Correlation Analysis Between Coronary Artery Lesions And Left Ventricular Function In Patients With Unstable Angina Pectoris Complicated With Hypertension

Objective To analyze the correlation between the degree of coronary artery lesions and left ventricular function in patients with unstable angina pectoris(UAP)complicated with hypertension,and to explore the diagnostic value of echocardiography in evaluating the condition of UAP patients complicated with hypertension.Methods 302 patients suspected of unstable angina pectoris(UAP)diagnosed by Qingdao municipal hospital from December 2017 to August 2018 and planned to undergo coronary angiography(CAG)were selected,and echocardiography was performed on all patients.Patients who did not meet the inclusion criteria,such as heart valve disease and pericardial disease and so on,were excluded,and then grouped according to the CAG results and the diagnostic criteria of hypertension:patients at least one major coronary artery stenosis degree ≥50% who combined with hypertension as the case group;CAG confirmed no coronary artery disease as the control group.Finally,a total of 113 patients were included in the statistical analysis,including 73 cases in the case group and 40 cases in the control group.Aortic valve flow rate and left ventricular ejection fraction(LVEF)was measured by echocardiography;peak blood flow velocity(E)and peak blood flow velocity(A)in early and late diastolic stage of mitral valve were measured under pulsed wave doppler(PW);at the same time,the time "a” from the end of the A peak to the beginning of the E peak of the next cycle was measured;the left ventricular ejection time" b” was measured under the apical five-chamber view;the left ventricular pulse Doppler myocardial work index(PW-Tei index)was calculated =(a-b)/b.Mitral annulus diastolic early peak(Ea),late diastolic peak(Aa),and systolic peak(Sa)were measured under tissue doppler imaging(TDI);measure the time a’ from the end of the Aa wave of the mitral annulus motion spectrum to the start of the Ea wave of the motion spectrum of the next cycle,and measure the duration b’ of the Sa wave of the systolic spectrum of the mitral annulus,and calculate the Dolly index of tissue Doppler myocardial work(TDI-Tei)=(a’-b’)/ b’.Echocardiographic parameters such as aortic valve flow rate,LVEF,E/A,Ea/Aa,E/(Ea×Sa),PW-Tei index and TDI-Tei index among two groups were compared;the correlation between the Gensini score representing the degree of coronary artery stenosis of the case group and the echocardiographic parameters was analyzed;theobjective working characteristic curve(The ROC curve)was used to evaluate the predictive value of ultrasound index in coronary artery lesions.Results(1)There were no significant differences in gender,age,heart rate,BMI and aortic valve velocity between the case group and the control group(P>0.05).(2)There were significant differences in LVEF,E/A,E/Ea,Ea/Aa,E/(Ea*Sa),PW-Tei and TDI-Tei between the two groups : the median of E/Ea and E/(Ea*Sa)in the case group was significantly higher than that in the control group;the mean values of PW-Tei and TDI-Tei in the case group were significantly higher than those in the control group;the median of LVEF,E/A and Ea/Aa in the case group was significantly lower than that in the control group.(3)The correlation analysis between Gensini score and the variables in the case group showed that: Gensini score was positively correlated with age,systolic blood pressure,BNP,fasting blood glucose,cholesterol,triglyceride,LDL-C,Non-HDL-C,E/Ea,E/(Ea*Sa),PW-Tei,and TDI-Tei,and the correlation coefficients were 0.270,0.385,0.437,0.321,0.375,0.257,0.423,0.372,0.455,0.608,and0.692,respectively;however,the Gensini score was negatively correlated with LVEF,Ea/Aa,and the correlation coefficients were-0.317 and-0.240,respectively.(4)Taking the Gensini score as the dependent variable and the significant index in the correlation analysis as the independent variable,multivariate linear regression analysis was carried out with the stepwise method.Age,triglycerides,Non-HDL-C,E/(Ea*Sa)and TDI-tei were all independent predictors of the Gensini score.(5)The value analysis of coronary artery disease showed that the area under ROC curve of TDI-Tei was 0.882 and the critical value was 0.455,with a sensitivity of 84.9% and a specificity of 82.5%.Conclusions The degree of coronary artery lesions in patients with UAP complicated with hypertension is closely related to left ventricular function.TDI-Tei and E/(Ea*Sa)are relatively new indicators to judge the overall cardiac function and independent predictors of the degree of coronary artery lesions.Echocardiography can indirectly assess the degree of coronary artery lesions through the detection of left ventricular function,providing an important reference basis for judging the condition of patients with UAP combined with hypertension.However,each echocardiographic measurement index has its own advantages and disadvantages.Only by comprehensive use of these indicators,can we make more accurate judgments for patients with different conditions.