Myocardial performance index is associated with Systematic Coronary Risk Estimation (SCORE) system in chronic coronary syndrome

Yıl 2021, , 818 - 827, 01.10.2021

Hazar Harbalıoğlu , Omer Genc , Abdullah Yıldırım

https://doi.org/10.31362/patd.910961

Öz

Objective: The Systematic Coronary Risk Estimation (SCORE) system is used to determine 10-year cardiovascular risk. Myocardial performance index (MPI), a well-accepted echocardiographic parameter, is used to provide an information about global function of the ventricle. We aimed to investigate the relationship between MPI and SCORE.
Methods: A total of 168 participants with chronic coronary syndrome (CCS) presented to cardiology outpatient clinic between 1 June and 31 December 2020 were retrospectively enrolled in the study. Cardiovascular risk estimation was calculated by SCORE assessment. The participants were divided into two groups as 46 patients with low cardiovascular risk, and 122 patients with moderate-high-very high risk, according to the SCORE. Laboratory parameters and echocardiography findings of the patients were recorded.
Results: There was no difference in body mass index, office systolic, and diastolic blood pressure between the groups. While blood glucose was 94.5 (83.0-110.3) in the low-risk group, it was 101.0 (90.0-130.5) in the moderate-high risk patient group (p = 0.007). Similarly, Urea, creatinine, lactate dehydrogenase, total cholesterol, NT pro-BNP, and Troponin T in the moderate-high risk group were significantly higher than was the low-risk group. MPI was significantly higher in the moderate-high risk patient group (p <0.001). MPI (OR = 2.358, 95 % CI: 1.033-5.382, p = 0.042), urea (OR = 1.090, 95 % CI: 1.019-1.166, p = 0.012), and glucose (OR = 1.023, 95 % CI: 1.003-1.043, p = 0.025) were independently associated with the moderate-high SCORE.
Conclusion: We found that MPI predicted moderate-high SCORE system. Further studies are warranted to better clarify the association of SCORE with echocardiographic parameters including MPI.

Anahtar Kelimeler

myocardial performance index, Systematic Coronary Risk Estimation (SCORE) system, chronic coronary syndrome, cardiovascular risk

Kronik koroner sendromda miyokardial performans indeks ile Sistematik Koroner Risk Tahmini (SCORE) arasındaki ilişki

Öz

Amaç: Sistematik Koroner Risk Tahmin (SCORE) sistemi, 10 yıllık kardiyovasküler riski belirlemek için kullanılır. Kabul gören bir ekokardiyografik parametre olan miyokardiyal performans indeksi (MPI), ventrikülün global işlevi hakkında bilgi sağlamak için kullanılır. Biz; MPI ve SCORE arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: 1 Haziran - 31 Aralık 2020 tarihleri arasında kardiyoloji polikliniğine başvuran kronik koroner sendromlu (KKS) toplam 168 hasta retrospektif olarak çalışmaya alındı. Kardiyovasküler risk tahmini SCORE değerlendirmesi ile hesaplandı. SCORE'a göre hastalar düşük kardiyovasküler riskli 46 hasta ve orta-yüksek-çok yüksek riskli 122 hasta olarak iki gruba ayrıldı. Hastaların laboratuvar parametreleri ve ekokardiyografi bulguları kaydedildi.
Bulgular: Gruplar arasında vücut kitle indeksi, ofis sistolik ve diyastolik kan basıncı açısından fark yoktu. Kan şekeri düşük risk grubunda 94,5 (83,0-110,3) iken, orta-yüksek riskli hasta grubunda 101,0 (90,0-130,5) idi (p = 0,007). Benzer şekilde, orta-yüksek risk grubundaki Üre, kreatinin, laktat dehidrogenaz, total kolesterol, NT pro-BNP ve Troponin T, düşük risk grubuna göre anlamlı olarak daha yüksekti. Orta-yüksek riskli hasta grubunda MPI anlamlı olarak daha yüksekti (p <0.001). MPI (OR = 2,358,% 95 CI: 1,033-5,382, p = 0,042), üre (OR = 1,090,% 95 CI: 1,019-1,166, p = 0,012) ve glikoz (OR = 1,023,% 95 CI: 1,003 -1,043, p = 0,025) bağımsız olarak orta-yüksek SCORE ile ilişkilendirildi.
Sonuç: MPI'nin orta-yüksek SCORE sistemini öngördüğünü bulduk. SCORE ile MPI de dahil olmak üzere ekokardiyografik parametreler arasındaki ilişkiyi daha iyi açıklığa kavuşturmak için ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Miyokardiyal performans indeks, Sistematik Koroner Risk Tahmin (SCORE) sistemi, kronik koroner sendrom, kardiyovasküler risk

Kaynakça

• 1. Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe 2015: epidemiological update. Eur Heart J 2015;36:2696–2705. https://doi.org/10.1093/eurheartj/ehv428.
• 2. Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987–1003. https://doi.org/10.1016/s0195-668x(03)00114-3.
• 3. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903–1913. https://doi.org/10.1016/s0140-6736(02)11911-8.
• 4. Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med 1992;152:1490–1500.
• 5. Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ 1998;316:1043–1047. https://doi.org/10.1136/bmj.316.7137.1043.
• 6. Jousilahti P, Vartiainen E, Tuomilehto J, Puska P. Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation 1999;99:1165–1172. https://doi.org/10.1161/01.cir.99.9.1165.
• 7. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37:2315-2381. https://doi.org/10.1093/eurheartj/ehw106.
• 8. Tei C, Nishimura RA, Seward JB et al. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997;10:169–178. https://doi.org/10.1016/s0894-7317(97)70090-7.
• 9. Arnlöv J, Ingelsson E, Risérus U, Andrén B, Lind L. Myocardial performance index, a Doppler-derived index of global left ventricular function, predicts congestive heart failure in elderly men. Eur Heart J 2004;25:2220-5. https://doi.org/10.1016/j.ehj.2004.10.021.
• 10. Masugata H, Senda S, Goda F, et al. Independent determinants of the Tei index in hypertensive patients with preserved left ventricular systolic function. Int Heart J. 2009;50:331–340. https://doi.org/10.1536/ihj.50.331.
• 11. Bruch C, Schmermund A, Marin D, et al. Tei-index in patients with mildto-moderate congestive heart failure. Eur Heart J 2000;21:1888-1895. https://doi.org/10.1053/euhj.2000.2246.
• 12. Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357-366.
• 13. Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996;9:838-847. https://doi.org/10.1016/s0894-7317(96)90476-9.
• 14. Yilmaz R, Gencer M, Ceylan E, Demirbag R. Impact of chronic obstructive pulmonary disease with pulmonary hypertension on both left ventricular systolic and diastolic performance. J Am Soc Echocardiogr 2005;18:873-881. https://doi.org/10.1016/j.echo.2005.01.016.
• 15. Kim WH, Otsuji Y, Yuasa T, Minagoe S, Seward JB, Tei C. Evaluation of right ventricular dysfunction in patients with cardiac amyloidosis using Tei index. J Am Soc Echocardiogr 2004;17:45-49. https://doi.org/10.1016/j.echo.2003.09.006.
• 16. Bennett S, Wong CW, Griffiths T, et al. The prognostic value of Tei index in acute myocardial infarction: a systematic review. Echo Res Pract 2020;7:49-58. https://doi.org/10.1530/ERP-20-0017.
• 17. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407-477. https://doi.org/10.1093/eurheartj/ehz425.
• 18. Prigent A. Monitoring renal function and limitations of renal function tests. Semin Nucl Med 2008;38:32-46. doi: 10.1053/j.semnuclmed.2007.09.003.
• 19. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-270. https://doi.org/10.1093/ehjci/jev014.
• 20. Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357-366.
• 21. Arnlöv J, Lind L, Andren B, Risérus U, Berglund L, Lithell H. A Doppler-derived index of combined left ventricular systolic and diastolic function is an independent predictor of cardiovascular mortality in elderly men. Am Heart J 2005;149:902-907. https://doi.org/10.1016/j.ahj.2004.07.022.
• 22. Kılıç A, Yarlioglues M, Ercan EA, et al. Association of total serum antioxidant capacity with the Tei index in echocardiography in patients with microvascular angına. Coron Artery Dis 2015;26:620-625. https://doi.org/10.1097/MCA.0000000000000293.
• 23. Al-Daydamony MM, El-Tahlawi MA, Shawky A. Can myocardial performance index predict the presence of silent ischemia in asymptomatic type 2 diabetic patients? Echocardiography 2016;33:1823-1827. https://doi.org/10.1111/echo.13359.
• 24. Poulsen SH, Jensen SE, Tei C, Seward JB, Egstrup K. Value of the Doppler index of myocardial performance in the early phase of acute myocardial infarction. J Am Soc Echocardiogr 2000;13:723–730. https://doi.org/10.1067/mje.2000.105174.
• 25. Ascione L, Michele MD, Accadia M, et al. Myocardial global performance index as a predictor of in-hospital cardiac events in patients with first myocardial infarction. J Am Soc Echocardiogr 2003;16:1019–1023. https://doi.org/10.1016/S0894-7317(03)00589-3.
• 26. Sikora-Frac M, Zaborska B, Maciejewski P, Budaj A, Bednarz B. Improvement of left ventricular function after percutaneous coronary intervention in patients with stable coronary artery disease and preserved ejection fraction: Impact of diabetes mellitus. Cardiol J 2019 Jul 1. https://doi.org/10.5603/CJ.a2019.0066.
• 27. Attali JR, Sachs R, Valensi P, et al. Asymptomatic diabetic cradiomyopathy: a noninvasive study. Diabetes Res Clin Pract 1988;4:183-190. https://doi.org/10.1016/s0168-8227(88)80016-0.
• 28. Di Bonito P, Cuomo S, Moio N, et al. Diastolic dysfunction in patients with noninsulin-dependent diabetes mellitus of short duration. Diabet Med 1996;13:321-324. https://doi.org/10.1002/(SICI)1096-9136(199604)13:4<321::AID-DIA3>3.0.CO;2-7.
• 29. Schaffer SW, Mozaffari MS, Artman M, Wilson GL. Basis for myocardial mechanical defects associated with noninsulin-dependent diabetes. Am J Physiol 1989;256:25-30. https://doi.org/10.1152/ajpendo.1989.256.1.E25.
• 30. Flarsheim CE, Grupp IL, Matlib MA. Mitochondrial dysfunction accompaines diastolic dysfunction in diabetic rat heart. Am J Physiol 1996;271:192-202. https://doi.org/10.1152/ajpheart.1996.271.1.H192.
• 31.Orem C, Küçükosmanoğlu M, Hacıhasanoğlu A, et al. Association of Doppler-derived myocardial performance index with albuminuria in patients with diabetes. J Am Soc Echocardiogr 2004;17:1185-1190. https://doi.org/10.1016/j.echo.2004.07.006.
• 32. Brutsaert DL, Sys SU, Gillebert TH. Diastolic failure: pathophysiology and therapeutic implications. J Am Coll Cardiol 1993;22:318-325. https://doi.org/10.1016/0735-1097(93)90850-z.
• 33. Yılmaz R, Seydaliyeva T, Ünlü D, Uluçay A. The effect of left ventricular geometry on myocardial performance index in hypertensive patients. Anadolu Kardiyol Derg 2004;4:217-222.
• 34. Deanfield JE, Shea MJ, Wilson RA, Horlock P Landsheere CMD, Selwyn AP. Direct effects of smoking on the heart: silent ischemic disturbances of coronary flow. Am J Cardiol. 1986;57:1005-1009. https://doi.org/10.1016/0002-9149(86)90665-x.
• 35. Barutcu I, Esen AM, Kaya D, et al. Effect of acute cigarette smoking on left and right ventricle filling parameters: a conventional and tissue Doppler echocardiographic study in healthy participants. Angiology 2008;59:312-316. https://doi.org/10.1177/0003319707304882. 36. Karakaya O, Barutcu I, Esen AM, et al. Acute smoking-induced alterations in Doppler echocardiographic measurements in chronic smokers. Tex Heart Inst J 2006;33:134-138.