Correlation Research Between Brachial-ankle Pulse Wave Velocity, Homocysteine And Coronary Artery Lesion

Aim:To investigate the association between brachial-ankle pulse wave velocity (BaPWV)、the levels of serum homocysteine(HCY)and CAD severity assessed by angiography and the Gensini score. To explore the relationship between brachial-ankle pulse wave velocity and homocysteine.Methods:378patients underwent measurement coronary angiography from October2011to December2012, Patients were divided into the CHD group (n=294) and non-CHD group (n=84) according to the outcomes of CAG. According to the number of suffered coronary artery, single branch group, double branches group and several branches group were defined. CHD patients were divided into three sub-groups:mild group. moderate group and severe group according to Gensini score. According to plasma total HCY concentration, all patients were categorized into quartiles, namely low level group (HCY≦12.7umol/L); Median level group (12.7umol/L<HCY≦15.2umol/L); High level group (15.2umol/L<HCY≦18umol/L); Extremely High level group (HCY>18.9umol/L).The differences among these groups were analyzed. All patients were underwent blood biochemistry and brachial-ankle pulse wave velocity examination before coronary angiography.Results:Age、male、smoking、hypertensive history、diabetes、systolic blood pressure、 pulse pressure、total cholesterol and creatinine were significant risk factor of coronary atherosclerosis(P<0.05). The difference of BaPWV between coronary group and control group was significant (1697±271vs.1446±217P<0.001). The difference of BaPWV between mild group (1583±218cm/s). moderate group (1674±230cm/s) and severe group (1801±219cm/s) was significant(P<0.001). The difference of BaPWV between Low level group (1463±194cm/s) Median level group (1563±203cm/s) High level group (1739±247cm/s) and Extremely High level group(1795±319cm/s) was significant(P<0.001). The difference of BaPWV and HCY between single branch group, double branches group and several branches group were significant (P<0.001). There was a moderate and positive correlation between brachial-ankle pulse wave velocity and CAD severity assessed by Gensini score(r=0.332,P<0.001).There was a moderate and positive correlation between Log-HCY and CAD severity assessed by Gensini score(r=0.370, p<0.001).With the outcomes of CAG as the gold standard for drawing ROC curve, BaPWV had a moderate predictive value for CHD with the cut-off point of1535cm/s, the sensitivity was70.4%, the specificity was77.3%. HCY had a moderate predictive value for CHD with the cut-off point of14.1umol/L, the sensitivity was69.7%, and the specificity was60.7%. An advanced predictive value was detected when we combined the BaPWV with HCY (series test).Its sensitivity and specificity were54.1%and85.5%respectively. To our surprise, a remarkable predictive value method emerged when we combined the BaPWV with HCY (parallel test).Its sensitivity and specificity were85.7%and52.3%respectively. There was a moderate and positive correlation between Log-HCY and brachial-ankle pulse wave velocity (r=0.472, p<0.001). In multivariate logistic repression analyses of CHD subjects, BaPWV, diabetes, male, HCY, age were significantly related to CHD (odds ratio [OR]5.389,3.168,2.538,1.743,1.079,separately)Conclusion:1、BaPWV and HCY increases with the severity and complexity of coronary atherosclerosis, both of them can reflect severity of coronary heart disease, and these two index can be regarded as an important risk factor for coronary heart disease.2、In this study we found a positive correlation between BaPWV and HCY.3、By depicting the ROC curve of BaPWV and HCY, the critical point derived has important clinical value in the prediction of coronary heart disease. It can increase the sensitivity or specificity in predicting of CAD when we combined the BaPWV with HCY.