatic hyperuricemia and gout without tophi, no significant difference in CCARI (p = 0.656), E/A ratio (p = 0.472), DT (p = 0.990) and Em (p = 0.488) was found. Gouty tophi in comparison with gout without tophi and asymptomatic hyperuricemia had significantly lower Em (mean ± SD 0.07 ± 0.02 vs 0.09 ± 0.03 vs 0.13 ± 0.17) and significantly higher CCARI (mean ± SD 0.74 ± 0.05 vs 0.70 ± 0.05 vs 0.69 ± 0.05). Further multiple logistic regression revealed that tophi increased subject’s likelihood of having category of CCARI ≥ 0.7 with an OR = 10.91 (95 % CI 1.80–66.14, p = 0.009), while the category of Em < 0.08 m/s was influenced by renal insufficiency with an OR = 3.07 (95 % CI 1.17–8.02, p = 0.022). Gouty tophi are associated with progression of arteriosclerotic-type vessel changes. Worsening of diastolic dysfunction of the heart is independently associated with renal insufficiency. In terms of CV risk, tophi are an indicator of its increase.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Choi HK, Curhan G (2007) Independent impact of gout on mortality and risk for coronary heart disease. Circulation 116:894–900

    Article  PubMed  Google Scholar 

  2. Feig DI, Kang DH, Johnson RJ (2008) Uric acid and cardiovascular risk. N Engl J Med 359:1811–1821

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Cannon PJ, Stason WB, Demartini FE, Sommers SC, Laragh JH (1966) Hyperuricemia in primary and renal hypertension. N Engl J Med 275:457–464

    Article  CAS  PubMed  Google Scholar 

  4. Tuttle KR, Short RA, Johnson RJ (2001) Sex differences in uric acid and risk factors for coronary artery disease. Am J Cardiol 87:1411–1414

    Article  CAS  PubMed  Google Scholar 

  5. Lehto S, Niskanen L, Ronnemaa T, Laakso M (1998) Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke 29:635–639

    Article  CAS  PubMed  Google Scholar 

  6. Siu YP, Leung KT, Tong MK, Kwan TH (2006) Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis 47:51–59

    Article  CAS  PubMed  Google Scholar 

  7. Culleton BF, Larson MG, Kannel WB, Levy D (1999) Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 131:7–13

    Article  CAS  PubMed  Google Scholar 

  8. Cooney MT, Dudina A, D’Agostino R, Graham IM (2010) Cardiovascular risk-estimation systems in primary prevention do they differ? Do they make a difference? Can we see the future? Circulation 122:300–310

    Article  PubMed  Google Scholar 

  9. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, Backer GD, Baquer DD et al (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24:987–1003

    Article  CAS  PubMed  Google Scholar 

  10. Build DE, Bluemke DA, Burke GL, Detrano R, Diez Roux AV, Folsom AR et al (2002) Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 156:871–881

    Article  Google Scholar 

  11. Naqhavi M, Falk E, Hecht HS, Shah PK, Task Force SHAPE (2006) The first SHAPE (screening for heart attack Prevention and education) guideline. Crit Pathw Cardiol 5(4):187–190

    Article  Google Scholar 

  12. González-Gay MA, González-Juanatey C, llorca J (2012) Carotid Ultrasound in the cardiovascular risk stratification of patients with rheumatoid arthritis. Ann Rheum Dis 71(6):796–798

    Article  PubMed  Google Scholar 

  13. Groban L, Kitzman DW (2010) Diastolic function: a barometer for cardiovascular risk? Anesthesiology 112(6):1303–1306

    Article  PubMed Central  PubMed  Google Scholar 

  14. Staub D, Meyerhans A, Bundi B, Schmid HP, Frauchiger B (2006) Prediction of cardiovascular morbidity and mortality: comparison of the internal carotid artery resistive index with the common carotid artery intima-media thickness. Stroke 37:800–805

    Article  PubMed  Google Scholar 

  15. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20(3):895–900

    Article  CAS  PubMed  Google Scholar 

  16. Rakowski H, Appleton C, Chan KL, Dumesnil JG, Honos G, Jue J et al (1996) Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography: from the investigators of Consensus on Diastolic Dysfunction by Echocardiography. J Am SocEchocardiogr 9:736–760

    Article  CAS  Google Scholar 

  17. Ho CY, Solomon SD (2006) A clinician’s guide to tissue Doppler imaging. Circulation 113:396–398

    Article  Google Scholar 

  18. Frauchinger B, Schmid HP, Roedel C, Moosmann P, Staub D (2001) Comparison of carotid arterial resistive indices with intima-media thickness as sonographic markers of atherosclerosis. Stroke 32:836–841

    Article  Google Scholar 

  19. Palmieri V, Arezzi E, Sabatella M, Celentano A (2003) Interstudy reproducibility of parameters of left ventricular diastolic function: a Doppler echocardiography study. J Am Soc Echocardiogr 16(11):1128–1135

    Article  PubMed  Google Scholar 

  20. Nagueh SF, Middleton KJ, Kopelan HA, Zoghbi WA, Quiñones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533

    Article  CAS  PubMed  Google Scholar 

  21. Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA et al (2004) Changes in arterial stiffness and wave reflections with advancing age in healthy men and women: the Framingham Heart Study. Hypertension 43:1239–1245

    Article  CAS  PubMed  Google Scholar 

  22. Pannier B, Guérin AP, Marchais SJ, Safar ME, London GM (2005) Stiffness of capacitive and conduit arteries: prognostic significance for end-stage renal disease patients. Hypertension 45:592–596

    Article  CAS  PubMed  Google Scholar 

  23. Avolio AO, Chen SG, Wang RP, Zhang CL, Li MF, O’Rourke MF (1983) Effects of aging on changing arterial compliance and left ventricular load in a Northern Chinese urban community. Circulation 68:50–58

    Article  CAS  PubMed  Google Scholar 

  24. London G, Covic A, Goldsmith D, Wiecek A, Suleymanlar G, Ortiz A (2011) Arterial aging and arterial disease: interplay between central hemodynamics, cardiac work, and organ flow-implications for CKD and cardiovascular disease. Kidney Int Suppl 1:10–12

    Article  Google Scholar 

  25. Cipolli JA, Ferreira-Sae MC, Martins RP, Pio-Magalhães JA, Bellinazzi VR, Matos-Souza JR et al (2012) Relationship between serum uric acid and internal carotid resistive index in hypertensive women: a cross-sectional study. BMC Cardiovasc Disord 12:52. doi:10.1186/1471-2261-12-52

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Pan KL, Lin JC, Lin CL, Chen MC, Chang PJ, Hsiao JF et al (2014) The effects of gout on left atrial volume remodeling: a prospective echocardiographic study. Rheumatology (Oxford) 53(5):867–874. doi:10.1093/rheumatology/ket444

    Article  Google Scholar 

  27. Smielewski P, Czosnyka M, Kirkpatrick P, McEroy H, Rutkowska H, Pickard JD (1996) Assessment of cerebral autoregulation using carotid artery compression. Stroke 27:2197–2203

    Article  CAS  PubMed  Google Scholar 

  28. Kim MK, Kim B, Lee JY, Kim JS, Han BG, Choi SO et al (2013) Tissue Doppler-derived E/e’ ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease. Korean J Intern Med 28(1):35–44

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Roch-Ramel F, Guisan B (1999) Renal transport of urate in humans. News Physiol Sci 14:80–84

    CAS  PubMed  Google Scholar 

  30. Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126

    Article  CAS  PubMed  Google Scholar 

  31. Lyngdoh T, Marques-Vidal P, Paccaud F, Preisig M, Waeber G, Bochud M et al (2011) Elevated serum uric acid is associated with high circulating inflammatory cytokines in the population-based colaus study. PLoS ONE 6(5):e19901. doi:10.1371/journal.pone.0019901

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Bordoni V, de Cal M, Rassu M, Cazzavillan S, Segala C, Bonello M (2005) Protective effect of urate oxidase on uric acid induced-monocyte apoptosis. Curr Drug Discov Technol 2(1):29–36

    Article  CAS  PubMed  Google Scholar 

  33. Schumacher HR Jr (2008) The pathogenesis of gout. Clevel Clin J Med 75(5):2–4

    Article  Google Scholar 

  34. Carter JD, Keder RP, Anderson SR, Osorio AH, Albritton NL, Gnanashanmugam S et al (2009) An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology 48:1442–1446

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Clinic of Rheumatology, University Hospital, “St. Iv. Rilski”, 13, Urvich St., 1612, Sofia, Bulgaria

    Rada N. Gancheva, Mariana G. Ivanova, Rasho K. Rashkov & Zlatimir G. Kolarov

  2. Clinic of Nephrology, University Hospital “Alexandrovska”, 1, St. Georgi Sofiiski St., 1431, Sofia, Bulgaria

    Atanas I. Kundurdjiev

  3. Faculty of Public Health, Medical University, 8, Bialo more St., 1527, Sofia, Bulgaria

    Todor G. Kundurzhiev

Authors
  1. Rada N. Gancheva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atanas I. Kundurdjiev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariana G. Ivanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Todor G. Kundurzhiev
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rasho K. Rashkov
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zlatimir G. Kolarov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rada N. Gancheva.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gancheva, R.N., Kundurdjiev, A.I., Ivanova, M.G. et al. Ultrasonographic measurement of carotid artery resistive index and diastolic function of the heart in gout patients. Rheumatol Int 35, 1369–1375 (2015). https://doi.org/10.1007/s00296-015-3280-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-015-3280-7

Keywords

Search

Navigation