Study On The Correlation Between AASI And Preserved Ejection Fraction Heart Failure In Patients With Hypertension

Background and ObjectiveWith the increasing aging of contemporary society,The prevalence and morbidity of heart failure（HF）,as the terminal stage of all cardiovascular diseases,is increasing year by year,and the mortality rate is higher than that^[1]other cardiovascular diseases.The proportion of ejection fraction reserved heart failure（HFp EF）in all HF patients can be as high as 40%～71%^[2].However,unlike heart failure（HFr EF）with reduced ejection fraction,HFp EF heart failure related biomarkers and echocardiography and other cardiac function indicators are not obvious,which makes it difficult to identify in time and easy to miss diagnosis.Some studies show that the diagnostic rate of HFp EF in China is still very low^[3].The failure to diagnose and intervene in time is the main cause of poor HFp EF prognosis and even higher mortality than HFr EF.The survey shows that the number of hypertension in China is as many as 245million^[4],and among the many causes of HFp EF,hypertension is^[5]of the main causes,and the data show that about 80%of the HFp EF have hypertension^[6].Therefore,in the huge population of hypertension,it is particularly important to be able to predict and diagnose HFp EF in advance and clearly assess the severity of the disease.The dynamic arteriosclerosis index AASI)is a quantitative index calculated by using data to monitor 24-hour ambulatory blood pressure.It is now generally accepted that AASI can be used to predict the incidence and mortality^[7]of cardiovascular disease in hypertensive population.However,there is no research to explore the potential relationship between AASI and HFp EF in hypertensive population.This study included AASI as an indicator to explore the correlation between AASI and HFp EF in hypertensive population,and further explore the correlation between AASI and cardiac function and cardiac structure-related indicators.Whether the comprehensive evaluation AASI is expected to be a reference index for predicting the occurrence of HFp EF and evaluating the severity of the disease in the hypertensive population.MethodFrom January 2018 to December 2019,210 patients with essential hypertension and LVEF≥50%who were diagnosed in our hospital,including 104 men and 106women,with an average age of 70.7±12.0 years.The general clinical data,biochemical indexes,color Doppler ultrasound related data and ambulatory blood pressure monitoring results were collected.According to whether the patient was accompanied by HFp EF,112 cases were divided into HFp EF groups,98 cases in the control group.HFp EF group was divided into A subgroup（grade I～II）63 cases and B subgroup（grade IIII～IIIV）49 cases according to the cardiac function classification of the New York Cardiology Society.SPSS 25.0 statistical software was used to compare the difference of general clinical data,biochemical index,color Doppler index and AASI between HFp EF group and the control group,and the differences in AASI,cardiac function,and cardiac structure-related indicators between the two subgroups.The correlation between AASI and cardiac function and ventricular structure was further studied by Pearson correlation analysis.Multivariate linear regression analysis was used to analyze the relationship between AASI and various factors and ROC curve to determine the diagnostic value of HFp EF in hypertensive population.Results1、The comparison of general data between the HFp EF group and the control group showed that the HFp EF group was older than the control group（76.4±10.0 vs64.3±10.8）and the difference was statistically significant（P<0.05）.The number of cases in the HFp EF group was higher than that in the HFp EF group（61.6%vs 48.0%）and atrial fibrillation（34.8%vs 21.4%）,and the difference was statistically significant（p<0.05）.There was no significant difference in the remaining items（P≥0.05）.The highest proportion of NYHA cardiac function in HFp EF group was II（41.1%）and the lowest was IV（6.3%）.2、Comparison of biochemical and thyroid function-related indexes between the HFp EF group and the control group,the HFp EF group Scr（72.36±28.32 vs61.36±15.03）,BUN（338.81±87.45 vs 304.85±69.32）,Hcy（18.11±6.16 vs12.34±2.88）,TSH（4.10±1.70 vs 2.76±1.38）was higher than thethe control group,the difference was statistically significant（P<0.05）,However,the FT3 of the HFp EF group（3.34±0.87 vs 4.35±0.96）was lower than that of the control group,and the difference was statistically significant（P<0.05）,while the other indicators had no significant difference（P>0.05）.3、NT-pro BNP（1806.44±589.57 vs 78.52±28.2）,AASI（0.55±0.13 vs 0.49±0.15）,LVDd（53.37±6.18 vs 47.34±6.39）,LVMI（126.85±23.91 vs 110.76±19.70）in the HFp EF group were all higher than the control group group,and the difference was statistically significant（P<0.05）;The LVEF（58.16±5.33 vs 62.10±4.51）was lower than the control group group,and the difference was statistically significant（P<0.05）.4、In HFp EF,subgroup A compared with subgroup B NT-pro BNP（1417.10±363.28 vs 2307.08±418.86）,AASI（0.53±0.13 vs 0.58±0.13）,LVDd（50.67±5.55 vs 56.80±5.12）,LVMI（118.83±18.46 vs 18.46 vs 137.03±26.19）is lower than the B subgroup,the difference is statistically significant（P<0.05）,All NT-pro BNP、AASI、LVDd、LVMI increased with the increase of cardiac function classification.The LVEF of A subgroup（60.79±5.04 vs 54.67±3.38）was higher than that of B subgroup（0.05）,that is,the LVEF decreased with the increase of cardiac function grade.5、The AASI of patients with hypertension and HFp EF was positively correlated with NT-pro BNP（r=0.434,P<0.001）,LVDd（r=0.470,P<0.001）,and LVMI（r=0.417,P<0.001）.LVEF（r=-0.410,P<0.001）was negatively correlated（r=-0.410,P<0.001）.6、The multiple linear regression analysis of the influencing factors of AASI showed that Age（β=0.304）,history of diabetes（β=0.318）and Hcy（β=0.195）were the influencing factors for AASI.7、The ROC curve analysis of the predictive value of AASI to HFp EF in hypertensive patients shows that the area under the AASI curve is the AUC value of0.653,the 95%CI is 0.578～0.728,and the P value is 0.000（P<0.05）.The calculated maximum Youden index is 0.352,the corresponding AASI value is 0.529,that is,the cutoff point of AASI is 0.529,that is,when AASI≥0.529,the possibility of HFp EF in hypertensive patients is higher,and the sensitivity and specificity of predicting its occurrence are 0.679 respectively.And 0.673.Conclusion1、AASI can predict the occurrence of HFPEF in patients with hypertension.The cutoff value of AASI is 0.529,and the sensitivity and specificity of predicting the occurrence of HFPEF in patients with hypertension are 0.679 and 0.673,respectively.2、AASI is related to the severity of cardiac insufficiency and Myocardial hypertrophy in patients with hypertension and HFp EF.