脉搏波传导速度与冠心病心功能不全的相关性

Relationship between pulse wave velocity and the NYHA classification of coronary insufficiency

目的评价踝臂脉搏波传导速度（baPWV）与冠心病不同程度心功能不全的相关性。方法连续入院253例明确诊断冠状动脉粥样硬化性心脏病的患者，按纽约心脏病学协会标准（NYHA）进行心功能分级，所有患者采用无创动脉硬化自动测定仪测量baPWV，同时测定脑钠肽（BNP），左室射血分数（LVEF），左室舒张末容量（LVEDV），左室收缩末容量（LVESV），并进行相关性分析。结果baPWV与BNP（r=0．394，P〈0．001）、NYHA分级（r=0．444，P〈0．001）、LVEDV（r=-0．130，P〈0．05）之间具有显著相关性，但与LVEF、LVESV之间无显著相关性。ROC曲线下面积表明：当baPWV〉1717cm／s时，诊断心功能不全的敏感性为72．9％，特异性为61．8％；左侧踝臂脉搏波传导速度（LbaPWV）≥1900cm／s时，其对应的敏感性是61．5％，特异性是81．9％。结论baPWV与冠心病患者NYHA分级之间具有显著相关性，可作为评价心功能的一个指标。

Objective To investigate the relationship between brachial-ankle pulse wave velocity （baPWV） and different stage of cardiac dysfunction. Methods 253 consecutive patients with coronary atherosclerotic heart disease were enrolled from August 2006 to February 2007, Patients were grouped according to the functional classification of New York Heart Association （NYHA） . The baPWV was measured non-invasively with a VP1000 automated PWV/ABI analyzer （PWV/ABI, Colin CO. Ltd. , Komaki ,Japan）. At the same time, BNP, EF,LAEDV and LVESV were measured in all the patients, Results Brachialankle PWV was significantly correlated with cardiac function classification of NYHA （ r = 0. 444, P 〈 0. 001 ）, BNP（ r = 0. 394, P 〈 0. 001 ） and left ventricular end diastolic volume （ r = - 0. 130, P 〈 0, 05 ）. The under area of receiver operating charachateistic （ROC） curve was 73.9%. The ROC curve demonstrated that when the value of brachial-ankle PWV was equal to or larger than 1717 cm/s （ ≥ 1717 cm/s ）, the sensitivity of diagnosing mild cardiac dysfunction was 72. 9% and specifity 61.8%. When its value was equal to or larger than 1900 cm/s（≥ 1900 cm/s） ,the sensitivity and specificity were 61.5% and 81.9% respectively. Conclusion Brachial-ankle PWV is significantly correlated to the NYHA classification of heart failure and it may be a prospective index to diagnose early stage of cardiac dysfunction.