Development of a multivariate model to predict significant coronary artery disease in Thai patients with left ventricular systolic dysfunction and determine the applicability of coronary angiography: a single-center, retrospective, case–control study
et | 10 oct. 2018
À propos de cet article
Article Category: Brief communication
Publié en ligne: 10 oct. 2018
Pages: 419 - 425
DOI: https://doi.org/10.1515/abm-2018-0017
Mots clés
© 2017 Ratikorn Methavigul, Komsing Methavigul published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Figure 1
Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for each cutoff point
| Cutoff score | Sensitivity, % (95% CI) | Specificity, % (95% CI) | PPV, % (95% CI) | NPV, % (95% CI) | Accuracy (%) |
|---|---|---|---|---|---|
| -2 | 87.6 (86.5-88.6) | 56.0 (54.9-57.1) | 49.7 (48.5-50.9) | 90.1 (89.2-90.9) | 66.48 |
| 0 | 60.5 (58.9-62.0) | 85.1 (84.3-85.9) | 66.8 (65.3-68.4) | 81.3 (80.4-82.1) | 76.93 |
| 1 | 51.4 (49.8-53.0) | 87.1 (86.3-87.8) | 66.4 (64.6-68.0) | 78.3 (77.4-79.2) | 75.23 |
Baseline characteristics of the patients with left ventricular systolic dysfunction
| Number (%) or mean ± SD | ||||
|---|---|---|---|---|
| Characteristics | Total | Ischemic cardiomyopathy | Nonischemic cardiomyopathy | |
| (N = 240) | (n = 80) | (n = 160) | ||
| Male sex | 167 (70) | 61 (76) | 106 (66) | 0.11 |
| Age (years) | 55.7 ± 12.2 | 60.3 ± 10.6 | 53.5 ± 12.4 | <0.001 |
| ≤60 | 157 (73) | 41 (51) | 116 (73) | 0.001 |
| Body weight (kg) | 65.5 ± 16.8 | 58.7 ± 11.8 | 69.0 ± 17.9 | <0.001 |
| Height (cm) | 163.4 ± 8.6 | 163.2 ± 7.0 | 163.5 ± 9.5 | 0.77 |
| Body mass index (kg/m2) | 24.4 ± 5.2 | 22.0 ± 3.8 | 25.6 ± 5.3 | <0.001 |
| ≤25 | 142 (59.7) | 63 (79.7) | 79 (49.7) | <0.001 |
| Creatinine (mg/dL) | 1.1 ± 0.2 | 1.1 ± 0.2 | 1.1 ± 0.3 | 0.54 |
| Baseline LVEF (%) | 26.7 ± 8.6 | 26.0 ± 9.3 | 27.0 ± 8.3 | 0.41 |
| LVEF at follow-up visit (%) | 40.4 ± 13.7 | 37.2 ± 13.6 | 42.2 ± 37.2 | 0.06 |
| LVEF improvement | ||||
| No | 103 (43) | 40 (50) | 63 (39) | 0.23 |
| Yes | 33 (14) | 8 (10) | 25 (16) | |
| N/A | 104 (43) | 32 (40) | 72 (45) | |
| ECG | ||||
| Pathologic Q wave in contiguous leads | 24 (10) | 14 (18) | 10 (6) | 0.006 |
| LBBB | 15 (6) | 2 (3) | 13 (8) | 0.09 |
| Atrial fibrillation or atrial flutter | 42 (18) | 8 (10) | 34 (21) | 0.03 |
| Underlying diseases | ||||
| Diabetes mellitus | 72 (30) | 39 (49) | 33 (21) | <0.001 |
| Hypertension | 127 (53) | 44 (55) | 83 (52) | 0.65 |
| Dyslipidemia | 114 (48) | 49 (61) | 65 (41) | 0.003 |
| Obstructive sleep apnea | 3 (1) | 0 (0) | 3 (2) | 0.55 |
| LV thrombus | 11 (5) | 3 (4) | 8 (5) | 0.76 |
| Atrial fibrillation or atrial flutter | 42 (18) | 8 (10) | 34 (21) | 0.03 |
| Valvular heart disease | 80 (33) | 30 (38) | 50 (31) | 0.33 |
| Chronic kidney disease | 7 (3) | 3 (4) | 4 (3) | 0.69 |
| Peripheral arterial disease | 3 (1) | 3 (4) | 0 (0) | 0.04 |
| Pulmonary hypertension | 22 (9) | 13 (16) | 9 (6) | 0.007 |
| Transient ischemic attack | 3 (1) | 1 (1) | 2 (1) | >0.99 |
| Past history of stroke | 6 (3) | 1 (1) | 5 (3) | 0.67 |
| COPD | 19 (8) | 12 (15) | 7 (4) | 0.004 |
| Smoking habit | 134 (56) | 50 (63) | 84 (53) | 0.14 |
| Alcohol habit | 94 (39) | 27 (34) | 67 (42) | 0.22 |
| Family history of premature coronary artery disease | 44 (18) | 12 (15) | 32 (20) | 0.35 |
Coronary artery disease prediction score for left ventricular systolic dysfunction
| CAD score = 0.937(male sex) + 1.080(age > 60 years) – 1.572(BMI > |
| 25 kg/m2) - 1.720(LBBB) + 1.780(DM) - 1.749 |
Multiplying by 3 and then rounding the coefficients |
| CAD score = 3(male sex) + 3(age > 60 years) –5(BMI > 25 kg/m2) - |
| 5(LBBB) + 5(DM) - 5 |
| Sex: male = 1, female = 0 |
| Age: >60 years old = 1, |
| BMI: >25 kg/m2 = 1, |
| LBBB: yes = 1, no = 0 |
| DM: yes = 1, no = 0 |
Predictors of ischemic cardiomyopathy
| Univariate analysis | Multivariate analysis | |||
|---|---|---|---|---|
| Predictors | OR (95% CI of OR) | OR (95% CI of OR) | ||
| Male sex | 1.64 (0.89-3.01) | 0.11 | 2.55 (1.23-5.30) | 0.012 |
| Age (>60 years) | 2.51 (1.43-4.39) | 0.001 | 2.94 (1.52-5.69) | 0.001 |
| BMI (>25 kg/m2) | 0.84 (0.78-0.90) < | 0.001 | 0.21 (0.10-0.42) | <0.001 |
| LVEF at follow-up | 0.97 (0.95-1.0) | 0.06 | - | - |
| visit (%) | ||||
| Pathologic | 3.18 (1.34-7.53) | 0.008 | - | - |
| Q wave | ||||
| LBBB | 0.29 (0.06-1.32) | 0.11 | 0.18 (0.03-0.98) | 0.047 |
| Diabetes mellitus | 3.66 (2.05-6.55) < | 0.001 | 5.93 (2.94-11.98) | <0.001 |
| Dyslipidemia | 2.31 (1.33-4.0) | 0.003 | - | - |
| Atrial fibrillation | 0.41 (0.18-0.94) | 0.04 | - | - |
| or atrial flutter | ||||
| Pulmonary | 3.26 (1.33-7.99) | 0.01 | - | - |
| hypertension | ||||
| COPD | 3.86 (1.46-10.23) | 0.007 | - | - |
| Smoking habit | 1.51 (0.87-2.61) | 0.14 | - | - |