Fatih AKSOY, Ali BAĞCI, İsmail Barkın IŞIK

Sinus Ritmindeki Hastalarda Ekokardiyografik Aortik Sertlik Parametreleri ile CHA2DS2-VASc Skoru Arasındaki İlişki

Amaç: CHA2DS2-VASc skoru, atriyal fibrilasyonda (AF) tromboembolik riski tahmin etmek için kullanılır. Ekokardiyografik aortik sertlik parametreleriyle ilişkisi bilinmemektedir. Mevcut çalışmada CHA2DS2-VASc skoruna göre hesaplanan risk gruplarında aortik sertlik parametrelerinin prediktif değeri araştırılması amaçlanmıştır. Materyal-Metot: Kardiyolojik kontrol için rutin olarak başvuran toplam 272 hasta (116 kadın, 156 erkek, ort. yaş 61,76±11.5 yıl), CHA2DS2-VASc skorlarına göre iki gruba ayrıldı (skor 0 ve 1) düşük risk ve “≥2”yüksek risk olarak). 272 hastanın 153'ünde yüksek risk vardı. Bulgular: Aortik gerilim ve aort esneyebilirliği yüksek riskli hastalarda düşük riskli bireylerde olduğundan anlamlı derecede düşüktü (8,9±3,2 ve 14,1±3,9; sırasıyla P<0,001 ve 3,4±2,3 ve 6,9±3,2; P<0,001, sırasıyla). Aortik sertlik indeksi ve elastik modulus yüksek riskli bireylerde düşük riskli bireylere göre anlamlı olarak daha yüksekti (6,5±2,9 ve 3,5±1,4; P<0,001 ve 766,6±374,5 vs. 348,4±175,9; P<0,001, sırasıyla). Aortik gerilim ve aort esneyebilirliği, yüksek risk grubuyla negatif korelasyon gösterdi. Aortik sertlik indeksi ve elastik modülus, yüksek risk grubuyla pozitif olarak korele idi. Çok değişkenli lojistik regresyon analizine göre, elastik modulus, CHA2DS2-VASc skoru açısından yüksek tromboembolik riskin bağımsız belirleyicisiydi. Sonuç: Bulgularımız, Aort sertliği parametreleri ölçümünün, tromboembolik olaylar gibi kardiyovasküler riski değerlendirmede ek bilgi sağlayabileceğini ve aort sertliği bozuk olan kişilerin, olumsuz kardiyovasküler risk faktörlerini ve gelecekteki kardiyovasküler olayların gelişimini azaltmada daha fazla dikkat etmesi gerektiğini ortaya koymaktadır.

Anahtar Kelimeler:

CHA2DS2-VASc skoru, aortik sertlik, tromboembolik risk

The Relation Between Echocardiographic Aortic Stiffness Parameters and CHA2DS2-VASc Score in Patients With Sinus Rhythm

Background: The CHA2DS2-VASc score is used to estimate thromboembolic risk in atrial fibrillation (AF). Its relationship with aortic stiffness parameters is unknown. Objective: We evaluated the predictive value of the aortic stiffness parameters in risk groups of CHA2DS2-VASc score. Methods: A total 272 consecutive patients (116 females, 156 males, mean age 61.76±11.5 years) who admitted routinely for cardiologic control were divided into two groups according to CHA2DS2-VASc scores (a score of “0 and 1” was regarded as low risk, and “≥2” as high risk). 153 of 272 patients had high risk. Results: Aortic strain and aortic distensibility were significantly lower in patients with in patients with high risk than in low risk subjects (8.9±3.2 vs. 14.1±3.9 respectively; P<0.001 and 3.4±2.3 vs. 6.9±3.2 respectively; P<0.001). Aortic strain ındex and elastic modulus were significantly higher in patients with high risk than in low risk subjects (6.5±2.9 vs. 3.5±1.4 respectively; P<0.001 and 766.6±374.5 vs. 348.4±175.9 respectively; P<0.001). Aortic strain and aortic distensibility were negatively correlated with high risk group. Aortic stiffness index and elastic modulus were positively correlated with high risk group. According to multivariate logistic regression analysis, elastic modulus was independent predictors of high thromboembolic risk in terms of CHA2DS2-VASc score. Conclusion: Our findings suggest that Aortic stiffness parameters measurement could provide additional information on assessing cardiovascular risk such as thromboembolic events, and individuals with impaired aortic stiffness should receive more attention to reduce unfavorable cardiovascular risk factors and the development of future cardiovascular events.

Keywords:

CHA2DS2-VASc score, aorist stiffness, thromboembolic risk,

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Referans1 G.F. Mitchell, S.-J. Hwang, R.S. Vasan, M.G. Larson, M.J. Pencina, N.M. Hamburg, J.A. Vita, D. Levy, E.J. Benjamin, Arterial stiffness and cardiovascular events: the Framingham Heart Study, Circulation 121(4) (2010) 505.
Referans1 M. Cecelja, P. Chowienczyk, Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: a systematic review, Hypertension 54(6) (2009) 1328-1336.
Referans3 A.A. Haydar, A. Covic, H. Colhoun, M. Rubens, D.J. Goldsmith, Coronary artery calcification and aortic pulse wave velocity in chronic kidney disease patients, Kidney international 65(5) (2004) 1790-1794.
Referans4 E.E. Gunturk, T. Ekiz, H. Akkaya, Evaluation of carotid-femoral pulse wave velocity, aortic stiffness index, and aortic distensibility in patients with fibromyalgia, Clinical rheumatology (2019) 1-5.
Referans5 G. Cioffi, O. Viapiana, F. Ognibeni, A. Dalbeni, G. Orsolini, S. Adami, D. Gatti, M. Fisicaro, L. Tarantini, M. Rossini, Clinical profile and outcome of patients with rheumatoid arthritis and abnormally high aortic stiffness, European journal of preventive cardiology 23(17) (2016) 1848-1859.
Referans6 M. AlGhatrif, E.G. Lakatta, The conundrum of arterial stiffness, elevated blood pressure, and aging, Current hypertension reports 17(2) (2015) 12.
Referans7 M. Cecelja, P. Chowienczyk, Role of arterial stiffness in cardiovascular disease, JRSM cardiovascular disease 1(4) (2012) 1-10.
Referans8 A. Yildiz, M. Gur, R. Yilmaz, R. Demirbag, The association of elasticity indexes of ascending aorta and the presence and the severity of coronary artery disease, Coronary artery disease 19(5) (2008) 311-317.
Referans9 Q. Lu, H. Liu, Correlation of ascending aorta elasticity and the severity of coronary artery stenosis in hypertensive patients with coronary heart disease assessed by M-mode and tissue doppler echocardiography, Cell biochemistry and biophysics 71(2) (2015) 785-788.
Referans10H. Arı, F. Kahraman, Y. Türker, S. Güler, H.A. Baş, D. Erdoğan, Aortic propagation velocity does not correlate with classical aortic stiffness parameters in healthy individuals, Anatolian Journal of Cardiology 18(5) (2017) 340.
Referans11 C.T. January, L.S. Wann, J.S. Alpert, H. Calkins, J.E. Cigarroa, J.C. Cleveland, Jr., J.B. Conti, P.T. Ellinor, M.D. Ezekowitz, M.E. Field, K.T. Murray, R.L. Sacco, W.G. Stevenson, P.J. Tchou, C.M. Tracy, C.W. Yancy, A.A.T.F. Members, 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society, Circulation 130(23) (2014) e199-267.
Referans12 D.J. Sahn, A. DeMaria, J. Kisslo, A. Weyman, Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements, Circulation 58(6) (1978) 1072-1083.
Referans13 A. Nemes, M.L. Geleijnse, T. Forster, O.I. Soliman, F.J. Ten Cate, M. Csanády, Echocardiographic evaluation and clinical implications of aortic stiffness and coronary flow reserve and their relation, Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease 31(7) (2008) 304-309.
Referans14 M. Bozbay, H. Uyarel, G. Cicek, A. Oz, M. Keskin, A. Murat, E. Yildirim, G. Karaca, M. Ergelen, M. Eren, CHA2DS2-VASc score predicts in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were undergoing primary percutaneous coronary intervention, Clinical and Applied Thrombosis/Hemostasis 23(2) (2017) 132-138.
Referans15 F. Aksoy, H.A. Bas, A. Bagci, T. Oskay, The CHA2DS2-VASc score for predicting atrial fibrillation in patients presenting with ST elevation myocardial infarction: prospective observational study, Sao Paulo Med J 137(3) (2019) 248-254.
Referans16 F. Aksoy, A. Bagci, Predictive value of ATRIA risk score for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction, Rev Assoc Med Bras (1992) 65(11) (2019) 1384-1390.
Referans17 G. Ceyhun, The relationship of the serum endocan level with the CHA 2 DS 2-VASc score in patients with paroxysmal atrial fibrillation, The Egyptian Heart Journal 73(1) (2021) 1-6.
Referans18 F. Aksoy, D. Uysal, A Simple Risk Scoring Systems to evaluate the presence of aneurysm and one-year mortality in patients with abdominal aortic aneurysm using CHA2DS2-VASc and ATRIA, Revista da Associação Médica Brasileira 67 (2021) 101-106.
Referans19 F. Aksoy, İ.B. IŞIK, H.A. BAŞ, A. BAĞCI, F. Kahraman, Y.E. Okudan, M.S. Kuyumcu, A. ALTINBAŞ, Usefulness of the cha2ds2-vasc score to predict “st segment resolution failure” in patients treated with primary percutaneous coronary intervention for st-segment elevation myocardial infarction, Dicle Tıp Dergisi 46(4) (2019) 847-855.
Referans20 D. Uysal, F. Aksoy, E. Ibrişim, The Validation of the ATRIA and CHA 2 DS 2-Vasc Scores in Predicting Atrial Fibrillation after Coronary Artery Bypass Surgery, Brazilian Journal of Cardiovascular Surgery 35 (2020) 619-625.
Referans21 F. Aksoy, A. Bagcı, Predictive value of ATRIA risk score for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction, Revista da Associação Médica Brasileira 65 (2019) 1384-1390.
Referans22 F. Aksoy, S. Guler, F. Kahraman, T. Oskay, E. Varol, The relation between echocardiographic epicardial fat thickness and CHA2DS2-VASc score in patients with sinus rhythm, Brazilian journal of cardiovascular surgery 34(1) (2019) 41-47.
Referans23 F. Aksoy, S. Guler, F. Kahraman, M.S. Kuyumcu, A. Bagci, H.A. Bas, D. Uysal, E. Varol, The Relationship Between Mitral Annular Calcification, Metabolic Syndrome and Thromboembolic Risk, Braz J Cardiovasc Surg 34(5) (2019) 535-541.
Referans24 A. BAĞCI, F. AKSOY, Akut Koroner Sendromu Olan Bireylerde CHA2DS2-VASc ve ATRIA Skorlarının Değerlendirilmesi, Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi 10(4) 377-380.
Referans25 Ö. Şatiroğlu, M. Bostan, N. Bayar, Y. Çiçek, M. Cetin, E. Bozkurt, Relation between aortic stiffness and extension of coronary artery disease, Turkish Journal of Medical Sciences 42(3) (2012) 417-424.
Referans26 M.E. Safar, F. Thomas, J. Blacher, R. Nzietchueng, J.-M. Bureau, B. Pannier, A. Benetos, Metabolic syndrome and age-related progression of aortic stiffness, Journal of the American College of Cardiology 47(1) (2006) 72-75.
Referans27 R.H. Mackey, K. Sutton-Tyrrell, P.V. Vaitkevicius, P.A. Sakkinen, M.F. Lyles, H.A. Spurgeon, E.G. Lakatta, L.H. Kuller, Correlates of aortic stiffness in elderly individuals: a subgroup of the Cardiovascular Health Study, American journal of hypertension 15(1) (2002) 16-23.
Referans28 S.J. Zieman, V. Melenovsky, D.A. Kass, Mechanisms, pathophysiology, and therapy of arterial stiffness, Arteriosclerosis, thrombosis, and vascular biology 25(5) (2005) 932-943.
Referans29 J. Gong, Q. Xie, Y. Han, B. Chen, L. Li, G. Zhou, T. Wang, L. Xie, Relationship between components of metabolic syndrome and arterial stiffness in Chinese hypertensives, Clinical and Experimental Hypertension (2019) 1-7.
Referans30 Y.-H. Chan, K.-H. Yiu, K.-K. Lau, Y.-F. Yiu, S.-W. Li, T.-H. Lam, C.-P. Lau, C.-W. Siu, H.-F. Tse, The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: role of incorporating PR prolongation, Atherosclerosis 237(2) (2014) 504-513.