Relationships Among Pulse Pressure, Left Ventricular Mass Index And Coronary Artery Gensini Score

Objective:We compared the pulse pressure, left ventricular mass index between the normal control group and coronary heart disease group, explored the the relationships among pulse pressure, left ventricular mass index and the Gensini score.Method:590hospitalized patients who had accepted coronary angiography(CAG) from January2013to January2014in cardiology of the Second Hospital of TianJin medical university were enrolled. According to the results of the CAG, the patients were divided into two groups:normal control group (non-CHD Gensini score=0) and coronary heart disease group(CHD), and the CHD group were divided into three groups:mild lesion group (Ml-CHD0<Gensini score≤20), moderate lesion group (Md-CHD20<Gensini score≤40) and severe lesion group (S-CHD Gensini score>40). The clinical data included sex, age, diabetes, stroke, smoking, heart rate, blood pressure, blood lipid, fasting blood glucose, height, weight, surface area, systolic blood pressure, diastolic blood pressure, pulse pressure.we got the interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular ejection fraction and left ventricular mass index by ultrasonic cardiogram, and compared the indicators all above between the two groups.Then we substituted the meaningful variables into the Logistic regression and analyzed the risk factors of CHD and make the ROC curve of the pulse pressure and left ventricular mass index to predict the CHD. We compared the differences between the subgroups on the index above, and analyzed the correlation between pulse pressure, left ventricular mass index and other indicators and Gensini score, then made the linear regression analysis on the factors affecting the Gensini score.Results:1. Age(56.96±8.74vs64.03±10.25), diabetes(7%vs27%), smoking(21%vs47%), pulse pressure(51.68±13.31vs58.22±15.98), pulse pressure^50mmHg(64%vs76%), fasting blood glucose(5.65±0.93vs6.16±1.86), triglycerides(1.57±0. 78vs1.89±1.50), high density lipoprotein cholesterol(1.04±0.17vs0.98±0.22), interventricular se-ptum thickness(8.20±1.51vs8.77±1.69), left ventricular poste rior wall thickness(8.09±1.29vs8.73±1.51), left ventricular end-diastolic diamet er(45.39±3.75vs47.51±5.10), left ventricular end-systolic diameter(29.25±4.25v s30.52±6.19), left ventricularejection fraction(59.67±7.32vs58.21±6.83), left ventricular mass index(72.25±18.96vs86.75±27.28) were different between the CHD group and the non-CHD group (P<0.05). In Logistic regression analysis model, influence factors of CHD were age, diabetes and smoking.2. The cutoff points predicting the CHD of pulse pressure is50.50mmHg, The area under the ROC curve is0.616(95%CI:0.541±0.692, P<0.05), the sensitivity is57.7%, the specificity is60.7%; The cutoff points predicting the CHD of left ventricular mass index is92.465g/m2, The area under the ROC curve is0.651(95%CI:0.585～0.718, P<0.05), the sensitivity is39.3%, the specificity is85.7%.3. Age, pulse pressure, fasting blood glucose, low density lipoprotein cholesterol, interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end diastolic diameter, left ventricular end systolic dimension, left ventricular mass index were positively related to the Gensini score; High density lipoprotein cholesterol, ejection fraction were negatively related to the Gensini score.4. There was a progressively increased tendency on interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and left ventricular mass index in the three subgroups, There was a progressively decreased tendency on left ventricular ejection fraction in the three subgroups.5. In the multiple linear regression model:age, pulse pressure, pulse pressure≥50mmHg, low density lipoprotein cholesterol, left ventricular end systolic dimension, left ventricular mass index were independent risk factors of the Gensini score; ejection fraction was an independent protect factor of the Gensini score.Conclusion 1. The patients with CHD had older age, smoking habit, diabete, high level of pulse pressure, fasting blood glucose, triglyceride, low level of high density lipoprotein cholesterol, high degree of interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and left ventricular mass index. low degree of left ventricular ejection fraction. Age, smoking, diabetes were risk factors for CHD occurs.2. Pulse pressure and left ventricular mass index had a higher sensitivity and specificity in predicting the occur of CHD.3. There was a progressively increased tendency on interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular mass index in the three subgroups; There was a progressively decreased tendency on left ventricular ejection fraction in the three subgroups.4. Age, pulse pressure, low density lipoprotein cholesterol, left ventricular end systolic diameter, left ventricular mass index, pulse pressure≥50mmHg were independent risk factors and ejection fraction was an independent protect factor for the Gensini score.