Background/Purpose Our aim was to assess the impact of gout on kidneys, diastolic function of the heart and carotid arteries. We examined ultrasonographic parameters that reflect resistance and compliance of the vessels and diastolic function of the left ventricle. Renal resistive index (RRI) and common carotid artery resistive index (CCARI) were measured. Diastolic function of the heart was assessed by parameters of the transmitral blood flow: E/A ratio and deceleration time (DT) which depend on preload and may give false negative results (pseudonormalization of mitral blood flow). That is why with the use of tissue doppler Em was determined which does not depend on preload and helps to differentiate normal from pseudonormal mitral blood flow as it decreases progressively with the worsening of diastolic dysfunction.

Methods A total of 117 patients (pts) were included in the study: Healthy controls without conventional CV risk factors – 37 pts, 18 males and 19 females in a mean age 47.4±13.8 years, asymptomatic hyperuricemia pts – 24 pts, 13 males and 11 females in a mean age 55.8±13.5 years and gout pts – 56 pts, 50 males and 6 females in a mean age 57±11.6 years, 36 of the pts with gout were without tophi and 20 were gouty tophi pts. All pts included in the study underwent a complex multimodal ultrasonography: 1. RRI was measured in both kidneys at the level of interlobar arteries with 3.5MHz transducer working with pulse repetition frequency (PRF) of 2.5MHz. 2. Echocardiography was performed with 2.5MHz transducer Phased Array working with Pulsed doppler frequency of 2.5MHz. 3. Carotid arteries were examined with 10MHz linear transducer working with PRF of 5MHz. Ultrasonographic examinations were performed once by one researcher who was unaware with the protocol of the study. Statistical analyses were done by ANOVA, Post-Hoc Tukey, Kruskal-Wallis and Mann-Whitney tests.

Results There was no significant difference in serum uric acid levels between asymptomatic hyperuricemia and gout pts (p=0.865). In all examined ultrasonographic parameters there was statistically significant difference between healthy controls and the other groups of pts with p˂0.001. Comparing parameters between asymptomatic hyperuricemia and gout pts we estimated no significant difference in RRI (p=0.692), E/A (p=0.195), DT (p=0.611), but we observed a tendency of lower Em (mean±SD, 0.13±0.17 vs 0.09±0.03, p=0.084) and higher CCARI (mean±SD, 0.69±0.05 vs 0.71±0.05, p=0.057) in gout pts. Comparing gouty tophi pts to gout pts without tophi we observed that tophi pts had significantly higher RRI (mean±SD, 0.69±0.06 vs 0.65±0.05, p=0.013) and significantly higher CCARI (mean±SD, 0.74±0.05 vs 0.70±0.05, p=0.027). Tophi pts also had significantly lower Em compared to gout pts without tophi (mean±SD, 0.07±0.02 vs 0.09±0.03, p=0.014). We did not estimate a significant difference in E/A ratio (p=0.233) and DT (p=0.419) between these two groups.

Conclusion We suggest that with the progression of the disease arteriosclerotic type vessel changes progress and diastolic function of the heart worsens.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-measurement-of-renal-and-carotid-artery-resistive-indices-and-diastolic-function-of-the-heart-in-gout-patients/