Predicting the coronary atherosclerosis severity in cardiac patients

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Abstract


Background. Coronary atherosclerosis is an ongoing pathological process, varying from asymptomatic forms to angina pectoris, myocardial infarction and even sudden cardiac death. Early identification of persons with an increased risk of the severe atherosclerosis will promote adequate diagnostic and therapeutic measures to prevent cardiovascular complications.

Aim. To make a prognostic model determining the probability of a severe coronary atherosclerosis in cardiac patients.

Material and methods. The actual study included 116 patients of cardiology departments with various degree of coronary atherosclerosis measured by coronary angiography: group I ≥70% coronary stenosis (≥50% in case of left main coronary artery), group II – those with less severe atherosclerotic process. All patients underwent electrocardiography (ECG) at rest and Holter monitoring. Pathological Q-waves, qualitative and quantitative characteristics of ventricular extrasystoles as well as QRS-fragmentation were assessed in all cases. In individuals having sinus rhythm, heart rate turbulence (HRT), T-wave alternans and QT, QTc dispersion on maximum and minimum heart rate were additionally calculated.

Results. The prognostic model included the following ECG-markers: HRT, pathological Q-waves, QTc dispersion on maximum heart rate and QRS-fragmentation in lateral leads (I, AVL, V6). All parameters have demonstrated a direct relationship with the likelihood of severe coronary atherosclerosis. The current model took into account 71% of the factors influencing significant atherosclerosis, AUC=0.94±0.04, the sensitivity and the specificity were 90.0 and 94.4% respectively.

Conclusion. A comprehensive assessment of the ECG data helps to identify the group with an increased risk of severe coronary atherosclerosis among cardiac patients.


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About the authors

Yuri N. Fedulaev

Pirogov Russian National Research Medical University

Email: kuwert@yandex.ru
ORCID iD: 0000-0003-4040-2971
SPIN-code: 2764-7250

Russian Federation, 117997, Moscow, Ostrovitianov Street, 1

D. Sci. (Med.), Prof., Head of the Department of Faculty Therapy

Irina V. Makarova

Pirogov Russian National Research Medical University

Author for correspondence.
Email: irina-makarova93@mail.ru
ORCID iD: 0000-0001-5127-1300
SPIN-code: 3525-1775
ResearcherId: ABE-1969-2020

Russian Federation, 117997, Moscow, Ostrovitianov Street, 1

assistant of the Department of Faculty Therapy

Tatiana V. Pinchuk

Pirogov Russian National Research Medical University

Email: doktor2000@inbox.ru
ORCID iD: 0000-0002-7877-4407
SPIN-code: 1940-2017

Russian Federation, 117997, Moscow, Ostrovitianov Street, 1

Cand. Sci. (Med.), Department of Faculty Therapy

Sergey E. Arakelov

City Clinical Hospital № 13; People’s Friendship University of Russia

Email: kuwert@yandex.ru
ORCID iD: 0000-0003-3911-8543

Russian Federation, 115280, Moscow, Velozavodskaya Street, 1/1; Moscow

D. Sci. (Med.), chief physician of city clinical hospital 13, head of the Department of Family Medicine with a course of palliative care at the RUDN University

Irina Y. Titova

City Clinical hospital №13

Email: kuwert@yandex.ru
ORCID iD: 0000-0001-7056-0634

Russian Federation, 115280, Moscow, Velozavodskaya Street, 1/1

Deputy Chief of City Clinical Hospital №13

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Supplementary files

Supplementary Files Action
1.
Fig. 1. ROC-curve describing the dependence of the severity of coronary atherosclerosis on the values of the logistic function p.

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Copyright (c) 2021 Fedulaev Y.N., Makarova I.V., Pinchuk T.V., Arakelov S.E., Titova I.Y.

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