Comparison Of Vascular Stiffness And Left Ventricular Diastolic Function In Patients With Dilated Cardiomyopathy And Ischemic Cardiomyopathy And Its Related Mechanism

Objective:Through the comparison of the patients’peripheral stiffness of primary dilated cardiomyopathy and ischemic cardiomyopathy, to find out whether compensatory caused by heart failure itself can lead to the increase of peripheral vascular stiffness and the mechanism is also discussed. At the same time the research analyses factors which affects cfPWV and left ventricular function with the method of multiple factors. The relationship between peripheral vascular stiffness and left ventricular diastolic function as well as its mechanism is discussed.Methods:A total of Fifty-eight patients were collected from the First Affiliated Hospital of Dalian medical university during July2013to march2014.Among the patients, thirty-three patients were suffered from Idiopathic dilated cardiomyopathy (twenty five men, eight women, average on59.5±9.7years old), and twenty five patients were suffered from Ischemic cardiomyopathy (nineteen men, six women, average on68.2±10.7years old). At the same time, Twenty five cases of healthy persons are collected as the comparison group (nineteen men, six women, average on63.4±11.1years old).The exclusion criteria is as follows(patients with these diseases were excluded):all patients went through coronary CTA or coronary angiography to clear up coronary condition (dilated cardiomyopathy patients without coronary artery involvement, ischemic cardiomyopathy patients have at least one major vascular stenosing more than50%), and exclude congenital heart disease, rheumatic heart disease, constrictive pericardial disease by echocardiography. Relevant laboratory tests were also used to exclude high power failure. Pregnant or lactating women, serious arrhythmia, severe liver and kidney dysfunction, peripheral vascular disease, chronic wasting disease, heart transplantation, cancer and so on were also excluded. All patients were tested by GE Vivid7and the data of conventional two-dimensional, color doppler and tissue doppler ultrasound, which collected and indicated the patients’heart structure, cardiac function, and other related indexes. cfPWV(Carotid femoral pulse wave velocity)were collected by automatic arteriosclerosis detector VaSera VS-1000. Fasting morning blood samples were collected for the tests of plasma glucose, Renal, plasma BNP, hsCRP and other biochemical indicators. After the data collection, statistical analysis was performed by SPSS19.0statistical software.Results:1. Compared with dilated cardiomyopathy group (6.24±1.78m/s), the normal group cfPWV (6.51±0.94m/s) keep no difference (P>0.05), in the ischemic heart disease group cfPWV (13.31±2.14m/s) there were significant differences (P <0.01). And cfPWV of cardiomyopathy group is significantly increased.2. Related Pearson analysis showed that cfPWV is positively correlated to age, hypertension, diabetes mellitus, systolic blood pressure, diastolic blood pressure, blood urea nitrogen, creatinine, fasting glucose, E/e’(r>0.3P<0.05), among which the correlation with hypertension, diabetes mellitus, and E/e’is significant. E/e’is positively correlated to hypertension, diabetes mellitus, BNP, LVDs, LAD, E, A, LVEF, LCAVI, RCAVI positive correlation (r>0.3, P<0.05), among which it was significantly correlated with hsCRP, BNP, LVDs, LAD, LVEF, cfPWV (r>0.5, P<0.01), and negative correlated with A peak (r<-0.3, P<0.05).3.Multiple stepwise linear regression analysis shows that, hypertension(β=3.305, p=0.005)diabetes mellitus(β=2.773, p=0.005),age(β=0.134, p=0.012),E/e’(β=0.186, p=0.017)are independently and positively associated with cfPWV. LVEF(β=-0.130, p=0.008, OR=0.878)and cfPWV(β=0.431, p=0.000, OR=1.511) are indepent e’factors of E/e’, and with the increase of cfPWV, E/e’elevated, while with the decrease of LVEF, E/e’elevated. Conclusion:1.The increase of peripheral arterial stiffness associated with heart failure are not caused by the failure itself compensatory vascular endothelial dysfunction, but by the impact of different disease due to heart failure.2. In this research, patients all kept systolic and diastolic dysfunction. Dilated cardiomyopathy groups tend to have systolic dysfunction, while schemic cardiomyopathy groups tend to have diastolic dysfunction.3. PWV is independent factors of E/e’. And with the increase of cfPWV, ventricular function reduced, and E/e’elevated. Age, hypertension, diabetes, E/e’are independent factors of cfPWV.