Lee Wen-Hsien, Hsu Po-Chao, Chu Chun-Yuan, Chen Szu-Chia, Su Ho-Ming, Lin Tsung-Hsien, Lee Chee-Siong, Yen Hsueh-Wei, Voon Wen-Chol, Lai Wen-Ter, Sheu Sheng-Hsiung
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Am J Hypertens. 2014 Mar;27(3):454-9. doi: 10.1093/ajh/hpt228. Epub 2013 Dec 10.
Patients with chronic kidney disease (CKD) often have poor vascular compliance and poor left ventricular diastolic dysfunction (LVDD). The pulse pressure index (PPI) defined as ((systolic blood pressure - diastolic blood pressure)/systolic blood pressure) reflects vascular compliance. Vascular compliance is reportedly associated with left ventricular diastolic function. This study of CKD patients investigated whether PPI correlates with the ratio of transmitral E wave velocity (E) to early diastole mitral annulus velocity (Ea) or with LVDD.
This study enrolled 511 CKD patients who had been referred for echocardiographic examination. Blood pressure was automatically measured with an ABI-form device. The LVDD was defined as E-to-transmitral A wave velocity ratio of ≥0.9, Ea <8 cm/s, or E/Ea ≥15.
Compared with those with E/Ea <15, patients with E/Ea ≥15 had significantly higher systolic blood pressure, pulse pressure, and PPI (all P < 0.001). Multivariable analysis showed that PPI was independently associated with E/Ea (unstandardized coefficient β = 1.348; P < 0.001) and with LVDD (odds ratio = 1.441 per 0.064 increase; P < 0.001).
This study showed that increased PPI significantly correlates with elevated E/Ea and LVDD in CKD patients. Because PPI can be rapidly acquired during blood pressure measurement, it may be helpful for identifying CKD patients with a high left ventricular filling pressure and LVDD.
慢性肾脏病（CKD）患者常存在血管顺应性差和左心室舒张功能障碍（LVDD）。脉压指数（PPI）定义为（收缩压 - 舒张压）/收缩压，反映血管顺应性。据报道，血管顺应性与左心室舒张功能相关。本研究对CKD患者进行调查，以探究PPI是否与二尖瓣E波速度（E）与舒张早期二尖瓣环速度（Ea）之比或LVDD相关。
本研究纳入了511例因超声心动图检查而转诊的CKD患者。使用ABI型设备自动测量血压。LVDD定义为E与二尖瓣A波速度之比≥0.9、Ea <8 cm/s或E/Ea≥15。
与E/Ea <15的患者相比，E/Ea≥15的患者收缩压、脉压和PPI显著更高（均P <0.001）。多变量分析显示，PPI与E/Ea独立相关（非标准化系数β = 1.348；P <0.001），与LVDD也独立相关（每增加0.064，比值比 = 1.441；P <0.001）。
本研究表明，CKD患者中PPI升高与E/Ea升高和LVDD显著相关。由于PPI可在血压测量过程中快速获得，它可能有助于识别左心室充盈压高和LVDD的CKD患者。
