Clinical Application Research Of ECG R-wave Pulse Wave Index(ERPWI) In The Detection Of Atherosclerosis

Objective:The ECG R-wave pulse wave velocity(ERPWV)was measured by ECG monitor.On this basis,the elastic index formula of blood vessels was introduced to calculate the ECG R-wave pulse wave conduction index.The accuracy and practicability of the ECG R-wave pulse wave conduction index in the diagnosis of carotid atherosclerosis were discussed.Methods:1.846 eligible volunteers were screened from the physical examination population in hospital from July 2016 to July 2018.ECG signals(R wave in ECG)and peak or trough of pulse oxygen wave were collected synchronously by ECG monitor to obtain ECG R-wave-gated photoplethysmography time(ERWPTT),then the ERPWI is calculated by formula.2.Pulse wave velocity is greatly influenced by blood pressure,so we choose ECG R-wave pulse wave index(ERPWI),an intrinsic stiffness index of blood vessels independent of blood pressure,that is,the elasticity index of blood vessels(“β”),to evaluate the degree of arteriosclerosis,and set the elasticity index of blood vessels derived from R-wave pulse wave velocity as ECG R-wave elasticity index,so β =ERPWI.3.The relationship between ERPWV and ERPWI and systolic and diastolic blood pressure was compared by scatter plot.We examined carotid atherosclerosis by color Doppler ultrasound and compared the results with ECG R-wave pulse wave index(ERPWI)to analyzed the sensitivity,specificity,area under curve and critical value of ERPWI in the diagnosis of atherosclerosis,so as to explored the threshold value of ERPWI in the diagnosis of peripheral arterial disease.Results:1.Compared with ERPWV,blood pressure has less influence on ERPWI;ERPWI has a significant correlation with atherosclerosis.When ERPWI equals or exceeds 0.505,carotid atherosclerosis can be diagnosed.ERPWI is a good indicator for carotid atherosclerosis.2.The ERPWI values of carotid atherosclerosis group and normal group were tested by independent sample t test.The statistical results showed that the ERPWI values of normal group and carotid atherosclerosis group were “0.46±0.05 ”and“ 0.53 ± 0.06 ”respectively,which showed a significant difference between the two groups(P < 0.001).The results of ROC curve analysis show that the area under ERPWI curve is larger than 0.5,(P < 0.001).The Yoden index of ERPWI is 0.523,and the corresponding value of ERPWI is 0.505 which can be used as the critical value of carotid atherosclerosis.When value of ERPWI equals or exceeds0.505,carotid atherosclerosis can be diagnosed,and the corresponding sensitivity and specificity were 0.669 and 0.854 respectively.3.The univariate analysis of ERPWI and common cardiovascular risk factors showed that age,systolic blood pressure,body mass index,fasting blood glucose,triglyceride,non-alcoholic fatty liver disease,creatinine and homocysteine were positively correlated with ERPWI in men(P < 0.05);while in women,age,systolic blood pressure,diastolic blood pressure,fasting blood sugar,uric acid,serum cholesterol,low density lipoprotein,triglyceride,non-alcoholic fatty liver disease,homocysteine were positively correlated with ERPWI.but creatinine was negatively correlated with ERPWI.In the general population,ERPWI was positively correlated with gender,age,systolic blood pressure,diastolic blood pressure,fasting blood sugar,uric acid,serum cholesterol,low density lipoprotein,triglyceride,non-alcoholic fatty liver disease and homocysteine(P < 0.05),while high density lipoprotein and creatinine were negatively correlated(P < 0.05).Multivariate linear stepwise regression model showed that systolic blood pressure,age,homocysteine,creatinine,non-alcoholic fatty liver and triglyceride were independent risk factors for the increase of ERPWI in males,while systolic blood pressure,age,homocysteine,creatinine and triglyceride were closely related to ERPWI in females(P < 0.05),which were independent risk factors for the increase of ERPWI in females.In general,male,systolic blood pressure,age,homocysteine,creatinine,nonalcoholic fatty liver disease and fasting blood sugar were independent risk factors for ERPWI elevation(i.e.arteriosclerosis),while diastolic blood pressure 、 female 、BMI is protective factors.Conclusion:1.EPRWI has a significant correlation with atherosclerosis.ERPWI(> 0.505)is the standard for the diagnosis of carotid atherosclerosis."ERPWI ≥0.505 ”can be used as a diagnostic threshold for carotid atherosclerosis,and ERPWI can be used as a reference index for the diagnosis of carotid atherosclerosis.2.Male,systolic blood pressure,age,homocysteine,creatinine,non-alcoholic fatty liver and fasting blood sugar are independent risk factors for the increase of ERPWI,while diastolic blood pressure、female 、BMI are the protective factors for ERPWI.