The Study On The Relationship Between Brachial-ankle Pulse Wave Velocity And Aortic Valve Sclerosis In Elderly Hypertensive Patients

Objectives: With the acceleration of the global population aging process,the incidence of calcific aortic valve disease(CAVD)increased year by year.Aortic valve sclerosis(AVS)as the early pathology of CAVD,its impact on human health has become increasingly prominent.It is common for elderly hypertensive patients complicated with AVS.However,there have been few reports on the risk factors in elderly hypertensive patients with AVS.Previous studies showed that AVS may be similar to the pathological process and risk factors of atherosclerosis.Brachial-ankle pulse wave velocity(ba PWV)is a classic index to evaluate the level of atherosclerosis,and it is important to evaluate the early diagnosis of atherosclerosis in hypertensive patients.However,so far for the studies on the correlation between ba PWV and AVS is unclear.The purpose of this study is to investigate the risk factors and echocardiographic features of elderly hypertensive patients complicated with AVS.Mean while,it is analyzed emphatically the relationship ba PWV and AVS in order to provide guidance for the prediction,prevention and clinical treatment of CAVD.Methods: 508 cases of elderly patients with hypertension who were ≥60 treated in Department cardiology of our hospital from January 2014 to November 2016.The diagnostic of AVS by Color Doppler echocardiography.The diagnostic criteria for AVS was aortic valve thickening,calcification,and the forward blood flow velocity was≤2.5cm/s.According to the results of the echocardiography,patients were divided into two groups:232 cases of AVS group and 276 cases of non-AVS group.Colected the clinical data,including basic information,biochemical indicator,ba PWV,ankle brachial index(ABI),echocardiographic index.To compare the differences of clinical data between AVS group and non-AVS group and to estimate the risk factors by Logistic regression model.Then on the base of theses,the paper further explored the relationship between ba PWV and AVS.Evaluation of ba PWV in the diagnosis of AVS by receiver operating characteristic curve Using ROC cure plotting obtained the best decisive threshold.Finally,the differences of cardiac structure and fuction between the two groups were compared.Results: 1.There was a significant differernce between the two groups in sex,age,systolic blood pressure,diastolic blood pressure,ba PWV,the number of ABI<1(P<0.05),after multivariate Logistic regression analysis,the independent risk factors of elderly hypertensive patients complicated with AVS includes male(OR=2.895,P<0.001),ba PWV(OR=2.207,P<0.001),age(OR=1.389,P=0.038),ABI(OR=0.695,P=0.043),SBP(OR=1.301,P=0.045).2.There was a significant difference in AVS incidence among elderly hypertensive patients in different peripheral arterial stiffness classifications(χ2=38.451,P<0.001).The incidences of AVS of mild peripheral arteriosclerosis group and peripheral arteriosclerosis group were statistically higher than that of normal peripheral arterial stiffness group,respectively,meanwhile incidence of AVS of peripheral arteriosclerosis group was statistically significantly higher than that of mild peripheral arteriosclerosis group(P<0.001).3.The ROC curves showed that ba PWV had certain value to predict the incidence of AVS in elderly hypertensive patients and the predictive value of male was higher than female.The AUC was 0.701(P<0.001)for male,the best critical point was 1676cm/s and the sensitivity and specificity were 0.664% and 0.679%,respectively.The AUC was 0.652(P<0.001)for female,the best critical point was 1719.5cm/s and the sensitivity and specificity were 0.699% and 0.540%,respectively.4.In elderly hypertensive patients,the E/e’ of the AVS group was higher than the non-AVS group both male and female.Among female,the Left ventricular end-diastolic dimension(LVEDd)and the left ventricular mass index(LVMI)in AVS group were significantly greater than the non-AVS group,meanwhile the left ventricular ejection fraction(LVEF)was apparently lower than the non-AVS group(P<0.05).Conclusions: 1.In elderly hypertensive patients,ba PWV is closely related to aortic valve sclerosis,moreover,ba PWV has some value in the assessment of aortic valve sclerosis.2.In elderly hypertensive patients,male,age,arterial stiffness increased and systolic blood pressure elevated are closely related to the development of aortic valve sclerosis.3.In elderly hypertensive patients,the detections of the aortic valve sclerosis are more likely to be complicated with left ventricular diastolic dysfunction,especially among female patients are prone to be complicated with left ventricular dilation,left ventricular hypertrophy,left ventricular systolic dysfunction.