Correlation Of Pulse Pressure,pulse Pressure Index And Cardiac Structure And Function In Heart Failure With Preserved Ejection Fraction

Objective To investigate the correlation between pulse pressure,pulse pressure index and cardiac structure and function in heart failure with preserved ejection fraction.Methods A total of 738 patients with heart failure symptoms such as shortness of breath,impaired exercise tolerance and fatigue were selected from the first ward of Geriatrics Department of Lanzhou University Hospital from January 1,2015 to December 31,2019.According to the inclusion and exclusion criteria,a total of 214 patients with HFp EF（male 110 cases,female 104 cases）and 54 patients without cardiac structural and functional abnormalities admitted to hospital in the same period were selected in the control group.According to pulse pressure,patients with HFp EF were divided into four groups: < 50 mm Hg（n = 68）,50-59 mm Hg（n = 67）,60-69 mm Hg（n = 39）and ≥ 70 mm Hg（n = 40）.According to the pulse pressure index,patients with HFp EF were divided into three groups: < 40%（n = 56）,40-44.9%（n= 50）,45-49.9%（n = 54）and ≥ 50%（n = 54）.The basic data of patients in each group were compared and the new super parameters of cardiac structure and function were analyzed.Results 1.24-hour systolic blood pressure,24-hour pulse pressure,24-hour pulse pressure index,DBIL,BUN,Cr,UA,NT-pro BNP,CD-PWV,CF-PWV in HFp EF group were significantly higher than those in control group;while PLT,ALB,TC,HDL-C,LDL-C and T3 were significantly lower than those in control group.2.The left ventricular structural and functional parameters of IVSTd,PWTd,IVSTs,PWTs,LVMi,LAVi,E/E’,E/FPV in HFp EF group were higher than those in control group;E/A,E’L and E’S were lower than those in the control group.RV-D1,RV-D2,ROVT2,RA-D1,RA-D2,RA-A,PA and PASP in right heart structure and function parameters of HFp EF group were significantly higher than those of control group.The difference was statistically significant（P < 0.05）.3.In HFp EF patients,24 h systolic blood pressure increased gradually with the increase of pulse pressure level,and there was statistically significant difference between multiple groups（P < 0.001）,and the increase of pulse pressure was mainly related to the increase of 24 h systolic blood pressure,and there was no significant difference with 24 h diastolic blood pressure（P > 0.05）.The heart rate of the group with pulse pressure < 50 mm Hg was higher than that of the group with pulse pressure 50-59 mm Hg and ≥70mm Hg,CD-PWV of pulse pressure < 50 mm Hg group was lower than that of pulse pressure 50-59 mm Hg group and 60-69 mm Hg group,CF-PWV of pulse pressure < 50 mm Hg group was lower than that of pulse pressure 60-69 mm Hg group and ≥70mm Hg group,the difference was statistically significant（P < 0.001-0.05）.NTpro BNP in baseline indexes of HFp EF patients in the lowest pulse pressure group（<50mm Hg）and the highest pulse pressure group（≥70mm Hg）were higher than those in other groups.4.In the structural and functional parameters of left heart of HFp EF patients,E/E’of pulse pressure ≥70mm Hg group was higher than that of the other three groups,with statistical significance（P < 0.001）.In the group of pulse pressure < 50 mm Hg,LAVi was higher than the group of pulse pressure 60-69 mm Hg,E/FPV was higher than the group of pulse pressure 50-59 mm Hg and 60-69 mm Hg,LVMi was lower than the group of pulse pressure 60-69 mm Hg and ≥70mm Hg,the differences were statistically significant（P < 0.05）.In the right heart structure parameters of HFp EF patients,the RV-D1,RV-D2,ROVT2,RA-D1,RA-D2 and RA-A of pulse pressure < 50 mm Hg group were higher than those of the other three groups,and the differences among the multiple groups were statistically significant（P < 0.001-0.025）.In the group of pulse pressure < 50 mm Hg,ROVT1 was higher than that in the group of pulse pressure 50-59 mm Hg and 60-69 mm Hg,PA was higher than that in the group of pulse pressure 50-59 mm Hg,the difference was statistically significant（P < 0.05）.5.In HFp EF patients,the age of pulse pressure index ≥50% group was higher than that of pulse pressure index < 40% and 40-44.9% group,the difference was statistically significant（P < 0.001）.The 24 h systolic blood pressure gradually increased with the increase of pulse pressure index,and there was statistical difference between the multiple groups（P < 0.001）.The 24 h diastolic blood pressure in the pulse pressure index < 40% and 40-44.9% groups were higher than those in the pulse pressure index45-49.9% and ≥50% groups.The difference was statistically significant（P < 0.001）.The heart rate of pulse pressure index < 40% group was higher than that of the other three groups,the difference was statistically significant（P < 0.001）.The NT-pro BNP of pulse pressure index < 40% group was higher than that of pulse pressure index 40-44.9% and 45-49.9% group,the difference was statistically significant（P < 0.001）.The CF-PWV of pulse pressure index < 40% and 40-44.9% groups was lower than that of pulse pressure index ≥50% group,and the difference was statistically significant（P <0.05）.6.In the left heart structure and function parameters of HFp EF patients,the LAVi of pulse pressure index < 40% group was lower than that of pulse pressure index 40-44.9% and ≥50% group,the difference was statistically significant（P < 0.05）.The E/E ’of 40-44.9% group was lower than that of ≥50% group,and the difference was statistically significant（P < 0.05）.In the right heart structure parameters of HFp EF patients,the RV-FWD and RV-FWS of 45-49.9% group were lower than those of ≥50% group,the difference was statistically significant（P < 0.05）.The RV-D1,RV-D2,RA-D1,RA-D2,RA-A,PA in the group with pulse pressure index < 40% were higher than those in the other three groups,and the difference between the groups was statistically significant（P < 0.001-0.019）.In the group with pulse pressure index < 40%,ROVT2 was higher than 45-49.9% and ≥50%,PASP was higher than 40-44.9% and45-49.9%,the difference was statistically significant（P < 0.05）.7.Correlation analysis of pulse pressure and pulse pressure index baseline data in HFp EF patients: pulse pressure and pulse pressure index were positively correlated with age,24-hour systolic blood pressure and CF-PWV（P < 0.05-0.001）,and negatively correlated with 24-hour diastolic blood pressure,heart rate,hemoglobin,hematocrit,aspartate aminotransferase,alanine aminotransferase,direct bilirubin and indirect bilirubin（P < 0.05-0.001）.8.Correlation analysis between pulse pressure,pulse pressure index and cardiac structure and function in patients with HFp EF: pulse pressure and pulse pressure index were positively correlated with LVIDd,IVSTs,PWTs,LVMi,DT,E/E’（P < 0.05-0.001）,and negatively correlated with E’L,E’S,RV-D1,RV-D2,RA-D1,RA-D2,RAA（P < 0.05-0.001）.Pulse pressure was positively correlated with IVSTd,PWTd and LVEDVi（P < 0.05）,negatively correlated with E/FPV and ROVT2（P < 0.05）,pulse pressure index was positively correlated with FS and LVEF（P < 0.05）,and negatively correlated with PA（P < 0.05）.9.The diagnostic value of pulse pressure and pulse pressure index to HFp EF: the area under the curve of pulse pressure and pulse pressure index determined by drawing ROC curve is 0.838 and 0.824 respectively.When pulse pressure is in 48.5mm Hg,the sensitivity and specificity of diagnosing HFp EF are 71.5% and 90.7%;when the pulse pressure index is 39.5%,the sensitivity and specificity of diagnosing HFp EF are 77.1%and 81.5% respectively.10.Linear regression analysis: pulse pressure and pulse pressure index were taken as independent variables and cardiac structure and function as dependent variables.Pulse pressure and pulse pressure index were independently correlated with LVIDs,PWTs,FS,LV-ESVi,LVEF,E/E’,FPV,RV-FWd and RV-FWs,pulse pressure was also independently correlated with LVIDd,IVSTd,PWTd,IVSTs,LVMi,LVEDVi,E’S,and pulse pressure index was independently correlated with E/A,RV-D3,RA-D1 and RA-A.Conclusion The increase of pulse pressure and pulse pressure index affect left ventricular diastolic function and right ventricular volume in HFp EF,which are independent risk factors for ventricular remodeling in HFp EF.