Fragmented QRS is independently associated with subclinical LV dysfunction in patients with CKD and normal ejection fraction.

Objective: The aim of our study was to determine the usefulness of the aortic knob width (AKW) in the assessment of subclinical atherosclerosis in hypertensive patients. Methods: In this study on diagnostic accuracy, 374 consecutive hypertensive patients with at least one cardiovascular risk factor were enrolled. AKW was measured on chest X-ray. Cardio-ankle vascular index (CAVI) was measured by VaSera-1000 CAVI instrument. The diagnostic value of AKW was assessed using ROC analysis. Results: There was a significant correlation between aortic knob width and CAVI (r=0.45, p<0.001), age (0.39, p<0.001), systolic (r=0.17, p<0.001), diastolic (r=0.23, p<0.001) and mean (r=0.2, p<0.001) blood pressures. In linear regression analysis CAVI (β=0.3, 95% CI 0.33-0.98, p<0.001), age (β=0.3, 95% CI 0.09 -0.21, p<0.001) and diastolic blood pressure β=0.2, 95% CI 0.08-1.9, p<0.001) were independently associated with AKW. It was significantly higher in patients with subclinical atherosclerosis (CAVI ≥9) than borderline (8 ≤CAVI <9) (41.4±5.5 versus 36.7±5.3 mm, p<0.001) and healthy (CAVI <8) subjects (41.4±5.5 versus 35.5±4.3 mm, p<0.001). Analysis using the ROC curve has demonstrated that aortic knob of 41 mm constitutes the cut-off value for the presence of subclinical atherosclerosis with 71% sensitivity and 77% specificity (AUC-0.67, 95% CI 0.51-0.82). Conclusion: Observation of aortic knob on chest X-ray in hypertensive patients may provide important predictive information of subclinical atherosclerosis. (Anadolu Kardiyol Derg 2012; 12: 102-6) Key words: CAVI, subclinical atherosclerosis, aortic knob, diagnostic accuracy, sensitivity, specificity 102 ÖZET Amaç: Bu çalışmanın amacı göğüs grafisinde aort topuz genişliğinin (ATG) hipertansif hastalarda subklinik aterosklerozun bir göstergesi olup olmadığını araştırmaktır. Yöntemler: Hipertansif ve en az bir tane kardiyovasküler risk faktörü olan 374 hasta bu tanısal değeri çalışmaya alındı. Kardiyo-ayak bileği vasküler indeksi (CAVI) VaSera VS-1000 cihazı ile değerlendirildi. Aort topuz genişliği göğüs grafisinde ölçüldü. ATG'nin tanısal değeri ROC analizi ile değerlendirildi. Bulgular: Aort topuz genişliği ile CAVI arasında istatistiksel olarak anlamlı bir ilişki vardı (r=0.45, p<0.001). Ayrıca, yaş (0.39, p<0.001), sistolik kan basın-cı (r=0,17, p<0.001), diyastolik (r=0.23, p<0.001) ve ortalama kan basıncı (r=0.2, p<0.001) ile CAVI arasında anlamlı bir ilişki bulundu. Lineer regresyon analizinde CAVI (β=0.3, p<0.001), yaş (β=0.3, p<0.001) ve diyastolik kan basıncı (β=0.2, %95 GA 0.08-1.9, p<0.001) ile ATG arasında bağımsız bir ilişki vardı. ATG subklinik aterosklerozu olanlarda (CAVI ≥9) sınırda anormal (8 ≤ CAVI <9) (41.4±5.5 karşı 36.7±5.3 mm, p<0.001) ve normal olanlara (CAVI <8) (41.4±5.5 karşı 35.5±4.3 mm, p<0.001) göre anlamlı olarak yüksekti. ROC analizinde aortik topuzun 41 mm olması subklinik atherosklerozu %71 duyarlılık ve %77 özgüllük ile tespit edebiliyordu (EAA 0.67, %95 GA 0.51-0.82). Sonuç: Göğüs grafisinde aortik topuzun değerlendirilmesi hipertan...

We investigated the relationship between peripheral artery disease (PAD) and coronary artery disease (CAD) complexity in patients with acute coronary syndromes (ACS). Consecutive patients with first time diagnosis of ACS (n = 150) were enrolled. SYNTAX score (SS), a marker of CAD complexity, was assessed by dedicated computer software and diagnosis of PAD was established by ankle-brachial index (ABI) value. SYNTAX score was higher in patients with overt and borderline PAD (ABI ≤ 0.99) than normal participants (ABI 1-1.29; 16.7 ± 8.2 vs 10.1 ± 5.5; P < .001). In addition, there was a strong negative correlation between ABI and SS (r = -.46; P < .001).We have demonstrated increased CAD complexity in patients with ACS and PAD and strong correlation between degree of PAD and coronary lesion complexity.

AAC is a strong and independent predictor of CAC. The discriminative performance of AAC is high in detecting patients with low- and high-risk CAC scores.

No abstract