Diagnostic performance of whole blood viscosity indices in predicting the presence and severity of coronary artery disease

Year 2024, , 48 - 56, 29.02.2024

Ahmet Kıvrak , Alp Yıldırım

https://doi.org/10.47582/jompac.1424294

Abstract

Aims: Growing evidence suggests that blood viscosity plays a crucial role in both the development and acceleration of atherosclerosis. In this study, aimed to investigate the diagnostic performance of the mean platelet volume-age-total protein-hematocrit (MAPH) score, a new index for blood viscosity, in predicting the presence and severity of CAD in patients with suspected coronary artery disease (CAD).
Methods: We retrospectively evaluated 431 patients who underwent coronary angiography. SYNTAX score (SS) were divided into 3 groups; low group (<22), intermediate group (22-32) and, high group (≥32). Low (LSR) and and high (HSR) shear rates were derived using values of total protein and hematocrit. The MAPH score was calculated based on the threshold values of mean platelet volume, age, total protein, and hematocrit for predicting CAD.
Results: The median LSR (60.7 vs. 43.1, p<0.001), mean HSR (17.3±1.3 vs. 16.2±1.2, p<0.001), and mean MAPH score (2.7±0.8 vs. 1.6±0.5, p<0.001) were higher in the CAD group compared to the non-CAD group. These indices of blood viscosity were found to be higher in the intermediate-high SS group compared to the low SS group. The threshold value of MAPH score for predicting CAD was >2 (sensitivity=78.2%, specificity=70.0%). It also had a graduated threshold value (>3, sensitivity=71.1%, specificity=62.5%) in distinguishing intermediate-high SS than low SS groups. In predicting both the presence and severity of CAD, the MAPH score exhibited superior diagnostic performance relative to the levels of LSR and HSR.
Conclusion: In patients with suspected CAD, a gradual increase in the MAPH score demonstrated significant diagnostic performance in distinguishing both the presence and severity of CAD. In these patients, the MAPH score may serve as a potential screening tool and can be utilized for risk stratification.

Keywords

Blood viscosity, coronary artery disease, MAPH score, microcirculation, SYNTAX score

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Diskapi Yildirim Beyazit Training and Research Hospital Clinical Research Ethics Committee.

Project Number

Date: 12.09.2022, Decision No: 146/03

Koronari arter hastalığının varlığını ve şiddetini tahmin etmede tam kan viskozite indekslerinin tanısal performansı

Abstract

Amaç: Artan kanıtlar, kan viskozitesinin aterosklerozun hem gelişiminde hem de hızlanmasında önemli bir rol oynadığını göstermektedir. Bu çalışmada, şüpheli KAH'li hastalarda KAH'ın varlığını ve şiddetini tahmin etmede MAPH skorunun, yeni bir kan viskozitesi indeksi olan tanısal performansını incelemeyi amaçladık.
Metot: Koroner anjiyografi geçiren 431 hasta retrospektif olarak değerlendirildi. SYNTAX skoru (SS), 3 gruba ayrıldı; düşük grup (<22), orta grup (22-32) ve yüksek grup (≥32). HSR ve LSR, total protein ve hematokrit değerleri kullanılarak türetilmiştir. MAPH skoru, KAH'ı tahmin etmek için yaş, ortalama trombosit hacmi, total protein ve hematokritin eşik değerleri temel alınarak hesaplandı.
Bulgular: KAH grubunda, KAH olmayan gruba göre medyan LSR (60.7'ye karşı 43.1, p<0.001), ortalama HSR (16.2±1.2'ye karşı 17.3±1.3, p<0.001) ve ortalama MAPH skoru (1.6±0.5'e karşı 2.7±0.8, p<0.001) daha yüksekti. Kan viskozitesi indeksleri, düşük SS grubuna kıyasla orta-yüksek SS grubunda daha yüksek bulundu. KAH'ı tahmin etmek için MAPH skorunun eşik değeri >2 idi (duyarlılık=78.2%, özgüllük=70.0%). Ayrıca, düşük SS gruplarından orta-yüksek SS gruplarını ayırt etmede dereceli eşik değeri vardı (>3, duyarlılık=71.1%, özgüllük=62.5%). Hem KAH'ın varlığını hem de şiddetini tahmin etmede, MAPH skoru LSR ve HSR seviyelerine göre üstün tanısal performans sergiledi.
Sonuç: Şüpheli KAH'li hastalarda, MAPH skorundaki kademeli artış, hem KAH'ın varlığını hem de şiddetini ayırt etmede önemli bir tanısal performans gösterdi. Bu hastalarda, MAPH skoru potansiyel bir tarama aracı olarak hizmet verebilir ve risk stratifikasyonu için kullanılabilir.

Keywords

Kan viskozitesi, koroner arter hastalığı, MAPH skoru, mikrosirkülasyon, syntax skoru

Project Number

Date: 12.09.2022, Decision No: 146/03

References

• Turchetti G, Kroes MA, Lorenzoni V, et al. The cost-effectiveness of diagnostic cardiac imaging for stable coronary artery disease. Expert Rev Pharmacoecon Outcomes Res. 2015;15(4):625-633. doi: 10.1586/14737167.2015.1051037
• Rafieian-Kopaei M, Setorki M, Doudi M, Baradaran A, Nasri H. Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prev Med. 2014;5(8):927-946.
• Wang L, Tang C. Targeting platelet in atherosclerosis plaque formation: current knowledge and future perspectives. Int J Mol Sci. 2020;21(24):9760. doi: 10.3390/ijms21249760
• Soulis JV, Farmakis TM, Giannoglou GD, et al. Molecular viscosity in the normal left coronary arterial tree. Is it related to atherosclerosis? Angiol. 2006;57(1):33-40. doi: 10.1177/000331970605700105
• Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997;96(1):168-173. doi: 10.1046/j.1365-2141.1997.8532481.x
• de Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation. 1990;81(1):107-117. doi: 10.1161/01.cir.81.1.107
• Mazzi V, De Nisco G, Hoogendoorn A, et al. Early atherosclerotic changes in coronary arteries are associated with endothelium shear stress contraction/expansion variability. Ann Biomed Eng. 2021;49(9):2606-2621. doi: 10.1007/s10439-021-02829-5
• Arzani A. Coronary artery plaque growth: a two-way coupled shear stress-driven model. Int J Numer Method Biomed Eng. 2020;36(1):e3293. doi: 10.1002/cnm.3293
• Higuchi Y. Influence of arterial occlusion on hematocrit and plasma protein concentration of femoral venous blood in rabbit. Jpn J Physiol. 1985;35(3):503-511. doi: 10.2170/jjphysiol.35.503
• Khan HU, Khan MU, Noor MM, Hayat U, Alam MA. Coronary artery disease pattern: a comparision among different age groups. J Ayub Med Coll Abbottabad. 2014;26(4):466-469.
• Pafili K, Penlioglou T, Mikhailidis DP, Papanas N. Mean platelet volume and coronary artery disease. Curr Opin Cardiol. 2019;34(4):390-398. doi: 10.1097/HCO.0000000000000624
• Bapir M, Untracht GR, Hunt JEA, et al. Age-dependent decline in common femoral artery flow-mediated dilation and wall shear stress in healthy subjects. Life. 2022;12(12):2023. doi: 10.3390/life12122023
• Kanda H, Yamakuchi M, Matsumoto K, et al. Dynamic changes in platelets caused by shear stress in aortic valve stenosis. Clin Hemorheol Microcirc. 2021;77(1):71-81. doi: 10.3233/CH-200928
• Cakmak Karaaslan O, Coteli C, Ozilhan MO, et al. The predictive value of MAPH score for determining thrombus burden in patients with non-ST segment elevation myocardial infarction. Egypt Heart J. 2022;74(1):60. doi: 10.1186/s43044-022-00299-1
• Abacioglu OO, Yildirim A, Karadeniz M, et al. A new score for determining thrombus burden in STEMI patients: the MAPH score. Clin Appl Thromb Hemost. 2022;28:10760296211073767. doi: 10.1177/10760296211073767
• Akhan O, Kış M. A novel “mean platelet volume-age-total protein-hematocrit (MAPH)” score for blood viscosity: predictive capabilities for coronary slow-flow phenomenon. EJCM. 2023;11(2):70-77. doi: 10.32596/ejcm.galenos.2023.2023-01-05
• Peerwani G, Aijaz S, Sheikh S, Virani SS, Pathan A. Predictors of non-obstructive coronary artery disease in patients undergoing elective coronary angiography. Glob Heart. 2023;18(1):26. doi: 10.5334/gh.1204
• Ezhumalai B, Jayaraman B. Angiographic prevalence and pattern of coronary artery disease in women. Indian Heart J. 2014;66(4):422-426. doi: 10.1016/j.ihj.2014.05.009
• Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
• de Simone G, Devereux RB, Chinali M, Best LG, Lee ET, Welty TK. Association of blood pressure with blood viscosity in American Indians: the Strong Heart Study. Hypertension. 2005;45(4):625-630. doi: 10.1161/01.HYP.0000157526.07977.ec
• Serruys PW, Onuma Y, Garg S, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009;5(1):50-56. doi: 10.4244/eijv5i1a9
• He JQ, Gao YC, Yu XP, et al. Syntax score predicts clinical outcome in patients with three-vessel coronary artery disease undergoing percutaneous coronary intervention. Chin Med J. 2011;124(5):704-709.
• Morice MC. Has the SYNTAX score become obsolete? J Am Coll Cardiol. 2018;72(12):1330-1331. doi: 10.1016/j.jacc.2018.07.023
• Yokota S, Ottervanger JP, Mouden M, Timmer JR, Knollema S, Jager PL. Prevalence, location, and extent of significant coronary artery disease in patients with normal myocardial perfusion imaging. J Nucl Cardiol. 2014;21(2):284-290. doi: 10.1007/s12350 -013-9837-5
• Ouellette ML, Loffler AI, Beller GA, Workman VK, Holland E, Bourque JM. Clinical characteristics, sex differences, and outcomes in patients with normal or near-normal coronary arteries, non-obstructive or obstructive coronary artery disease. J Am Heart Assoc. 2018;7(10):e007965. doi: 10.1161/JAHA. 117.007965
• Jebari-Benslaiman S, Galicia-Garcia U, Larrea-Sebal A, et al. Pathophysiology of atherosclerosis. Int J Mol Sci. 2022;23(6):3346. doi: 10.3390/ijms23063346
• Rodriguez I, Gonzalez M. Physiological mechanisms of vascular response induced by shear stress and effect of exercise in systemic and placental circulation. Front Pharmacol. 2014;5:209. doi: 10.3389/fphar.2014.00209
• Ando J, Yamamoto K. Vascular mechanobiology: endothelial cell responses to fluid shear stress. Circ J. 2009;73(11):1983-1992. doi: 10.1253/circj.cj-09-0583
• Ishibazawa A, Nagaoka T, Takahashi T, et al. Effects of shear stress on the gene expressions of endothelial nitric oxide synthase, endothelin-1, and thrombomodulin in human retinal microvascular endothelial cells. Invest Ophthalmol Vis Sci. 2011;52(11):8496-8504. doi: 10.1167/iovs.11-7686
• Yagi H, Sumino H, Aoki T, et al. Impaired blood rheology is associated with endothelial dysfunction in patients with coronary risk factors. Clin Hemorheol Microcirc. 2016;62(2):139-150. doi: 10.3233/CH-151960
• Kumar A, Hung OY, Piccinelli M, et al. Low coronary wall shear stress is associated with severe endothelial dysfunction in patients with nonobstructive coronary artery disease. JACC Cardiovasc Interv. 2018;11(20):2072-2080. doi: 10.1016/j.jcin.2018.07.004
• Cowan AQ, Cho DJ, Rosenson RS. Importance of blood rheology in the pathophysiology of atherothrombosis. Cardiovasc Drugs Ther. 2012;26(4):339-348. doi: 10.1007/s10557-012-6402-4
• Cekirdekci EI, Bugan B. Whole blood viscosity in microvascular angina and coronary artery disease: significance and utility. Rev Port Cardiol (Engl Ed). 2020;39(1):17-23. doi: 10.1016/j.repc.2019.04.008
• Becker RC. The role of blood viscosity in the development and progression of coronary artery disease. Cleve Clin J Med. 1993;60(5):353-358. doi: 10.3949/ccjm.60.5.353
• Ceyhun G, Birdal O. Relationship between whole blood viscosity and lesion severity in coronary artery disease. Int J Angiol. 2021;30(2):117-121. doi: 10.1055/s-0040-1720968
• Karaman H, Karakukcu C, Kocer D. Can mean platelet volume serve as a marker for prostatitis? Int J Med Sci. 2013;10(10):1387-1391. doi: 10.7150/ijms.6126
• Senen K, Topal E, Kilinc E, et al. Plasma viscosity and mean platelet volume in patients undergoing coronary angiography. Clin Hemorheol Microcirc. 2010;44(1):35-41. doi: 10.3233/CH-2010-1249
• Nader E, Skinner S, Romana M, et al. Blood rheology: key parameters, impact on blood flow, role in sickle cell disease and effects of exercise. Front Physiol. 2019;10:1329. doi: 10.3389/fphys.2019.01329
• Fornal M, Korbut RA, Lekka M, et al. Rheological properties of erythrocytes in patients with high risk of cardiovascular disease. Clin Hemorheol Microcirc. 2008;39(1-4):213-219.
• Sumino H, Nara M, Seki K, et al. Effect of antihypertensive therapy on blood rheology in patients with essential hypertension. J Int Med Res. 2005;33(2):170-177. doi: 10.1177/147323000503300204
• Irace C, Cutruzzola A, Parise M, et al. Effect of empagliflozin on brachial artery shear stress and endothelial function in subjects with type 2 diabetes: results from an exploratory study. Diab Vasc Dis Res. 2020;17(1):1479164119883540. doi: 10.1177/1479164119883540
• Yurdam FS, Kis M. The relationship between TIMI flow and MAPH score in patients undergoing primary percutaneous coronary intervention for STEMI. Int Heart J. 2023;64(5):791-797. doi: 10.1536/ihj.23-024
• Sadr-Ameli MA, Saedi S, Saedi T, Madani M, Esmaeili M, Ghardoost B. Coronary slow flow: benign or ominous? Anatol J Cardiol. 2015;15(7):531-535. doi: 10.5152/akd.2014.5578
• Huang Q, Zhang F, Chen S, Dong Z, Liu W, Zhou X. Clinical characteristics in patients with coronary slow flow phenomenon: a retrospective study. Medicine. 2021;100(6):e24643. doi: 10.1097/MD.0000000000024643