The Analysis Of Correlation Between The Arterial Pulse Pressure And Spiral CT Cardiac Morphological Changes And Cardiac Valve Calcification Of Maintenance Hemodialysis Patients

Objective:Through the observation of the effect of pulse pressure(PP)on cardiac morphological changes and valve calcification of maintenance hemodialysis(MHD)patients in Chengde Central Hospital to investigate the correlation between PP and cardiac morphological changes and valve calcification under flat-scan of Multi-slice spiral CT(MSCT)in MHD patients,facilitate appropriate interventions to reduce the incidence of cardiovascular complications and improve the prognosis of MHD patients.Methods:Patients who underwent MHD treatment in Chengde Central Hospital from June 2021 to November 2022 were selected for the study.The patients’age were≥18 years old;dialysis age was≥6 months,and 1day≤the time between performing chest CT scan and dialysis≤3 days.We collected:I.basic patient information:gender,primary disease,presence of diabetes,age,dialysis age,systolic blood pressure,diastolic blood pressure,etc.;II.The items collected from MHD patients for regular review every 1-3 months,mainly were peripheral venous blood tests with a fasting period of 8 hours or more before dialysis,mainly as follows:C-reaction protein(CRP),Phosphorus(P),Calcium(Ca),Blood urea nitrogen(BUN),Ferritin(FER),serum creatinine(Scr),total cholesterol(TC),triglyceride(TG),Low density lipoprotein cholesterol(LDL-C),25-hydroxyvitamin D(25(OH)D),Hemoglobin(Hb),Albumin(ALB),Intact Parathyroid hormone(IPTH),etc;III.Items measured on the MSCT plain tomogram according to the standard method,including the CT-Cardiothoracic ratio(CT-CTR),CT-left atrial left and right diameter(CT-LARLD),CT-Left atrial anteroposterior diameter(CT-LAAPD),CT-Left ventricular end-diastolic anteroposterior diameter(CT-LAAPD),cardiac valves with or without calcifications,etc.In this retrospective study,PP was grouped into 4 groups according to PP<40mm Hg,40 mm Hg(40)～,60 mm Hg(60)～,and 80 mm Hg(80)～.Univariate analysis(ANOVA analysis)was performed between groups.The presence or absence of correlation and the magnitude of correlation strength.The presence and absence of heart valve calcification were divided into two groups,and the relevant factors were included in the binary logistic regression analysis using independent samples t test or nonparametric rank sum test between groups to observe the effect of PP on valve calcification.Results:1.Comparison of selected cases and general dataA total of 141 MHD patients cases(76 males and 65 females)were used in the study.The mean age was(63.15±10.61)years,the mean hemodialysis time was(48.80±19.58)months,and the mean PP value was(68.85±13.56)mm Hg.Valve calcification group(77 cases)and non-valve calcification group(64 cases).The prevalence of cardiac valve calcification was 54.61%.The prevalence of aortic valve calcification and mitral valve calcification was 44.68%and 31.91%,respectively.The prevalence of aortic valve calcification and mitral valve calcification was 21.99%.There was no statistically significant difference in terms of primary disease,gender,and the presence or absence of diabetes between the groups with different PP(P>0.05).There were no statistically significant differences in age,gender,age of dialysis,diabetes mellitus and primary disease between calcification group and non-calcification group(P>0.05).There were no significant differences in Hb,Scr,Ca,P,FER,i PTH,LDL-C among MHD patients with different PP levels(P>0.05).There were significant differences in age,dialysis age,systolic blood pressure,diastolic blood pressure,ALB,CRP.TG,TC and 25(OH)D(P>0.05).The correlation between PP and the basic data of patients and the significant biochemical indexes was analyzed.The results showed that PP values were positively correlated with age,dialysis age,systolic blood pressure,TG,TC and CRP(P>0.05),and negatively correlated with 25(OH)D(P<0.05).2.The correlations between PP values and cardiac chamber diameterThere were significant differences in CT-LARLD,CT-LAAPD,CT-LVEDD and CT-CTR among the MHD patients with different PP levels(P<0.05).Pearson correlation analysis showed that PP values were positively correlated with CT-LARLD(r=0.387,P<0.001),CT-LVEDD(r=0.307,P<0.001),CT-LAAPD(r=0.220,P=0.009)and CT-CTR(r=0.683,P<0.001)in the MHD patients.3.MHD cardiac valve calcification group compared with non-cardiac valve calcification groupThere were significant differences in the systolic blood pressure,PP,P,ALB,TG,TC,CRP,CT-LARLD and CT-CTR between the two groups of patients(P<0.05).Spearman rank correlation analysis of CT-LARLD,CT-CTR and cardiac valve calcification:with PP(r_s=0.498,P<0.001),with CT-LARLD(r_s=0.192,P=0.023),with CT-CTR(r_s=0.504,P<0.001).4.Binary Logistic regression analysis to analyze the cardiac valve alcificationThe presence or absence of cardiac valve calcification was used as a dichotomous variable.The variables with statistical significance between the two groups and serum calcium were included in the single factor Logistic regression analysis.The results showed that the values of PP,P,TG,TC,CRP,CT-LARLD,CT-CTR were the risk factors of cardiac valve calcification for the MHD patients.The increased ALB level is a protective factor for valve calcification in MHD patients.Multiple Logistic regression analysis suggested that PP and TG were independent risk factors for valve calcification.Conclusions:1 The values of PP were positively correlated with the values of CT-LARLD,CT-LAAPD,CT-LVEDD and CT-CTR in the MHD patients.2 The values of PP were positively correlated with cardiac valves calcification in the MHD patients and it was an independent risk factor for cardiac valve calcification.3 The levels of CT-LARLD and CTR in the MHD patients with calcification were higher than those without calcification.