Dr Noor Mohammad, Associate Professor, Department of Medicine, Dinajpur Medical College, Dinajpur, Bangladesh.
Mymensingh Med J. 2023 Jan;32(1):161-167.
Although improvement in the risk scoring, there are patients with chronic stable angina identified as low risk who experience CAD events, as well as, patients deemed high risk remained free of CAD events. Invasive coronary angiogram is the gold standard method for assessment of extent and severity of CAD. However, search for additional noninvasive tool that may aid in risk discrimination is going on. Myocardial performance index (MPI) is emerging as one of them. To assess the relationship between Myocardial Performance Index and severity of coronary artery disease assessed with SYNTAX Score in chronic stable angina. This cross-sectional study was conducted during the period of January, 2015 to December, 2015 among the patients of chronic stable angina undergoing elective coronary angiogram. Total 90 patients were enrolled by purposive sampling. All the data were recorded in structured questionnaire. Coronary angiogram with SYNTAX scoring was done during index hospital admission. Doppler study was done 1 day prior to CAG to measure MPI. The mean age was found 45.5±26.1 years varied from 36 to 68 years. Male female ratio was 1.9:1. A negative significant correlation (r= -0.792; p=0.001) was found between ejection fraction (EF) and myocardial performance index (MPI). Regarding the association between risk factors with MPI status, the mean MPI was found 0.65±0.10 in diabetes mellitus and 0.57±0.10 in without diabetes mellitus. Mean MPI was significantly higher in diabetes mellitus, others risk factors are not significantly associated with MPI status. Majority (38.9%) patient's SYNTAX score belonged to 0-22, 28(31.1%) was SYNTAX 23-32 score and 27(30.0%) was SYNTAX ≥33 score. The mean MPI was found 0.51±0.04 in low SYNTAX, 0.61±0.03 in intermediate SYNTAX and 0.74±0.07 in high SYNTAX score. The mean MPI was significantly (p<0.05) elevated with increased SYNTAX score. A positive significant correlation (r=0.985; p=0.001) was found between MPI with SYNTAX score. Higher value of SYNTAX score (>22) had a 2.29 times increase (95% CI 0.16 to 33.70%) in odds of having CAD. A subject with diabetes mellitus had 1.52 times increase (95%CI 2.02 to 21.54%) in odds having CAD. Others factors are not significantly associated with CAD in Multiple regression models. The MPI value is independently associated with the extent and severity of CAD. The MPI value measured by Doppler is a cheap, radiation free, available noninvasive method and may be considered as an additional risk stratification tool beyond other investigations.
尽管风险评分有所改善，但仍有一些被认为是低危的慢性稳定型心绞痛患者发生 CAD 事件，而一些被认为是高危的患者则没有发生 CAD 事件。冠状动脉造影是评估 CAD 程度和严重程度的金标准方法。然而，人们正在寻找其他可能有助于风险区分的非侵入性工具。心肌做功指数（MPI）就是其中之一。评估慢性稳定型心绞痛患者心肌做功指数与 SYNTAX 评分评估的冠状动脉疾病严重程度之间的关系。这项横断面研究于 2015 年 1 月至 2015 年 12 月期间在接受选择性冠状动脉造影的慢性稳定型心绞痛患者中进行。采用目的抽样法共纳入 90 例患者。所有数据均记录在结构化问卷中。在指数住院期间进行冠状动脉造影和 SYNTAX 评分。在 CAG 前 1 天进行多普勒研究，以测量 MPI。平均年龄为 45.5±26.1 岁，年龄范围为 36 至 68 岁。男女比例为 1.9:1。发现射血分数（EF）和心肌做功指数（MPI）之间存在负显著相关性（r=-0.792；p=0.001）。关于危险因素与 MPI 状态的关系，糖尿病患者的平均 MPI 为 0.65±0.10，无糖尿病患者的平均 MPI 为 0.57±0.10。糖尿病患者的平均 MPI 明显更高，其他危险因素与 MPI 状态无显著相关性。大多数（38.9%）患者的 SYNTAX 评分为 0-22，28（31.1%）为 SYNTAX 23-32 评分，27（30.0%）为 SYNTAX≥33 评分。低 SYNTAX 组的平均 MPI 为 0.51±0.04，中 SYNTAX 组为 0.61±0.03，高 SYNTAX 组为 0.74±0.07。MPI 随着 SYNTAX 评分的增加而显著升高（p<0.05）。MPI 与 SYNTAX 评分之间存在正显著相关性（r=0.985；p=0.001）。SYNTAX 评分>22 的患者发生 CAD 的几率增加 2.29 倍（95%CI 0.16 至 33.70%）。糖尿病患者发生 CAD 的几率增加 1.52 倍（95%CI 2.02 至 21.54%）。多元回归模型中，其他因素与 CAD 无显著相关性。MPI 值与 CAD 的程度和严重程度独立相关。多普勒测量的 MPI 值是一种廉价、无辐射、可获得的非侵入性方法，可作为其他检查之外的附加风险分层工具。
Zotero 插件