冠状动脉粥样硬化性心脏病患者左心室舒张功能与冠状动脉狭窄程度和大动脉弹性的相关性分析

摘要

目的 分析冠状动脉粥样硬化性心脏病(冠心病)患者左心室舒张功能与冠状动脉狭窄程度和大动脉弹性大动脉弹性的相关性.方法 纳入2009年6月至2010年3月行冠状动脉造影和左心室造影的疑似冠心病患者81例,根据冠状动脉造影结果分为冠心病组和对照组.检测颈-股脉搏波速度(cfPWV)以评价大动脉弹性,采用有创心导管术检测左心室舒张末期压力(LVEDP)反映左心室舒张功能,对冠心病组患者通过计算Gensini积分评估冠状动脉病变程度.比较2组间一般基线资料、超声心动图指标、cfPWV及LVEDP差异;分析冠心病组患者LVEDP与心血管危险因素、超声心动图指标、Gensini积分及cfPWV的相关性.结果 冠心病组患者56例、对照组患者25例,冠心病组患高血压和糖尿病比例、左心室后壁厚度(LVPWT)、左心室质量指数(LVMl)、左心室射血分数(LVEF)、LVEDP和cfPWV与对照组比较差异均有统计学意义[73.2％ (41/56)比48.0％ (12/25)、57.1％(32/56)比16.0％ (4/25)、(0.99±0.12)cm比(0.94±0.10)cm、(125±29)g/m2比(108±22)g/m2、(66±7)％比(69±6)％、(21±10) mmHg比(16±5) mmHg(1 mmHg =0.133 kPa)、(8.3±2.l)m/s比(7.1±2.0)m/s](均P＜0.05);采用多元Logistic回归排除混杂因素后,2组间LVEDP差异有统计学意义(P＜0.05或P＜0.01),cfPWV差异无统计学意义(P＞0.05).Pearson相关分析显示LVEDP与冠状动脉Gensini积分、中心动脉收缩压、室间隔厚度(IVST)之间呈正相关(r=0.336,P=0.001;r =0.381,P=0.004;r=0.266,P=0.009),与cfPWV无相关性(r=-0.154,P=0.258);对Gensini积分、中心动脉收缩压、IVST与LVEDP相关性行Logistic多元逐步回归,显示Gensini积分和中心动脉收缩压与LVEDP独立相关(P＜0.05).结论 冠心病患者左心室舒张功能与冠状动脉狭窄程度呈正相关,与大动脉弹性无相关性.%Objective To investigate the correlation among left ventricular diastolic function, coronary stenosis degree and arterial elasticity in patients with coronary heart disease (CHD).Methods Totally 81 patients with suspected coronary heart disease who underwent coronary angiography and left ventriculography were enrolled and divided into CHD group and control group.The carotid-femoral pulse wave velocity (cfPWV)was measured to evaluate the arterial elasticity;the left ventricular end diastolic pressure (LVEDP) was determined by invasive cardiac catheterization, and the coronary stenosis degree in CHD group was assessed by Gensini score.The correlations among LVEDP, cardiovascular risk factors, echocardiography parameters, Gensini scores and cfPWV were analyzed.Results There were 56 cases in CHD group and 25 cases in control group.In CHD group, the proportion of hypertension and diabetes, left ventricular posterior wall thickness (LVPWT) , left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), LVEDP and cfPWV were all significantly different with those in control group [73.2％ (41/56) vs 48.0％ (12/25) , 57.1％ (32/56) vs 16.0％(4/25), (0.99±0.12) cm vs (0.94±0.10) cm, (125±29) g/m2 vs (108±22) g/m2, (66±7) ％ vs (69 ±6) ％, (21±10) mmHgvs (16±5) mmHg, (8.3 ±2.1) m/s vs (7.1 ±2.0) m/s] (P＜0.05 or P＜0.01);after removing the confounding factors by Logistic analysis, there was significant difference regarding LVEDP (P ＜ 0.05), while no difference regarding cfPWV (P ＞ 0.05) between the two groups.Pearson analysis showed that LVEDP was positively correlated with Gensini score, central aortic systolic blood pressure, and interventricular septum thickness (IVST) (r =0.336, P =0.001;r =0.381, P =0.004;r =0.266, P =0.009), but it was not correlated with cfPWV (r =-0.154, P =0.258).Multiple Logistic stepwise regression analysis showed that LVEDP was positively correlated with Gensini score and central aortic systolic blood pressure (P ＜ 0.05).Conclusion Impaired left ventricular diastolic function is positively correlated with coronary stenosis degree but it is not correlated with arterial elasticity in CHD patients.