Clinical Significance And Related Factors Of Left Ventricular End-diastolic Pressure In Patients With Unstable Angina

Background: According to the epidemiological investigation and analysis,the incidence of cardiovascular disease in China goes up year by year,especially in the elderly population holds a high proportion of risk factors,in recent years,it also has become a younger trend for the past few years.So far,one of the major diseases threatening human health is Coronary Heart Disease(CHD).The occurrence of CHD is the basis of coronary artery atherosclerosis.With the gradual progress of atherosclerosis,coronary artery lumen stenosis or occlusion will gradually appear,then the myocyte ischemia hypoxia or necrosis occur,finally it makes the cardiac function decline and causes a corresponding complications.Coronary artery stenosis reduces the blood flow of myocardial in diastolic,myocardial cell come up degeneration,atrophy or fibrosis with that,which lead to the decrease of the myocardial compliance,thus affected the diastolic function of heart.When serious stenosis or occlusion occurs,it can directly lead to ischemic necrosis of myocardial cells,then causes myocardial remodeling,such not only affects the myocardial diastolic function,but also can make the myocardial systolic function decline.Because the left ventricular diastolic function reduce in advance of the left ventricular systolic function in the process of the development of CHD,so the myocardial diastolic function may be a sensitive and significant index to reflect the overall heart function.Left Ventricular End-diastolic Pressure(LVEDP)is the best hemodynamic index that can reflect the heart capacity state,that can reflect sensitively and specifically the overall performance of the heart.Providing the evidence that can predict early reduction of cardiac function and guide the clinical medicine.In addition,we can find the related factors to LVEDP through the research.Control or intervention the related factors early,it can postpone the progress of CHD,and reduce the occurrence of cardiovascular events and improve the long-term prognosis of patients.Objective: To contrast the control group(Non-CHD)with unstable angina(UA)group,we want to know whether the LVEDP measured by the left cardiac catheterization is statistically different or not,and further confirm the clinical worth of LVEDP.The clinical data of LVEDP normal group and LVEDP elevation group are analyzed to find the risk factors associated with LVEDP.Material and Methods: This study enrolled 99 patients who met the selection criteria and underwent coronary angiography and left heart catheterization in the cardiology department of Qingdao municipal hospital from January 2017 to July 2017.We collected the related clinical data of these 99 patients,including gender,age,calculated their body mass index(BMI).We inquired their history of cigarette smoking,hypertension,diabetes mellitus,cerebral thrombosis and folks.Gathered the vital signs,especially resting heart rate(HRrest)and blood pressure(BP).We completed the relevant inspection of the laboratory before coronary artery intervention treatment,such as blood routine,total cholesterol(TC),low density lipoprotein(LDL),triglyceride(TG),high-density lipoprotein(HDL),lipoprotein(a),fasting blood glucose(Glu),myocardial marker,b-type brain natriuretic peptide(BNP),D-dimer(D-Di),creatinine(Cr),uric acid(UA),urine trace albumin(UMA),C-reactive protein(CRP)and other laboratory examination etc.We calculated the rate of glomerular filtration(e GFR)by medical calculator.An electrocardiogram was performed to calculate the Sokolow-Lyon index and the Cornell voltage QRS interval product.We calculated the left ventricular mass index(LVMI)and relative ventricular wall thickness(RWT)through the data detected by echocardiography.We also recorded the medication situation after admission to hospital.Meanwhile,we recorded the signs,left ventricular pressure curve and the condition of coronary artery disease in the process of coronary angiography and left ventricular catheterization,then calculateed the numberical value of LVEDP,GENSINI score and SYNTAX integration.Analyzing on the basis of these clinical data: The first Part: The above clinical information were divided into two parts: the first part: the total patients were fallen into two groups in accordance with above clinical data: group A: the matched group(Non-CHD group)was 49 cases,Group B: the UA group was 50 cases,then used the SPSS.22 to analyze whether the LVEDP was different statistically between the tow groups.At the same time,we analyzed whether there was a statistically significant difference between the two groups in the evaluation results of left ventricular diastolic function by cardiac ultrasound or not.The second part: we fallen the total patients into two groups in accordance with the value of LVEDP: group a: normal LVEDP group,the value of it was between 3 and 12 mm Hg.Group b: elevated LVEDP group,LVEDP>12mm Hg.Then,we used the SPSS.22 software to analysis the clinical dates in order to find the relevant factors of LVEDP.Results: 1.We compared the values of LVEDP in the control group and the UA group utilizing the Mann-Whitney U test of non-parametric test.The consequences showed P<0.05,indicating that the LVEDP values of the two groups were statistically different,meanwhile Z<0,indicating that the LVEDP of UA group was higher than the matched group.In addition,we used Chi-Square test to compare the left ventricular function assessed by cardiac ultrasound of this two groups,the result showed that the number of left ventricular diastolic function reduction of unstable angina group is more than NonCHD group,P<0.05,it meant there was a statistical difference of this two group.2.We contrasted all kinds of clinical data of the normal LVEDP group and the elevated LVEDP group.Part of the measurement data was examined by non-parametric MannWhitney U test,the result showed that the GENSINI score and the SYNTAX score contrast,P < 0.05,the statistical discrepancy of these two groups was verified,meanwhile Z < 0,that is mean the GENSINI score and the SYNTAX score of elevated LVEDP group was higher than LVEDP normal group.Examined between LVEDP and GENSINI score,SYNTAX integrate respectively through the bivariate correlation analysis.The consequences clued that the score of spearman correlation coefficient was 0.478 between LVEDP and GENSINI score,P<0.01,that clued a relativity between them.And the score of spearman correlation coefficient was 0.450 between LVEDP and SYNTAX integrate,P<0.01,that clued a relativity between them.Count data can adopted Chi-Square test to examine,showing that in the smoking history,P < 0.05,the statistical discrepancy of these two groups was verified,and the elevated LVEDP group was more than the normal LVEDP group.The test results of the others clinical data were P>0.05,showing that there is no difference of statistics between the two groups.Conclusion: 1.The left ventricular diastolic function has begun to reduce possibly in patients with UA,and LVEDP is of certain value in the assessment of diastolic function reduction.evaluable the function of left ventricular diastolic function.2.There is a correlation between the level of LVEDP and the severity of coronary artery lesions.3.Cigarette smoking may have a certain effect on the increase of LVEDP,but whether there is a correlation between them,it still needs to vertify.4.Elevated LVEDP group and normal LVEDP group is no significant differences in gender,age,BMI,medical history,family history,general laboratory index,left ventricular hypertrophy and coronary heart disease(CHD)class II prophylaxis.