Abundant scoring systems are available to assess the severity of coronary artery disease (CAD) and its intervention. However, the majority of them require advanced technologies. CHA2DS2-VASc-HSF is a novel and simple risk scoring, easily used for screening in primary care level. We hypothesize that CHA2DS2-VASc-HSF is predictive for severe CAD and indicative for coronary artery bypass grafting (CABG). Additionally, we compared its predictive value with CHA2DS2 and CHA2DS2-VASc score. A total of 210 consecutive patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score. Severe CAD is defined as Gensini Score >20. CABG indication was defined based on Class I recommendation from the American Heart Association (AHA). Statistical analyses were done using SPSS 25.0. Receiver operating characteristic (ROC) curve analysis showed the CHA2DS2 score (AUC [Area Under the Curve], 0.630; 95% CI, 0.555–0.706; p = 0.001), CHA2DS2-VASc score (AUC, 0.680; 95% CI, 0.608–0.752; p=0.000), and CHA2DS2-VASc-HSF score (AUC, 0.785; 95% CI, 0.723–0.846; p=0.000) were predictive of severe CAD. CHA2DS2-VASc-HSF score (AUC, 0.841; 95% CI, 0.711–0.971; p=0.00) were predictive of CABG indication. The CHA2DS2-VASc-HSF score provides the highest predictive value for severe CAD and CABG indication compared to the CHA2DS2 and CHA2DS2-VASc score, suggesting that CHA2DS2-VASc-HSF score may be used in primary care settings to suggest referral for coronary angiography and predict CABG possibilities.
BACKGROUND: Various risk scoring methods are available to predict the severity of coronary artery disease (CAD). However, the majority of them are complex and require advanced technologies, thus limiting its usage in primary care settings. CHA2DS2-VASc-HSF is a novel risk scoring which we develop from CHA2DS2-VASc score. AIM: We hypothesize that CHA2DS2-VASc-HSF is predictive for the risk of severe CAD, and we compare its validity with previously established CHADS2 and CHA2DS2-VASc score. MATERIALS AND METHODS: A total of 210 patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2-VASc-HSF score. Severe CAD defined as coronary artery occlusion with the Gensini score of ≥20. Statistical analyses were done using SPSS 25.0 and MedCalc 18.2.1. RESULTS: This research showed that the patient with severe CAD has significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score compared to normal and mild CAD (p < 0.001). CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF correlated significantly with the CAD severity (r = 0.315, p ≤ 0.001; r = 0.395, p ≤ 0.001; r = 0.612, p ≤ 0.001, respectively). CHA2DS2-VASc-HSF may predict the risk of severe CAD independent from other variables (odds ratio = 2.540; 95% confidence interval = 1.794–3.595; p = 0.002) with the cutoff value of ≥2.5 (sensitivity = 81.4% and specificity = 68.1%). Pairwise comparison of receiver operating characteristic curves showed that CHA2DS2-VASc-HSF was superior to predict severe CAD. CONCLUSIONS: CHA2DS2-VASc-HSF scores may predict the risk of severe CAD better than CHADS2 and CHA2DS2-VASc score. This score may easily be used in primary care physicians to predict the risk of severe CAD and provide an early referral to the cardiologist.
As a chronic disease, heart failure may have a significant impact on a patient’s quality of life. There are conflicting study results regarding the relationship between systolic function and quality of life in patients with chronic heart failure. This study identifies the relationship between systolic function and quality of life in patients with chronic heart failure. This study was conducted on 34 consecutive Chronic Heart Failure (CHF) patients in Cardiovascular Department, Sosodoro Djatikoesoemo General Hospital. Left Ventricle Ejection Fraction (LVEF) was obtained from echocardiography, and quality of life was assessed using Minnesota Living with Heart Failure Questionnaire (MLHFQ). A low quality of life was defined as MLHFQ score ≥ 45. The correlation between LVEF and physical, emotional dimension, and overall score from MLHFQ shows significant results (p > 0.05). The correlation between LVEF and physical dimension and between LVEF and an overall score of MLHFQ shows strong negative degree (r = -0.727). The correlation between LVEF with both physical and emotional dimension shows negative strong degree (r = -0.678, the latter r = -0.547). There is a significant correlation between systolic function and physical, emotional, and overall quality of life in chronic heart failure patients.
Background: Atherosclerosis is a condition in which the medium to large arteries become inflamed over time. The cornerstone to the atherosclerosis process is endothelial dysfunction. Simvastatin is a cholesterol-lowering drug known for its endothelial cell pleiotropic properties. The role of genetic polymorphisms in simvastatin-resistance difficulties has recently piqued people’s interest. This problem is thought to be linked to the pleiotropic action of simvastatin, particularly in terms of restoring endothelial function. The goal of this study is to see if there is a link between the single nucleotide polymorphism (SNP) c.521T>C and the pleiotropic effect of simvastatin as determined by the endothelial function parameter, flow-mediated dilation (FMD). Methods: This research was a multicentre cross-sectional study including 71 hypercholesterolemia patients who have been on simvastatin for at least 3 months. The real-time polymerase chain reaction identified SNP c.521T>C. The right brachial artery ultrasonography was used to measure FMD. Results: In 71 hypercholesterolemia patients, the SNP c.521T>C was found in 9.9% of them. On χ2 analysis, there was no significant association between SNP c.521T>C (TC genotype) and FMD ( p = 0.973). On logistic regression analysis, the duration of simvastatin medication was linked with an increased incidence (Adj. OR (adjusted odds ratio) = 2.424; confidence interval (CI) = 1.117–5.260, p = 0.025) and a reduction in systolic blood pressure (Adj. OR = 0.92; CI = 0.025–0.333, p = 0.001). Conclusion: There was no association between FMD and the SNP c.521T>C (TC genotype). The duration of simvastatin medication and systolic blood pressure were both associated to FMD.
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