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The Anatolian Journal of Cardiology Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy [Anatol J Cardiol]
Anatol J Cardiol. 2012; 12(2): 102-106 | DOI: 10.5152/akd.2012.034  

Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy

Levent Korkmaz1, Hakan Erkan2, Ayça Ata Korkmaz3, Zeydin Acar4, M. Tarık Ağaç2, Hüseyin Bektaş2, Ali Rıza Akyüz5, Adem Adar4, Şükrü Çelik6
1Clinic of Cardiology, Ahi Evren Thorac and Cardiovascular Surgery, Training and Research Hospital, Trabzon-Turkey
2Clinic of Cardiology, Ahievren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon
3Clinic of Radiology, Demirci State Hospital, Manisa
4Clinic of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon-Turkey
5Clinic of Cardiology, Akçaabat Haçkalı Baba State Hospital, Trabzon-Turkey
6Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

Objective: The aim of our study was to determine the usefulness of the aortic knob width (AKW) in the assessment of subclinical atheroscle- rosis 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), dia- stolic (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.

Keywords: CAVI, subclinical atherosclerosis, aortic knob, diagnostic accuracy, sensitivity, specificity


Hipertansif hastalarda aortik topuz genişliği ile kardiyo - ayak bileği vasküler indeks arasındaki ilişki ve aortik topuzun subklinik aterosklerozun tanısındaki yeri: Bir tanısal değeri çalışması

Levent Korkmaz1, Hakan Erkan2, Ayça Ata Korkmaz3, Zeydin Acar4, M. Tarık Ağaç2, Hüseyin Bektaş2, Ali Rıza Akyüz5, Adem Adar4, Şükrü Çelik6
1Clinic of Cardiology, Ahi Evren Thorac and Cardiovascular Surgery, Training and Research Hospital, Trabzon-Turkey
2Clinic of Cardiology, Ahievren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon
3Clinic of Radiology, Demirci State Hospital, Manisa
4Clinic of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon-Turkey
5Clinic of Cardiology, Akçaabat Haçkalı Baba State Hospital, Trabzon-Turkey
6Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

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 indek- si (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, %95 GA 0.33-0.98, p<0.001), yaş (β=0.3, %95 GA 0.09-0.21, 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 hipertansif hastalarda subklinik aterosklerozun varlığı ile ilgili bilgi sağlayabilir.

Anahtar Kelimeler: CAVI, subklinik ateroskleroz, aort topuzu, tanısal değer, duyarlılık, özgüllük


Levent Korkmaz, Hakan Erkan, Ayça Ata Korkmaz, Zeydin Acar, M. Tarık Ağaç, Hüseyin Bektaş, Ali Rıza Akyüz, Adem Adar, Şükrü Çelik. Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy. Anatol J Cardiol. 2012; 12(2): 102-106


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