Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy

Abstract

Objective: The relationship between silent neuronal injury (SNI) and arterial stiffness assessed by cardio-ankle vascular index (CAVI) has not been evaluated in patients treated with coronary angiography and intervention due to acute coronary syndrome (ACS). The aim of this study is to evaluate the value of CAVI in prediction of SNI after percutaneous coronary angiography and intervention in patients presented with ACS. Methods: Eighty-three consecutive patients presented with ACS, who underwent percutaneous coronary angiography and intervention, were included in this prospective observational study on diagnostic accuracy. Neuron specific enolase (NSE) was studied before and 18 hour after the coronary angiography and intervention. CAVI was measured by VaSera-1000 instrument. Clinical and echocardiographic characteristics were analyzed and independent predictors of SNI were evaluated. Chi-square, Student t-test, Mann-Whithney U test, correlation analysis and logistic regression analysis was used for statistical analysis. Results: NSE levels significantly increased after cardiac catheterization (9.82±3.22 mg/dL vs. 13.15±8.55 mg/dL, p<0.001). CAVI (OR=2.992, 95% CI: 1.494-5.713, p=0.002), left ventricular ejection fraction (LVEF) (OR=0.911, 95% CI: 0.843-0.983, p=0.017) and undergoing percutaneous coronary intervention (OR=4.430, 95% CI: 1.034-18.97, p=0.045) were the independent predictors of SNI in logistic regression analysis. The cut-off value to show SNI for CAVI was 10.45 (sensitivity=71.8%, specificity=91.5%) in receiver operator charecteristic (ROC) curve analysis. The area under curve was 0.832 (95% CI=0.746-0.918, p<0.001). Conclusion: Besides undergoing PCI and having LVEF, measurement of CAVI may be a useful tool for predicting the development of SNI after percutaneous coronary angiography and intervention in patients with ACS. (Anadolu Kardiyol Derg 2014; 14: 606-11)

The Influence of Pathological Cardio-Ankle Vessel Index on Annual Results of Coronary Bypass in Patients With Ischemic Heart Disease

“…В настоящее время появились работы по исследованию прогностического значения СЛСИ у коронарных больных [5,6,12]. В опубликованной ранее работе не удалось выявить влияния повышенной жесткости артерий на результаты КШ [12].…”

“…Также у больных острым коронарным сидромом повышение СЛСИ при логистическом регрессионном анализе было одним из независимых предикторов бессимптомных повреждений нейронов после коронароангиографии (ОР=2,992; 95% ДИ 1,494-5,713; p=0,002), наряду с ФВ ЛЖ (ОР=0,911; 95% ДИ 0,843-0,983; p=0,017) и проведением ЧКВ (ОР=4,430; 95% ДИ 1,034-18,97, p=0,045). Значения СЛСИ ≥10,45 предсказывали развитие бессимптомного повреждения нейронов с чувствительностью 71,8% и специфичностью 91,5% (площадь под ROC-кривой -0,832; 95% ДИ 0,746-0,918; p<0,001) [5]. В другом сравнительно недавнем исследовании у больных ИБС СЛСИ оценивали в динамике через полгода на фоне воздействий на факторы риска атеросклероза.…”

“…В последнее время стал популярным новый показатель жесткости артериальной стенки -сердечнолодыжечный сосудистый индекс (СЛСИ), который не зависит от уровня артериального давления [2], что делает его удобным в оценке эффективности терапии [3]. Еще одной тенденцией в настоящее время становится оценка клинического и прогностического значения СЛСИ у больных с выраженной сердечно-сосудистой патологией, у больных ишемической болезнью сердца (ИБС) [4][5][6], при хронической сердечной недостаточности [7].…”

Assessment of arterial stiffness in patients with venous thromboembolism: Separate or continuous circuits?

“…CAVI is associated with epicardial fat thickness, atherosclerosis, chronic obstructive lung disease, coronary syndrome-x, dipping status, silent neuronal injury, diabetes, aging, chronic renal failure, dyslipidemia, smoking, hypertension, and obstructive sleep apnea. [14][15][16][17][18][19] Additionally, vasoactive medications including alpha-blockers, betablockers, angiotensin-converting enzyme inhibitors also alter CAVI. 19 None of our patient used antihypertensive medications in this study.…”

Assessment of Silent Neuronal Injury Following Coronary Angiography and Intervention in Patients With Acute Coronary Syndrome

“…Increased vascular stiffness is associated with SNI. 32 Therefore, patients with higher SS may be prone to excessive aortic injury secondary to catheter manipulations of vulnerable aorta.…”