Correlation between arterial elasticity index and cardiac diastolic function measured by percutaneous catheterization
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摘要: 目的 探讨通过有创与无创监测动脉弹性指数与左心室舒张功能的相关性。方法 随机选取疑似诊断为急性冠脉综合征(ACS)并行冠状动脉(冠脉)造影的患者，根据冠脉狭窄程度分为A组(无狭窄)、B组(冠脉狭窄 < 50%)、C组(50%≤冠脉狭窄 < 75%)与D组(冠脉狭窄≥75%)。对所有疑似ACS的患者均行超声心动图、颈动脉超声、颈-股动脉脉搏波传导速度(cfPWV)及左心室造影检查，测定左心室舒张功能、外周动脉弹性指数，对比4组患者动脉弹性指数及心脏舒张功能。结果 ① 4组间心功能指标结果显示：左心室等容松弛时间常数(T)、心室僵硬指数(K)、二尖瓣舒张早期血流峰值与二尖瓣环运动速度之比(E/e’)、左心室上升最大速度(LV+dp/dtmax)、左心室下降最大速度(LV-dp/dtmax)、舒张功能异常例数差异均有统计学意义(均P< 0.01)；C、D两组的T、K、E/e’值、舒张功能异常例数均高于A、B两组，LV+dp/dtmax、LV-dp/dtmax均低于A、B两组(均P< 0.05)。② 4组间动脉弹性指标结果显示：cfPWV、脉压、中心动脉脉压差异均有统计学意义(均P< 0.01)；C、D两组的cfPWV、脉压、中心动脉脉压均高于A、B两组(均P< 0.05)。③ Spearman相关性分析结果显示：cfPWV、脉压、中心动脉脉压、Gensini评分、E/e’值、左心房容积指数(LAVI)与T呈正相关。调整相关因素后，偏相关分析显示，cfPWV与T呈正相关(r=0.761，P< 0.01)。④二元logistic回归分析结果显示：cfPWV是左心室心脏舒张功能减退的危险因素(OR=3.124，95%CI：2.195~4.447，P=0.000)。结论 动脉弹性指数随冠脉狭窄程度的增加而增大；动脉弹性指数与左心室舒张功能不全显著正相关；动脉弹性指数升高是独立于年龄之外的舒张功能减退的危险因素。Abstract: Objective To investigate the correlation between arterial elasticity index and left ventricular diastolic function by invasive and non-invasive monitoring.Methods Patients with suspected diagnosis of acute coronary syndrome(ACS) with coronary angiography(CAG) were randomly selected and divided into group A(no stenosis), group B(coronary stenosis < 50%), group C(50% ≤ coronary stenosis < 75%) and group D(coronary stenosis ≥75%) according to the degree of coronary stenosis. Echocardiography, carotid ultrasound, carotid-femoral pulse wave velocity(cfPWV) and left ventriculography were performed in all patients with suspected ACS to determine left ventricular diastolic function and peripheral arterial elasticity index, and to compare arterial elasticity index and cardiac diastolic function in the four groups.Results (1) The results of cardiac function indexes among the four groups showed that: the left ventricular isovolumic relaxation time constant(T), the ventricular stiffness index(K), the ratio of peak mitral valve early diastolic blood flow to mitral annular motion velocity(E/e'), the maximum left ventricular rise velocity(LV+dp/dtmax), the maximum left ventricular fall velocity(LV-dp/dtmax), and the number of cases of abnormal diastolic dysfunction were statistically significant(allP< 0.01); The T, K, E/e' values and the number of diastolic function abnormalities were higher in groups C and D than in groups A and B. The LV+dp/dtmaxand LV-dp/dtmaxwere lower than in groups A and B(allP< 0.05). (2) The results of arterial elasticity indexes between the four groups showed that the differences in cfPWV, pulse pressure, and central arterial pulse pressure were statistically significant(allP< 0.01); cfPWV, pulse pressure, and central arterial pulse pressure were higher in groups C and D than in groups A and B(allP< 0.05). (3) Spearman correlation analysis showed that cfPWV, pulse pressure, central arterial pulse pressure, Gensini score, E/e' value, and left atrial volume index(LAVI) were positively correlated with T. After adjusting for relevant factors, the partial correlation analysis showed that cfPWV was positively correlated with T(r=0.761,P< 0.01). (4) The results of binary logistic regression analysis showed that cfPWV was significantly correlated with left ventricular diastolic dysfunction(OR=3.124, 95%: 2.195-4.447,P=0.000).Conclusion Arterial elasticity index increases with increase of coronary artery stenosis. Arterial elasticity index is significantly and positively associated with left ventricular diastolic insufficiency. Elevated arterial elastance index is a risk factor for diastolic dysfunction independent of age.
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表 1 一般资料比较
Table 1. Comparison of general information of patients
X±S 项目 A组(100例) B组(100例) C组(100例) D组(100例) P值 男性/例(%) 46(46.00) 52(52.00) 48(48.00) 47(47.00) 0.842 年龄/岁 53.74±13.40 59.84±10.21 59.00±10.54 59.20±11.32 0.25 高血压病史/例(%) 52(52.00) 59(59.00) 56(56.00) 55(55.00) 0.798 糖尿病病史/例(%) 21(21.00) 22(22.00) 25(25.00) 26(26.00) 0.814 吸烟史/例(%) 26(26.00) 24(24.00) 26(26.00) 30(30.00) 0.807 BSA/m2 1.80±0.14 1.83±0.16 1.83±0.19 1.84±0.13 0.352 FBS/(mmol·L-1) 5.96±2.03 5.79±2.13 6.09±1.82 6.44±2.22 0.165 TC/(mmol·L-1) 4.39±0.71 4.37±1.17 4.31±1.09 4.47±1.17 0.710 TG/(mmol·L-1) 1.45±1.01 1.38±0.52 1.52±0.76 1.73±1.66 0.110 HDL-C/(mmol·L-1) 1.53±0.81 1.42±0.65 1.46±0.63 1.44±0.62 0.067 LDL-C/(mmol·L-1) 2.73±0.55 2.74±0.71 2.75±0.83 2.97±1.01 0.090 Cr/(μmol·L-1) 70.48±38.82 67.48±13.75 67.13±16.09 71.72±14.64 0.423 BNP/(pg·mL-1) 39.13±67.02 49.11±80.78 35.31±46.66 45.75±77.05 0.485 cTnI/(ng·mL-1) 0.017±0.040 0.018±0.040 0.040±0.120 0.418±3.600 0.310 Gensini评分/分 0 0 6.65±5.391)2) 47.89±37.691)2)3) < 0.01 注：TC：总胆固醇；TG：甘油三酯；HDL-C：高密度脂蛋白胆固醇；LDL-C：低密度脂蛋白胆固醇。与A组比较，1)P < 0.05；与B组比较，2)P < 0.05；与C组比较，3)P < 0.05。 
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表 2 心功能指标比较
Table 2. Comparison of cardiac function indices in patients
X±S 指标 A组(100例) B组(100例) C组(100例) D组(100例) P值 LVEDV/mL 145.55±2.95 146.82±4.651) 147.99±3.451)2) 150.16±2.881)2) < 0.01 LVESV/mL 38.42±1.80 39.31±1.58 40.06±1.77 40.77±1.93 0.265 E/e′值 9.89±0.62 10.22±1.181) 12.99±1.4811)2) 14.43±1.261)2) < 0.01 LAVI/(mL·m-2) 21.81±5.13 26.25±8.90 35.36±4.231)2) 38.92±4.611)2) < 0.01 LVMI/(g·m-2) 110.06±5.14 111.68±5.571) 111.92±6.251) 112.23±5.591) 0.033 DT/mm 199.68±26.19 207.80±22.021) 231.04±21.311)2) 239.96±22.261)2) < 0.01 LVEF/% 68.38±3.44 67.51±4.60 67.36±3.50 60.54±3.421)2) < 0.01 LV+dp/dtmax/(mmHg·s-1) 2556.63±217.91 2493.32±171.341) 2350.75±130.301)2) 2078.79±131.181)2) < 0.01 LV-dp/dtmax/(mmHg·s-1) 2291.94±90.47 2178.87±91.651) 2102.27±81.411)2) 2000.70±216.791)2) < 0.01 K 0.031±0.002 0.037±0.003 0.042±0.0031)2) 0.042±0.0041)2) < 0.01 T 31.62±1.70 32.11±1.48 38.34±1.501)2) 41.65±2.401)2) < 0.01 舒张功能异常/例(%) 0(0) 2(2.00) 13(13.00)1)2) 39(39.00)1)2) < 0.01 注：1 mmHg=0.133 kPa。与A组比较，1)P < 0.05；与B组比较，2)P < 0.05。
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表 3 动脉弹性指标比较
Table 3. Comparison of arterial elasticity indexes in patients
X±S 指标 A组(100例) B组(100例) C组(100例) D组(100例) P cfPWV/(m·s-1) 10.57±0.68 10.82±0.771) 13.09±0.581)2) 13.91±0.741)2) < 0.01 脉压/mmHg 50.26±12.44 53.76±11.761) 60.08±11.631)2) 64.70±11.741)2) < 0.01 中心动脉脉压/mmHg 42.72±4.56 45.14±8.061) 50.24±6.301)2) 54.73±8.171)2) < 0.01 IMT/mm 0.77±0.14 0.78±0.13 0.82±0.181) 0.82±0.171) < 0.05 R+dp/dtmax/(mmHg·s-1) 2274.89±199.29 2200.01±209.791) 2154.26±168.481)2) 1936.27±179.981)2) < 0.01 R-dp/dtmax/(mmHg·s-1) 2192.63±191.17 2139.10±193.131) 2020.68±130.541)2) 1879.41±129.761)2) < 0.01 R-T 35.33±1.42 35.78±1.301) 38.58±1.511)2) 41.65±2.051)2) < 0.01 A+dp/dtmax/(mmHg·s-1) 2315.88±199.90 2275.96±193.89 2142.21±227.371)2) 1934.20±230.731)2) < 0.01 A-dp/dtmax/(mmHg·s-1) 2144.62±158.10 2095.55±142.91 1995.31±341.551)2) 1832.41±154.121)2) < 0.01 A-T 35.25±1.43 35.75±1.421) 38.57±1.461)2) 41.59±2.261)2) < 0.01 S+dp/dtmax/(mmHg·s-1) 2275.50±180.62 2212.53±195.52 2162.04±164.951)2) 1963.32±173.741)2) < 0.01 S-dp/dtmax/(mmHg·s-1) 2090.00±140.84 2062.27±134.50 1962.19±171.961)2) 1862.70±187.661)2) < 0.01 S-T 35.29±1.35 35.76±1.391) 38.57±1.541)2) 41.66±2.071)2) < 0.01 C+dp/dtmax/(mmHg·s-1) 2269.52±204.80 2205.28±186.161) 2148.09±188.211)2) 1995.03±188.941)2) < 0.01 C-dp/dtmax/(mmHg·s-1) 2204.06±231.10 2118.57±201.921) 2005.63±169.841)2) 1878.19±149.771)2) < 0.01 C-T 34.51±2.06 35.21±1.841) 37.97±1.831)2) 41.36±2.671)2) < 0.01 与A组比较，1)P < 0.05；与B组比较，2)P < 0.05。
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表 4 T与相关因素的Spearman相关分析
Table 4. Spearman correlation analysis of T and related factors
变量 r值 P值 cfPWV 0.796 < 0.01 脉压 0.383 < 0.01 中心动脉脉压 0.520 < 0.01 LVEF -0.500 < 0.01 Gensini评分 0.863 < 0.01 E/e’ 0.775 < 0.01 R-T 0.819 < 0.01 S-T 0.822 < 0.01 A-T 0.794 < 0.01 C-T 0.747 < 0.01
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表 5 动脉弹性指标与左心室舒张功能不全的二元logistic回归分析
Table 5. Binary logistic regression analysis of arterial elasticity index and left ventricular diastolic insufficiency
变量 β值 SE值 Wald值 OR P值 cfPWV 1.139 0.180 39.983 3.124 0.000 年龄 0.067 0.023 8.210 1.069 0.004 常数 -22.074 2.879 58.794 0 0
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