颈-股脉搏波传导速度与冠心病患者左室舒张功能的相关性及诊断价值

Correlation between carotid-femoral pulse wave conduction velocity and left ventricular diastolic function in patients with coronary artery disease and its diagnostic value

目的通过无创检测动脉弹性指数探讨外周动脉弹性与心室舒张功能变化的相关性。方法回顾性分析2020年6月—2021年6月上海市XX区中心医院就诊的390例疑似冠心病(Coronary heart disease,CHD)并完善冠状动脉造影(Coronary angiography,CAG)患者的临床资料,根据冠状动脉病变程度分为对照组(n=73)、冠状动脉粥样硬化组(n=128)和CHD组(n=189)三组。采用相关性分析及多元线性回归分析动脉弹性指数与心功能指标的关系。结果冠状动脉粥样硬化组二尖瓣舒张早期血流峰值与二尖瓣环速度之比(Ratio of peak mitral valve blood flow during early diastolic period to mitral ring velocity,E/e')、颈-股脉搏波传导速度(Carotid-femoral pulse wave conduction velocity,cfPWV)、左心室等容舒张松弛时间常数T均高于对照组,左心室射血分数(Left ventricular ejection fraction,LVEF)低于对照组,差异有统计学意义(P<0.05);CHD组LVEF低于对照组,左心室压力上升最大速度(Maximum velocity of left ventricular rise,LV+dp/dtmax)、左心室压力下降最大速度(Maximum velocity of left ventricular descent,LV-dp/dtmax)均慢于对照组,差异有统计学意义(P<0.05);E/e'、左心房容积指数(Left atrial volume index,LAVI)、左心室质量指数(Left ventricular mass index,LVMI)、E峰减速时间(Deceleration time,DT)、T均高于对照组,cfPWV快于对照组,差异有统计学意义(P均<0.05);CHD组LVEF、左心室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)低于冠状动脉粥样硬化组,LV+dp/dtmax、LV-dp/dtmax均慢于冠状动脉粥样硬化组,E/e'、LAVI、DT、T均高于冠状动脉粥样硬化组,cfPWV快于冠状动脉粥样硬化组,差异有统计学意义(P均<0.05)。调整性别、年龄、吸烟史、高血压病史、糖尿病病史、血脂指标、肌酐、肌钙蛋白I(Cardiac troponin,cTnI)、B型利尿钛(B-type natriuretic peptide,BNP)、体表面积(Body surface area,BSA)评分等相关因子后,Partial分析显示,cfPWV与T(r=0.42,P<0.001)、E/e'(r=0.26,P<0.001)、LAVI(r=0.22,P<0.001)呈正相关,与LV-dp/dtmax(r=-0.12,P=0.02)呈负相关,而与其他指标不相关。线性回归分析,结果显示,E/e'、LAVI、T、LV+dp/dtmax是cfPWV的影响因素。结论cfPWV与CHD患者左心室舒张功能减退显著相关,可作为预测左室舒张功能减退的敏感指标。

Objective To investigate the correlation between peripheral arterial elasticity and changes in ventricular diastolic function by testing arterial elasticity indexes through non-invasive technology.Methods A retrospective analysis was conducted on 390 patients with suspected coronary artery disease(CHD)who underwent coronary angiography(CAG)at Shanghai Fengxian Central Hospital from June 2020 to June 2021.Patients were divided into a control group(n=73),coronary atherosclerosis group(n=128),and CHD group(n=189)based on the degree of coronary artery lesions.Correlation and multiple linear regression analyses were used to examine the relationship between arterial elasticity indexes and cardiac function indices.Results The coronary atherosclerosis group had higher values of the ratio of peak mitral valve blood flow during early diastolic period to mitral ring velocity(E/e'),carotid-femoral pulse wave conduction velocity(cfPWV),and left ventricular isovolumic diastolic relaxation time constant(T)compared to the control group,with a lower left ventricular ejection fraction(LVEF),differences were statistically significant(P<0.05).In the CHD group,LVEF was lower than the control group,and the maximum velocity of left ventricular rise(LV+dp/dtmax)and descent(LV-dp/dtmax)were slower than the control group,differences were statistically significant(P<0.05).The CHD group also had higher values of E/e',left atrial volume index(LAVI),left ventricular mass index(LVMI),deceleration time(DT),and T,and a faster cfPWV than the control group,differences were statistically significant(P<0.05).After adjusting for gender,age,smoking history,hypertension,diabetes,lipid profiles,creatinine,cardiac troponin I(cTnI),B-type natriuretic peptide(BNP),and body surface area(BSA),partial correlation analysis showed that cfPWV was positively correlated with T,E/e',and LAVI,and negatively correlated with LV-dp/dtmax.Linear regression analysis indicated that E/e',LAVI,T,and LV+dp/dtmax were influencing factors of cfPWV.Conclusions cfPWV is significantly correlated with left ventricular diastolic dysfunction in patients with CHD and can be used as a sensitive indicator to predict left ventricular diastolic dysfunction.