| Objective: Coronary artery heart disease (CAD) is a kind of heart disease, which is caused by myocardial ischemia (angina) or myocardial necrosis (myocardial infarction), due to organic coronary artery (atherosclerosis or vasospasm power) stenosis or obstruction of atherosclerosis or vasospasm. With the increase in its incidence and mortality, coronary heart disease has become one of the most serious diseases threatening people's health in our country. Recent years have witnessed the wide application of non-invasive equipment to predict coronary heart disease. Through the detection on intima-media thickness(IMT) of carotid, Flow - mediated dilation (FMD), Brahial-ankle pulse wave velocity(baPWV) by the use of non-invasive method such as high-resolution two-dimensional ultrasound, this study aims at evaluating the relevance between the carotid IMT,brachial artery FMD,baPWV and CAD, and thus analyzing the correlation between the carotid IMT with brachial artery FMD and baPWV.Methods:Inpatients of cardiology in our hospital from January 2008 to January 2009, (a total of 98 cases),were taken as the subjects of this study. All patients were confirmed by coronary angiography, among which the patients, with at least one coronary artery diameter stenosis≥50%, were defined as a coronary heart disease group (a total of 83 cases). According to the number of coronary artery disease, they were divided into a vascular lesion group (20 cases), 2 vascular lesion group (25 cases) and multi-vessel disease group (38 cases). The normal ones of coronary angiography were regarded as the control group (a total of 15 cases). Ultrasound equipment of PHILIPS HDI 5000,IU22 were used to measure IMT,FMD of the coronary artery heart disease groups and the control group. Also, in this research, atherosclerosis automatic detection manufactured by Colin JAPAN VP-1000 was used to detect brachial - ankle pulse wave velocity (baPWV) and, in addition, to compare the data.Results:1 There was no statistically significant difference (P﹥0.05) as to the comparison of the age, gender composition, body mass index, systolic blood pressure, diastolic blood pressure, pulse pressure, total cholesterol, triglyceride, fasting blood glucose between the control group and coronary heart disease groups.2 Comparison of IMT: The mean value of IMT in the control group was 0.74±0.08mm,while that in coronary heart disease group was 0.79±0.14mm. So the mean value of IMT in CAD group was greatly larger than that in the control group with statistically significant difference (P﹤0.01). IMT of 2 vessel lesion group or multi-vessel lesion group was significantly higher than that of the control group(P﹤0.01). IMT of one vessel lesion group was not significantly different from that of the control group(P﹥0.05).3 Comparison of FMD: The FMD of Control group was (10.89±3.23)%, and it was(5.62±2.81)% of coronary heart disease group, so that FMD in CAD group was significantly greater than that in the control group with significant differences(P﹤0.01). FMD in 2 vascular lesion group and multi-vessel lesion group was smaller than that in the control group with significant differences(P<0.01). There was no significant differences (P>0.05)due to the fact that FMD in a vascular lesion group was smaller than that in the control group.4 Comparison of baPWV : The baPWV in the control group was (1495±135cm/s), while in coronary heart disease group, it was (1694.36±211.51cm/s). Consequently, baPWV in CAD group was greater than that in the control group(P<0.01), and 2 lesion group and multi-vessel disease groups were greater than that in the control group. As a result, there were significant differences(P<0.01). There was increasing trend of baPWV in a lesion group than in the control group,but there was no significant difference(P>0.05).5 The prediction for Carotid IMT of coronary heart disease:By the ROC curve expression of the prediction of coronary heart disease by carotid IMT, and drawing ROC curve (Fig 1),the area of the curve(AUC)was 0.729±0.057,P=0.005, and AUC95% confidence interval was(0.617,0.840. The confidence interval does not include 0.5,illustrating that the carotid IMT's predicting coronary ROC curves had a statistical significance.6 The prediction for brachial artery FMD of coronary heart disease: By the use of the ROC curve expression of prediction coronary heart disease by brachial artery FMD, and drawing ROC curves (Fig 2, the area of the curve(AUC) was 0.916±0.029,P<0.001, and AUC95% confidence interval was (0.859,0.973. The confidence interval does not include 0.5,showing that the brachial artery FMD diagnostic coronary ROC curves had a statistical significance.7 The prediction for baPWV of coronary heart disease: By the use of the ROC curve expression of prediction coronary heart disease by baPWV, and drawing ROC curves (Fig 2), the area of the curve(AUC) was 0.785±0.055,P<0.001, and AUC95% confidence interval was ( 0.677,0.893 ) . The confidence interval does not include 0.5,which means that the baPWV diagnostic coronary ROC curves had a statistical significance.8 The prediction value to coronary heart disease from carotid IMT, brachial artery FMD and baPWV at the best critical point: From the ROC curve, it can be seen that at the point of IMT=0.82mm, the sensitivity was 66.3%, 1-specificity was 20%, and Youden index was 0.463. In the study, carotid IMT≥0.82mm is the most appropriate point to predict coronary heart disease. In the FMD curve,the furthest point from the control slash was FMD=8.4%,with that the sensitivity was 78.3%,1-specificity was 13.3%,and Youden ndex was 0.65. In the study, brachial artery FMD≤8.4% was the most appropriate point to predict coronary heart disease. In the baPWV curve,the furthest point from the control slash was baPWV=1502cm/s , with the sensitivity of 73.5% , and 1-specificity of 22.6%. In the study baPWV≥1502cm/s was the most appropriate point predict of coronary heart disease.9 The straight line correlation analysis was made between FMD, baPWV and IMT in all examiners, with a result that baPWV had the positive correlation with IMT(r=0.519,P<0.01), and FMD had negative correlation with IMT (r=-0.647,P<0.01).Conclusion:1 As to patients with coronary heart disease, the more severe coronary artery disease is, the thicker the carotid artery is.2 As to patients with coronary heart disease, the severity of coronary artery disease has a negative correlation with FMD, that is, the more serious the degree of coronary artery disease is, and the smaller FMD is.3 As to patients with coronary heart disease, the more serious coronary artery disease is, the greater baPWV is, and the poorer the arterial elastic is.4 The prediction to coronary heart disease by Carotid IMT, brachial artery FMD, baPWV by the use of drawing ROC curve have all proved that the ROC curve of diagnosis of coronary heart disease by using carotid IMT, brachial artery FMD, and baPWV has statistical significance.5 The best critical point of IMT, FMD and baPWV to predict coronary heart disease has important clinical value.6 FMD and IMT has negative correlation. The lower FMD is, the thicker IMT is; and baPWV and IMT has positive correlation. The larger baPWV is, the thicker IMT is.
|
PDF Full Text Request