J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 5, May 2017, pages 439-445

Cardio-Ankle Vascular Index and C-Reactive Protein Are Useful Parameters for Identification of Ischemic Heart Disease in Acute Heart Failure Patients

Figure 1. (a) Receiver operating curve of CRP for detection of the IHD group. The cut-point value was 1.7. AUC and 95% CI were 0.625 and 0.461 - 0.79, respectively. (b) Receiver operating curve of CAVI for detection of the IHD group. The cut-point value was 9.25. AUC and 95% CI were 0.752 and 0.615 - 0.89, respectively.

Figure 2. (a) The CRP plus CAVI in IHD group was significantly higher than in non-IHD group (11.09 ± 2.45 vs. 8.20 ± 1.85, P < 0.001). (b) Receiver operating curve of CAVI plus CRP for detection of the IHD group. The cut-point value was 9.00. AUC and 95% CI were 0.839 and 0.719 - 0.959, respectively.

**Table 1.** Clinical Profiles Between Both Groups
	IHD group (n = 19)	Non-IHD group (n = 34)	P value
sBP: systolic blood pressure; dBP: diastolic blood pressure; NYHA: New York Heart Association; IHD: ischemic heart disease; RAS-I: renin-angiotensin-aldosterone system inhibitor; CCB: calcium channel blocker; statin: HMG-CoA reductase inhibitor. Continuous data were expressed as mean ± standard deviation. P values were determined by unpaired Student’s t-test.
Age (years)	67.9 ± 10.0	65.7 ± 11.4	n.s.
Gender (male/female)	13/6	23/11	n.s.
sBP (mm Hg)	135.3 ± 23.4	153.5 ± 42.1	n.s.
dBP (mm Hg)	80.5 ± 15.0	78.4 ± 20.7	n.s.
Heart rate (bpm)	93.8 ± 28.5	93.9 ± 25.0	n.s.
NYHA I/II/III/IV	0/1/8/11	0/3/20/10	n.s
Hypertension (n, %)	9 (47.4%)	19 (55.9%)	n.s.
Diabetes mellitus (n, %)	8 (42.1%)	4 (11.8%)	0.005
Dyslipidemia (n, %)	5 (26.3%)	4 (11.8%)	n.s.
Smoking (n, %)	7 (36.8%)	12 (35.3%)	n.s.
Family history of IHD (n, %)	0 (0%)	2 (5.9%)	n.s.
RAS-inhibitor	4 (21.0%)	13 (38.2%)	n.s.
CCB	5 (26.3%)	6 (17.6%)	n.s.
β-blocker	2 (10.5%)	5 (14.7%)	n.s.
α-blocker	0 (0%)	1 (2.9%)	n.s.
Statin	4 (21.0%)	4 (11.8%)	n.s.
Glucose lowering drugs	5 (26.3%)	2 (5.9%)	n.s.

Table 1. Clinical Profiles Between Both Groups

IHD group (n = 19)

Non-IHD group (n = 34)

P value

sBP: systolic blood pressure; dBP: diastolic blood pressure; NYHA: New York Heart Association; IHD: ischemic heart disease; RAS-I: renin-angiotensin-aldosterone system inhibitor; CCB: calcium channel blocker; statin: HMG-CoA reductase inhibitor. Continuous data were expressed as mean ± standard deviation. P values were determined by unpaired Student’s t-test.

Age (years)

67.9 ± 10.0

65.7 ± 11.4

n.s.

Gender (male/female)

13/6

23/11

n.s.

sBP (mm Hg)

135.3 ± 23.4

153.5 ± 42.1

n.s.

dBP (mm Hg)

80.5 ± 15.0

78.4 ± 20.7

n.s.

Heart rate (bpm)

93.8 ± 28.5

93.9 ± 25.0

n.s.

NYHA I/II/III/IV

0/1/8/11

0/3/20/10

n.s

Hypertension (n, %)

9 (47.4%)

19 (55.9%)

n.s.

Diabetes mellitus (n, %)

8 (42.1%)

4 (11.8%)

0.005

Dyslipidemia (n, %)

5 (26.3%)

4 (11.8%)

n.s.

Smoking (n, %)

7 (36.8%)

12 (35.3%)

n.s.

Family history of IHD (n, %)

0 (0%)

2 (5.9%)

n.s.

RAS-inhibitor

4 (21.0%)

13 (38.2%)

n.s.

CCB

5 (26.3%)

6 (17.6%)

n.s.

β-blocker

2 (10.5%)

5 (14.7%)

n.s.

α-blocker

0 (0%)

1 (2.9%)

n.s.

Statin

4 (21.0%)

4 (11.8%)

n.s.

Glucose lowering drugs

5 (26.3%)

2 (5.9%)

n.s.

**Table 2.** Laboratory Findings Between Both Groups
	IHD group (n = 19)	Non-IHD group (n = 34)	P value
BUN: blood urea nitrogen; AST: aspartate transaminase; ALT: aspartate aminotransferase; LCH: lactate dehydrogenase; LDL: low-density lipoprotein-cholesterol; HDL: high-density lipoprotein-cholesterol; FBS: fasting blood glucose; HbA1c: hemoglobin A1c; CK: creatine kinase; CK-MB: CK muscle and brain; BNP: B-type natriuretic peptide. Continuous data were expressed as mean ± standard deviation. P values were determined by unpaired Student’s t-test.
C-reactive protein (mg/dL)	1.5 ± 2.1	0.4 ± 0.4	< 0.001
Albumin (mg/dL)	3.7 ± 0.5	3.8 ± 0.5	n.s
Total bilirubin (mg/dL)	1.1 ± 0.6	1.0 ± 0.4	n.s
BUN (mg/dL)	19.5 ± 5.3	20.8 ± 5.0	n.s
Creatinine (mg/dL)	0.91 ± 0.26	1.01 ± 0.30	n.s
AST (mg/dL)	48.2 ± 45.8	45.7 ± 40.7	n.s
ALT (mg/dL)	43.3 ± 52.4	38.8 ± 37.4	n.s
LDH (mg/dL)	296.4 ± 86.8	297.3 ± 97.3	n.s
Total cholesterol (mg/dL)	188.3 ± 31.5	191.6 ± 46.2	n.s
Triglyceride (mg/dL)	97.6 ± 44.2	85.6 ± 31.0	n.s
HDL (mg/dL)	53.0 ± 15.8	60.4 ± 17.2	n.s
LDL (mg/dL)	115.8 ± 27.6	114.0 ± 43.3	n.s
Non-HDL (mg/dL)	135.3 ± 29.1	131.2 ± 46.4	n.s
FBS (mg/dL)	163.9 ± 78.2	158.3 ± 101.1	n.s
HbA1c (JDS: %)	6.61 ± 1.74	6.04 ± 1.97	n.s
CK (mg/dL)	121.3 ± 100.5	126.7 ± 93.8	n.s
CK-MB (mg/dL)	14.1 ± 9.2	14.8 ± 6.7	n.s
Troponin I (mg/dL)	0.14 ± 0.267	0.08 ± 0.13	n.s
BNP (mg/dL)	1,471.4 ± 2,586.7	1,188.4 ± 1,375.1	n.s

Table 2. Laboratory Findings Between Both Groups

IHD group (n = 19)

Non-IHD group (n = 34)

P value

BUN: blood urea nitrogen; AST: aspartate transaminase; ALT: aspartate aminotransferase; LCH: lactate dehydrogenase; LDL: low-density lipoprotein-cholesterol; HDL: high-density lipoprotein-cholesterol; FBS: fasting blood glucose; HbA1c: hemoglobin A1c; CK: creatine kinase; CK-MB: CK muscle and brain; BNP: B-type natriuretic peptide. Continuous data were expressed as mean ± standard deviation. P values were determined by unpaired Student’s t-test.

C-reactive protein (mg/dL)

1.5 ± 2.1

0.4 ± 0.4

< 0.001

Albumin (mg/dL)

3.7 ± 0.5

3.8 ± 0.5

n.s

Total bilirubin (mg/dL)

1.1 ± 0.6

1.0 ± 0.4

n.s

BUN (mg/dL)

19.5 ± 5.3

20.8 ± 5.0

n.s

Creatinine (mg/dL)

0.91 ± 0.26

1.01 ± 0.30

n.s

AST (mg/dL)

48.2 ± 45.8

45.7 ± 40.7

n.s

ALT (mg/dL)

43.3 ± 52.4

38.8 ± 37.4

n.s

LDH (mg/dL)

296.4 ± 86.8

297.3 ± 97.3

n.s

Total cholesterol (mg/dL)

188.3 ± 31.5

191.6 ± 46.2

n.s

Triglyceride (mg/dL)

97.6 ± 44.2

85.6 ± 31.0

n.s

HDL (mg/dL)

53.0 ± 15.8

60.4 ± 17.2

n.s

LDL (mg/dL)

115.8 ± 27.6

114.0 ± 43.3

n.s

Non-HDL (mg/dL)

135.3 ± 29.1

131.2 ± 46.4

n.s

FBS (mg/dL)

163.9 ± 78.2

158.3 ± 101.1

n.s

HbA1c (JDS: %)

6.61 ± 1.74

6.04 ± 1.97

n.s

CK (mg/dL)

121.3 ± 100.5

126.7 ± 93.8

n.s

CK-MB (mg/dL)

14.1 ± 9.2

14.8 ± 6.7

n.s

Troponin I (mg/dL)

0.14 ± 0.267

0.08 ± 0.13

n.s

BNP (mg/dL)

1,471.4 ± 2,586.7

1,188.4 ± 1,375.1

n.s

**Table 3.** CAVI and Echocardiographic Findings Between Both Groups
	IHD group (n = 19)	Non-IHD group (n = 34)	P value
CAVI: cardio-ankle vascular index; ABI: ankle brachial index. Continuous data were expressed as mean ± standard deviation. P values were determined by unpaired Student’s t-test.
CAVI	9.58 ± 17.3	7.83 ± 1.86	0.001
ABI: right	1.08 ± 0.11	1.11 ± 0.15	n.s.
ABI: left	1.10 ± 0.08	1.11 ± 0.15	n.s.
Left ventricular diastolic diameter (mm)	55.2 ± 8.3	57.4 ± 11.8	n.s.
Left ventricular systolic diameter (mm)	41.8 ± 10.6	43.4 ± 11.0	n.s.
Ejection fraction (%)	47.6 ± 16.4	46.6 ± 18.8	n.s.

Table 3. CAVI and Echocardiographic Findings Between Both Groups

IHD group (n = 19)

Non-IHD group (n = 34)

P value

CAVI: cardio-ankle vascular index; ABI: ankle brachial index. Continuous data were expressed as mean ± standard deviation. P values were determined by unpaired Student’s t-test.

CAVI

9.58 ± 17.3

7.83 ± 1.86

0.001

ABI: right

1.08 ± 0.11

1.11 ± 0.15

n.s.

ABI: left

1.10 ± 0.08

1.11 ± 0.15

n.s.

Left ventricular diastolic diameter (mm)

55.2 ± 8.3

57.4 ± 11.8

n.s.

Left ventricular systolic diameter (mm)

41.8 ± 10.6

43.4 ± 11.0

n.s.

Ejection fraction (%)

47.6 ± 16.4

46.6 ± 18.8

n.s.