Value of carotid-femoral pulse wave velocity in prediction of atherosclerotic lesions of the coronary vessels depending on presence of type 2 diabetes mellitus
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Abstract
The aim – to assess carotid-femoral pulse wave velocity (cfPWV) in patients with coronary artery disease (CAD), depending on presence of type 2 diabetes mellitus (T2DM) and coronary arteries lesions, to establish its value in predicting presence and severity of coronary atherosclerosis.
Material and methods. 131 patients with CAD (89 men, 42 women), mean age of 59.60±9.11 years were examined. Depending on presence of T2DM patients with CAD were divided into 2 groups: 1st group (n=70) – patients with concomitant T2DM, 2nd group (n=61) – patients with CAD without T2DM. All patients were performed coronary angiography to verify the diagnosis of CAD. Also cfPWV was assessed in all patients. The comparison group consisted of 10 patients with T2DM without CAD. The control group consisted of 20 healthy volunteers of corresponding gender and age.
Results. The study found that patients with CAD both with and without concomitant T2DM had significantly increased levels of cfPWV compared to the control group and group of comparison (Р<0.05). In patients with diffuse lesions of coronary arteries with and without T2DM, cfPWV values were significantly higher than in patients without diffuse coronary artery lesions (p˂0.05). The predictive value for the presence of coronary atherosclerosis was set for the value of cfPWV more than 8.3 m/s, the sensitivity and specificity were high – 93.1 and 90 %, respectively, the area under the ROC curve (AUC) – 0.959±0.017 (95 % confidence interval: 0.914 to 0.984; P<0.0001). Prognostic significance of determining the value of cfPWV for the presence of hemodynamically significant stenosis of the coronary arteries was set for the value cfPWV more than 8.8 m/s, the sensitivity and specificity of 95.9 % and constitute 50.9 %, respectively, the area under the ROC curve (AUC) – 0.762±0.044 (95 % CI 0.685–0.827; P<0.0001). Prognostic significance of determining the value of cfPWV with predict the presence of diffuse coronary artery disease was set for the value cfPWV more than 11.4 m/s, the sensitivity and specificity of the method constitute 86.0 % and 73.3 %, respectively, the area under the ROC curve (AUC) – 0.853±0.032 (95 % confidence interval: 0.787–0.906; Р<0.0001).
Conclusions. Determination cfPWV is important both for predicting the presence of the coronary atherosclerotic lesions and diagnosis of hemodynamically significant coronary artery stenosis, diffuse coronary lesions.
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ідучак А.С., Шкробанець І.Д., Леонець С.І. Епідеміологічні особливості хвороб системи кровообігу в Україні й Чернівецькій області // Буковинський медичний вісник.– 2013.– Т. 17, № 3 (67).– С. 100–103.
Журавлёва Л.В., Лопина Н.А., Кузнецов И.В. и др. Нарушения липидного обмена у пациентов с ишемической болезнью сердца в зависимости от наличия сахарного диабета 2-го типа и характера поражения коронарных сосудов // Серце і судини.– 2016.– № 2.– С. 63–71.
Журавлёва Л.В., Лопина Н.А., Кузнецов И.В. и др. Сравнительная оценка измерения скорости распространения пульсовой волны с помощью реографии и ультразвуковой допплерографии // Серце і судини.– 2016.– № 4.– С. 72–80.
Лопина Н.А. Влияние модифицируемых и немодифицируемых факторов риска на выраженность атеросклеротического поражения коронарных артерий у больных ишемической болезнью сердца в зависимости от наличия сахарного диабета 2-го типа // Укр. терапевт. журн.–2016.– № 2.– С. 86–96.
Москаленко В.Ф., Гульчій О.П., Голубчиков М.В. та ін. Біостатистика.– К.: Книга плюс, 2009.– 184 с.
Стабільна ішемічна хвороба серця: адаптована клінічна настанова, заснована на доказах.– К.,2016.– 177 с.
Трухачёва Н.В. Математическая статистика в медико-биологических исследованиях применением пакета Statistica.– М.: ГЭОТАР Медиа, 2012.– 384 с.
Уніфікований клінічний протокол первинної та вторинної (спеціалізованої) медичної допомоги: Стабільна ішемічна хвороба серця / Hаказ МОЗ України від 02.03.2016 № 152.– 61 с.
Уніфікований клінічний протокол первинної та вторинної (спеціалізованої) медичної допомоги: цукровий діабет 2 типу (наказ МОЗ №1118 від 21.12.2012 р.).– 115 с.
Baguet J-P., Kingwell B.A., Dart A.L. et al. Analysis of the regional pulse wave velocity by Doppler: methodology and reproducibility // J. Human Hypertension.–2003.– Vol. 17.– P. 407–412.
Boutouyrie Р. et al. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’ // Eur. Heart J.– 2010.– Vol. 31 (Suppl. 19).– P. 2338–2350.
Calabia J., Torguet P., Garcia M., Garcia I. Doppler ultrasound in the measurement of pulse wave velocity: agreement with the Complior method // Cardiovasc. Ultrasound.– 2011.– Vol 9.– P. 13.
Davies J.M., Bailey M.A., Griffin K.J., Scott D.J. Pulse wave velocity and the non-invasive methods used to assess it: Complior, SphygmoCor, Arteriograph and Vicorder // Vascular.– 2012.– Vol. 20 (Suрpl. 6).– P. 342–349.
Jiang B., Liu B., McNeill K.L., Chowienczyk P.J. Measurement of pulse wave velocity using pulse wave doppler ultrasound: comparison with arterial tonometry // Ultrasound in Medicine and Biology.– 2008.– Vol. 34 (Suppl. 3).– P. 509–512.
Khoshdel A.R., Thakkinstian A., Carney S.L., Attia J. Estimation of an age-specific reference interval for pulse wave velocity: a meta-analysis // J. Hypertension.– 2006.– Vol. 24 (Suppl. 7).– P. 1231–1237.
Kilic H., Yelgec S., Salih O. An invasive but simple and accurate method for ascending aorta-femoral artery pulse wave velocity measurement // Blood Press.– 2013.– Vol. 22 (Suppl. 1).– P. 45–50.
Laurent S., Cockcroft J., Van Bortel L. et al. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications // Eur. Heart J.– 2006.– Vol. 27.– P. 2588–2605.
Mancia G., De Backer G., Dominiczak A. Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // J. Hypertension.– 2007.– Vol. 25.– P. 1105–1187.
Mancia G., Fagard R., Narkiewicz K. et al. ESH/ESC guidelines for the management of arterial hypertension // Eur. Heart J.– 2013.– Vol. 34.– P. 2159–2219.
Sugawara J., Hayashi K., Yokoi T. Carotid-femoral pulse wave velocity: impact of different arterial path length measurements // Artery Research.– 2010.– Vol. 4 (Suppl. 1).– P. 27–31.
Townsend R.R., Wilkinson I.B., Schiffrin E.L. et al. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement from the American Heart Association // Hypertension.– 2015.– Vol. 66 (Suppl. 3).– P. 698–722.