| Background:Coronary heart disease(CHD),which results in angusty and occlusion of coronary vascular lumen,is due to coronary artery atherosclerosis.Its morbidity and mortality increase with age,and it is one of the main reasons why it affects the health problems of the more elderly people.Studies have found that frailty is strongly associated with the incidence and prognosis of coronary heart disease.As a common clinical geriatric syndrome,frailty is mainly manifested as a decrease in multidimensional cumulative physiological reserve capacity and an increase in vulnerability.Frailty can significantly increase the risk of cardiovascular disease in the elderly adults.Elderly patients with coronary heart disease combined with frailty are more likely to face adverse health consequences such as falls,disability,anergy,rehospitalization and even death.Therefore,early diagnosis of frailty is of great value to predict and improve the poor prognosis of elderly patients with coronary heart disease.Arteriosclerosis is another important factor affecting the occurrence and development of coronary heart disease,and it is extremely common in the elderly.It is typically characterized by increased stiffness and decreased elasticity of the vessel wall caused by abnormal arterial vascular structure and function.A large number of studies have shown that arteriosclerosis is one of the important independent risk factors for coronary heart disease,and its severity is closely related to the degree of coronary artery disease,and can predict the occurrence of coronary heart disease and long-term adverse events.Brachial-ankle Pulse Wave Velocity(ba PWV)and Ankle Brachial Index(ABI)are commonly used indicators to evaluate the degree of arteriosclerosis,which can effectively reflect the condition of arterial stiffness.They have the advantages of non-invasive,simple and economical.Previous studies have shown that both arteriosclerosis and frailty involve chronic inflammation,endothelial dysfunction and hormone imbalance.Clinical studies have confirmed that there is a correlation between atherosclerosis and frailty in elderly patients,and improving the degree of atherosclerosis is expected to become a new direction for the prevention and treatment of frailty.It can be seen that coronary heart disease,arteriosclerosis,and frailty interact with each other.When arteriosclerosis occurs,Interleukin-6(IL-6),Tumor Necrosis Factor-α(TNF-α),C-Reactive Protein(CRP)and other inflammatory factors would be up-regulated.On the one hand,it can promote the transport of lipoproteins in endothelial cells and deposition in the vessel wall,accelerating the progression of coronary atherosclerosis.On the other hand,it can act as a transmitter to induce cell senescence,resulting in the decline of multiple organ system function and subsequent frailty.However,there are still few clinical studies on arteriosclerosis and frailty,especially the effect of arteriosclerosis on frailty in elderly patients with coronary heart disease has not been deeply studied.Objective:To investigate the correlation between brachial-ankle pulse wave velocity(ba PWV)and ankle brachial index(ABI),non-invasive markers of arterosclerosis,and frailty in elderly patients with coronary heart disease,and to analyze the relationship and influence between them,so as to provide clinical basis for early identification and intervention of frailty disease in elderly patients which have coronary heart disease,and to improve the prognosis and quality of life of the population.Methods:A total of 156 patients with coronary heart disease aged ≥60 years who were admitted to the Department of Cardiology of The Second Hospital of Jilin University from August 2022 to December 2022 were selected for the study.The general information and clinical indicators were collected from patients.The Chinese version of Tilburg Frailty Indicator(TFI)was used to assess the frailty status of the enrolled patients.According to the score,the patients were classified into frailty group(TFI score ≥5)and non-frailty group(TFI score < 5).Both sides of bilateral ba PWV and ABI were measured by arteriosclerosis detector.The high value of ba PWV and the average value of ABI on the left and right sides of all patients were taken.First,the incidence rate of frailty in elderly patients with CHD was analyzed,and then the differences in general clinical information and biochemical indicators between the two groups were further compared,and then the differences in ba PWV and ABI levels between the frailty group and the non-frailty group were compared.Then the indicators with statistical differences in the above analysis were incorporated into the multivariate regression model,and binary multivariate Logistic regression was used to analyze the independent influencing factors of frailty in elderly patients with coronary heart disease.Finally,ROC curve was used to assess the predictive value of ba PWV,ABI and their combination diagnosis for frailty in elderly patients with CHD.SPSS 26.0 statistical software was used to analyze the data.The measurement data were expressed as (?)±S or M(P25,P75),and the differences between groups were compared by independent sample T test or rank sum test.Count data would be expressed as case number and constituent ratio [n(%)],and analyzed by χ~2test.P < 0.05 had statistical significance.Results:1.Frailty status in elderly patients with CHDA total of 156 elderly patients with CHD were collected in this study.The maximum TFI score was 9 points,the minimum score was 0 points,and the medial score was 5 points.There were 84 patients in the frailty group(TFI≥5 points)and72 patients in the non-frailty group(TFI < 5 points).The prevalence of frailty among the registered patients was 53.8%.2.Comparison of general clinical information and biochemical indicators between frailty group and non-frailty groupThe results showed that there were statistically significant differences in gender,NT-pro BNP,left ventricular ejection fraction,serum creatinine and total cholesterol among the frailty group and the non-frailty group(P<0.05).Age,Body Mass Index(BMI),smoking status,marital status,NYHA heart function classification,hypertension,diabetes mellitus,stroke,history of coronary stent implantation,myoglobin,troponin,triglyceride,blood urea nitrogen,fasting blood glucose,glomerular filtration rate,serum uric acid,low density lipoprotein cholesterol,high density lipoprotein cholesterol,homocysteine,total protein,and albumin in two There was no significant difference among the two groups(P>0.05).3.Effects of arteriosclerosis index and frailty among the elderly patients with coronary heart disease3.1 Univariate analysis of ba PWV and ABI levels and frailty in elderly patients with coronary heart diseaseThe average ba PWV was(1736.03±498.97)cm/s and the average ABI was(0.88±0.10)in the non-frailty group.The mean ba PWV was(1984.14±396.29)cm/s and the mean ABI was(0.81±0.11)in frailty group.Independent sample t test showed that ba PWV and ABI levels have significant difference among the two groups(P<0.05).Spearman correlation analysis illustrated that ba PWV and ABI were observablly correlated with TFI frailty indicator(P<0.001).All the results above were statistically significant.3.2 Multivariate analysis of ba PWV and ABI levels and frailty in elderly patients with coronary heart diseaseThe results showed that after adjusting for all factors,the risk of frailty in elderly patients with coronary heart disease increased with the rising of ba PWV(OR=3.389,P=0.008),while the risk of frailty increased with the decrease of ABI level,and the difference was statistically significant(OR=0.005,P= 0.009).4.The predictive value of ba PWV and ABI in frailty of elderly patients with coronary heart diseaseROC curve analysis showed that the area under the curve of ba PWV was 0.690,P < 0.05,95%CI(0.603,0.776).When ba PWV≥1746.50cm/s,the sensitivity and specificity of predicting frailty were 77.4% and 58.3%,respectively.The maximum Youden index was 0.357.The area under the curve of ABI for independently diagnosing frailty was 0.688,P < 0.05,95%CI(0.604,0.772).When ABI≤0.898,the sensitivity was 45.8%,the specificity was 85.7%,and the maximum Youden index was 0.315.The area under the curve of the combined diagnosis of frailty was0.738,P < 0.05,95%CI(0.658,0.818),the sensitivity was 83.3%,and the specificity was 58.3%.The maximum Youden index was 0.416,and the area under the curve and sensitivity of ba PWV combined with ABI in the diagnosis of frailty were improved.Conclusion:1.ba PWV is an independent risk factor for frailty of elderly patients with CHD.The higher the ba PWV,the higher the TFI frailty score.ABI is an independent protective factor for frailty in elderly patients with CHD,and the lower the ABI level,the higher the TFI frailty score.2.Both ba PWV and ABI have predictive value in the diagnosis of frailty in elderly patients with CHD,and the combined diagnosis of bap WV and ABI has the better predictive value. |
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