Relationship between the Castelli risk indeces and the presence and severity of ischemia in non-geriatric patients with suspected coronary artery disease

Yıl 2023, Cilt: 14 Sayı: 1, 128 - 136, 23.03.2023

Birsen Doğanay

https://doi.org/10.18663/tjcl.1252801

Öz

Aims: This study aimed to investigate the relationship between ischemia severity and Castelli risk indices (CRI) levels in non-geriatric patients with suspected coronary artery disease (CAD) referred to myocardial perfusion scintigraphy (MPS) with gated single photon emission computed tomography (SPECT).
Material and Methods: This retrospective study included 417 non-geriatric patients referred to SPECT MPS for suspected CAD at the Cardiology Clinic between January 2019 and January 2021. Patients were divided into normal, mild, moderate, and severe ischemia groups according to MPS. CRIs were calculated as follows: CRI-I = total cholesterol / HDL ratio; CRI-II = LDL / HDL ratio.
Results: The CRIs levels were higher in ischemia group than non-ischemia group. Increase in CRI-II level was associated with increased ischemia severity. Increased CRI-II level was found to be an independent predictor of mild, moderate and severe ischemia group, but CRI-I was similar in moderate and severe ischemia groups. The threshold value of CRI-II for predicting the presence of ischemia was >2.1 (AUC ± SE = 0.787 ± 0.02, sensitivity = 79.5%, specificity = 71.4%). The threshold values of CRI-II showed a gradual increase in predicting the severity of ischemia.
Conclusion: CRI-II offers offers gradually increasing threshold values in distinguishing patients with suspected CAD but without perfusion defects or determining its severity in the case of ischemia. CRI-II can be a potential screening tool for patients with suspected CAD and it can be used for risk stratification.

Anahtar Kelimeler

Castelli risk index, coronary artery disease, ischemia, lipids

Destekleyen Kurum

No

Koroner arter hastalığı şüphesi olan non-geriatrik hastalarda Castelli risk indeksleri ile iskeminin varlığı ve şiddeti arasındaki ilişki

Öz

Amaç: Bu çalışmada, kapılı tek foton emisyonlu bilgisayarlı tomografi (SPECT) ile miyokardiyal perfüzyon sintigrafisine (MPS) yönlendirilen koroner arter hastalığı (KAH) şüphesi olan non-geriatrik hastalarda iskemi şiddeti ile Castelli risk indeksleri (CRI) arasındaki ilişkinin araştırılması amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif çalışmaya Ocak 2019 ile Ocak 2021 arasında Kardiyoloji Kliniğinde KAH şüphesi nedeniyle SPECT MPS'ye yönlendirilen 417 non-geriatrik hastayı dahil edildi. Hastalar MPS'ye göre normal, hafif, orta ve ağır iskemi gruplarına ayrıldı. CRI düzeyleri CRI-I = toplam kolesterol / HDL oranı; CRI-II = LDL / HDL oranı olarak hesaplandı.
Bulgular: CRI seviyeleri iskemi grubunda iskemisi olmayan gruba göre daha yüksekti. CRI-II seviyesindeki artış, artan iskemi şiddeti ile ilişkili saptandı. Artmış CRI-II düzeyi, hafif, orta ve ağır iskemi grubu için bağımsız bir belirteç olarak bulundu, ancak CRI-I, orta ve ağır iskemi gruplarında benzerdi. CRI-II'nin iskemi varlığını öngörme eşik değeri >2,1'dir (AUC ± SE = 0,787 ± 0,02; duyarlılık = %79,5; özgüllük = %71,4). İskeminin ciddiyetini öngörmede CRI-II’nin eşik değerleri kademeli bir artış gösterdi.
Sonuçlar: CRI-II, KAH şüphesi olan ancak perfüzyon kusurları veya normal koroner arterleri olmayan hastaları ayırt etmede ve iskemi ciddiyetini belirlemede kademeli artan eşik değerler sunar. Bu nedenle, CRI-II KAH şüphesi olan hastalar için potansiyel bir tarama aracı olabilir ve risk sınıflandırması için kullanılabilir.

Anahtar Kelimeler

Castelli risk indeksi, iskemi, koroner arter hastalığı, lipid, Castelli risk index, coronary artery disease, ischemia, lipids

Kaynakça

• 1. Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020; 76: 2982-3021.
• 2. Task Force M, Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34: 2949-3003.
• 3. Tragardh E, Tan SS, Bucerius J, et al. Systematic review of cost-effectiveness of myocardial perfusion scintigraphy in patients with ischaemic heart disease: A report from the cardiovascular committee of the European Association of Nuclear Medicine. Endorsed by the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2017; 18: 825-832.
• 4. Rathcke CN, Kjoller E, Fogh-Andersen N, Zerahn B, Vestergaard H. NT-proBNP and circulating inflammation markers in prediction of a normal myocardial scintigraphy in patients with symptoms of coronary artery disease. PLoS One 2010; 5: e14196.
• 5. Adams A, Bojara W, Schunk K. Early Diagnosis and Treatment of Coronary Heart Disease in Asymptomatic Subjects With Advanced Vascular Atherosclerosis of the Carotid Artery (Type III and IV b Findings Using Ultrasound) and Risk Factors. Cardiol Res 2018; 9: 22-27.
• 6. Lu Y, Cui X, Zhang L, et al. The Functional Role of Lipoproteins in Atherosclerosis: Novel Directions for Diagnosis and Targeting Therapy. Aging Dis 2022; 13: 491-520.
• 7. Hajar R. Risk Factors for Coronary Artery Disease: Historical Perspectives. Heart Views 2017; 18: 109-114.
• 8. Nair D, Carrigan TP, Curtin RJ, et al. Association of total cholesterol/ high-density lipoprotein cholesterol ratio with proximal coronary atherosclerosis detected by multislice computed tomography. Prev Cardiol 2009; 12: 19-26.
• 9. Millan J, Pinto X, Munoz A, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009; 5: 757-765.
• 10. 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: 499-502.
• 11. Arsanjani R, Xu Y, Dey D, et al. Improved accuracy of myocardial perfusion SPECT for detection of coronary artery disease by machine learning in a large population. J Nucl Cardiol 2013; 20: 553-562.
• 12. Yokota S, Ottervanger JP, Mouden M, Timmer JR, Knollema SJager PL. Prevalence, location, and extent of significant coronary artery disease in patients with normal myocardial perfusion imaging. J Nucl Cardiol 2014; 21: 284-290.
• 13. Shao C, Wang J, Tian J, Tang YD. Coronary Artery Disease: From Mechanism to Clinical Practice. Adv Exp Med Biol 2020; 1177: 1-36.
• 14. Koelwyn GJ, Corr EM, Erbay E, Moore KJ. Regulation of macrophage immunometabolism in atherosclerosis. Nat Immunol 2018; 19: 526-537.
• 15. Zhu Y, Xian X, Wang Z, et al. Research Progress on the Relationship between Atherosclerosis and Inflammation. Biomolecules 2018; 8.
• 16. Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen RHu G. Total and high-density lipoprotein cholesterol and stroke risk. Stroke 2012; 43: 1768-1774.
• 17. Dai M, Xu W, Chesnais H, et al. Atherogenic Indices as a Predictor of Aortic Calcification in Prostate Cancer Patients Assessed Using (18)F-Sodium Fluoride PET/CT. Int J Mol Sci 2022; 23: 13056.
• 18. Afsin A, Kaya H, Suner A, et al. Plasma atherogenic indices are independent predictors of slow coronary flow. BMC Cardiovasc Disord 2021; 21: 608.
• 19. Drwila D, Rostoff P, Nessler J, Konduracka E. Prognostic value of non-traditional lipid parameters: Castelli Risk Index I, Castelli Risk Index II, and triglycerides to high-density lipoprotein cholesterol ratio among patients with non-ST-segment elevation myocardial infarction during 1‑year follow-up. Kardiologiia 2022; 62: 60-66.
• 20. Tanaka H, Chikamori T, Hida S, et al. Relationship of SYNTAX score to myocardial ischemia as assessed on myocardial perfusion imaging. Circ J 2013; 77: 2772-2777.
• 21. Shomanova Z, Florian A, Bietenbeck M, Waltenberger J, Sechtem UYilmaz A. Diagnostic value of global myocardial perfusion reserve assessment based on coronary sinus flow measurements using cardiovascular magnetic resonance in addition to myocardial stress perfusion imaging. Eur Heart J Cardiovasc Imaging 2017; 18: 851-859.
• 22. Andrade LF, Souza AC, Peclat T, Bartholo C, Pavanelo TLima RSL. The Prognostic Value and Clinical Use of Myocardial Perfusion Scintigraphy in Asymptomatic Patients after Percutaneous Coronary Intervention. Arq Bras Cardiol 2018; 111: 784-793.
• 23. Wu MY, Li CJ, Hou MF, Chu PY. New Insights into the Role of Inflammation in the Pathogenesis of Atherosclerosis. Int J Mol Sci 2017; 18: 2034.
• 24. Spirig R, Schaub A, Kropf A, Miescher S, Spycher MORieben R. Reconstituted high-density lipoprotein modulates activation of human leukocytes. PLoS One 2013; 8: e71235.
• 25. Cameron SJ, Morrell CN, Bao C, Swaim AF, Rodriguez ALowenstein CJ. A Novel Anti-Inflammatory Effect for High Density Lipoprotein. PLoS One 2015; 10: e0144372.
• 26. Nazir S, Jankowski V, Bender G, Zewinger S, Rye KAvan der Vorst EPC. Interaction between high-density lipoproteins and inflammation: Function matters more than concentration! Adv Drug Deliv Rev 2020; 159: 94-119.
• 27. Badimon L, Pena E, Arderiu G, et al. C-Reactive Protein in Atherothrombosis and Angiogenesis. Front Immunol 2018; 9: 430.
• 28. Kurtul A, Murat SN, Yarlioglues M, et al. Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Angiology 2016; 67: 34-40.
• 29. Liu Y, Jia SD, Yao Y, et al. Impact of high-sensitivity C-reactive protein on coronary artery disease severity and outcomes in patients undergoing percutaneous coronary intervention. J Cardiol 2020; 75: 60-65.
• 30. Habib SS, A AAM. Relationship of high sensitivity C-reactive protein with presence and severity of coronary artery disease. Pak J Med Sci 2013; 29: 1425-1429.