A New Current to The Armamentarium: Is the CHA2DS2-Vasc-HS Score Predictive of Low Left Internal Mammary Artery (LIMA) Flow in Patients Underwent Coronary Bypass Surgery?

LIMA flow and CHA2DS2-Vasc-HS score

Authors

  • Nihat Söylemez Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
  • Mehmet Ballı Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
  • Fatma Köksal Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
  • Mahmut Yılmaz Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
  • Fazilet Ertürk Sağ Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
  • Esra Ertürk Tekin Department of Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
  • Mehmet Ali Yeşiltaş Department of Cardiovascular Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
  • Özden Vezir Department of Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
  • Bahar Aydınlı Department of Anesthesia and Reanimation, Mersin City Training and Research Hospital, Mersin, Turkey
  • Buğra Özkan Cardiology Clinic, Mersin University Medicine Faculty Mersin, Turkey

DOI:

https://doi.org/10.1532/hsf.3837

Keywords:

CHA2DS2-Vasc-HS score, LIMA flow, CAD

Abstract

Introduction: Left internal mammary artery (LIMA) grafts should be used in patients undergoing CABG. No other procedure results in patency equivalent to that of the left anterior descending coronary artery (LAD)–LIMA bypass graft. The CHA2DS2-Vasc-HS scoring system can be used to successfully predict CAD severity in stable CAD patients. We aimed to investigate the relationship between LIMA flow and the CHA2DS2-Vasc-HS score.

Methods: A total of 684 patients, who underwent CABG surgery, were included in this study. Previous history of bypass surgery, emergency operations, patients with Leriche syndrome and patients with severe obstructive pulmonary and subclavian artery disease were excluded from our study. Patients with a LIMA flow that was suitable for bypass grafting, as determined during the intraoperative evaluation, were included in the low LIMA flow group, and the CHA2DS2-Vasc-HS score was calculated for all patients.

Results: Patients in the low LIMA flow group (Group 1) were older. The CHA2DS2-Vasc-HS score (P < 0.001), presence of mild or moderate COPD (P = 0.022), number of severely diseased vessels (P = 0.036), and BMI (P < 0.001) were independent predictors of poor LIMA flow. The cutoff value of the CHA2DS2-VASc-HS score for the prediction of poor LIMA flow was >5.5, with a sensitivity of 92.9% and specificity of 83.4% (AUC: 0.938, 95% Cl: 0.906 – 0.970, P < 0.001).

Conclusion: A preoperative high CHA2DS2-Vasc-HS score can be used to predict low intraoperative LIMA flow. The CHA2DS2-Vasc-HS score is an easy-to-use and reliable estimation method and can be used as an additional preoperative of LIMA flow in patients undergoing CABG due to severe CAD.

References

Bahar L, Tüysüz ME. 2020. The Relationof Left Internal Mammary Artery Atherosclerosis With Urotensin II. Bratislava Medical Journal. 121: 516-521.

Cetin M, Cakici M, Zencir C, et al. 2014. Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score. Am J Cardiol. 15; :950-6.

Cheng K, Rehman SM, Taggart DP. 2015. A Review of Differing Techniques of Mammary Artery Harvesting on Sternal Perfusion: Time for a Randomized Study? Ann. Thorac. Surg. 100: 1942-53.

Cohn LH. 2001. Use of Internal Mammary Artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation. 103: 483–4.

Davignon J. 2004. Beneficial cardiovascular pleiotropic effects of statins. Circulation. 109: 39-43.

Duncan RF, Dundon BK, Nelson AJ, et al. 2011. A study of the 16-Segment Regional Wall Motion Scoring Index and biplane Simpson's rule for the calculation of left ventricular ejection fraction: a comparison with cardiac magnetic resonance imaging. Echocardiography 28: 597-604.

Grover-Páez F, Zavalza-Gómez AB. 2009. Endothelial dysfunction and cardiovascular risk

factors. Diabetes Res Clin Pract. 84: 1-10.

Grundy SM, Cleeman JI, Merz CN, et al. 2004. National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 110: 227-39.

Haberal I, Gurer O, Ozsoy D, Erturk E. 2015. Coronary flow reserve in patients with left anterior descending artery-left internal mammary artery long patch plasty anastomosis: a prospective study. J Cardiothorac Surg. 10: 51.

Harskamp RE, Alexander JH, Ferguson TB, Hager R, Mack MJ, Englum B. 2016. Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the PREVENT IV Trial. Circulation. 12; 131- 138.

Hata M, Shiono M, Orime Y, et al. 2000. Clinical results of coronary artery by pass grafting with use of internal thoracic artery under low free flow conditions.J.Thorac Cardiovas Surg 119: 125-9.

He GW, Fan L, Grove KL, Funnary A, et al. 2011. Expression and function of endothelial nitric oxide synthase messenger RNA and protein are higher in internal mammary than in radial arteries. Ann Thorac Surg. 92; 845-850.

Honda K, Okamura Y, Nishimura Y, et al. 2015. Graft flow assessment using a transit time flow meter in fractional flow reserve-guided coronary artery bypass surgery. J Thorac Cardiovasc Surg. 149: 1622–8.

Karthik S, Srinivasan AK, Grayson AD, Jackson M, Mediratta NK. 2004. Left Internal Mammary Artery to the Left Anterior Descending Artery: effect on morbidity and mortality and reasons for nonusage. Ann Thorac Surg. 78: 142–8.

Kolh P, Wijns W, Danchin N, et al. 2010. Guidelines on myocardial revascularization. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS); European Association for Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 38(Suppl): S1–S52.

Lambert J, Aarsen M, Donker AJ, Stehouwer CD. 1996. Endothelium-dependent and-independent vasodilation of large arteries in normoalbuminuric insulin-dependent diabetes mellitus. Arterioscler Thromb Vasc Biol. 16: 705-11.

Leavitt BJ, Olmstead EM, Plume SK, et al. 1997. Use of the Internal Mammary Artery Graft in Northern New England. Circulation. 96 (Suppl II): 32–7.

Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2019. 2018 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 40: 87–165.

Oesterle A, Laufs U, Liao JK. 2017. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 120: 229-243.

Otsuka F, Yahagi K, Sakakura K, Virmani R. 2013. Why is the mammary artery so special and What protect it from atherosclerosis? Ann Cardiothorac Surg. 2: 519-526.

Perk J, De Backer G, Gohlke H, et al. 2012. European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 33; 1635-701.

Tasolar H, Cetin M, Balli M, et al. 2016. CHA2DS2-Vasc-HS score in non-ST elevation acute coronary syndrome patients: assessment of coronary artery disease severity and complexity and comparison to other scoring systems in the prediction of in-hospital major adverse cardiovascular events. Anatol J Cardiol. 16: 742-8.

Van Guilder GP, Hoetzer GL, Dengel DR, Stauffer BL, DeSouza CA. 2006. Impaired endothelium- dependent vasodilation in normotensive and normoglycemic obese adult humans. J Cardiovasc Pharmacol. 47: 310-3.

Williams B, Mancia G, Spiering W, et al. 2018. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal. 33: 3021–3104.

Wojszel ZB, Kasiukiewicz A, Swietek M, Swietek ML, Magnuszewski L. 2019. CHA2DS2-VASc score can guide the screening of atrial fibrillation - cross-sectional study in a geriatric ward. Clinical Interventions in Aging. 14: 879–887.

Zhao SG, Xu JJ, Tao ZH, et al. 2019. CHA2DS2-Vasc score and CHA2DS2-Vasc-HS score are poor predictors of in-stent restenosis among patients with coronary drug-eluting stents. Journal of International Medical Research. 47; 2533–2544.

Published

2021-07-27

How to Cite

SOYLEMEZ, N. ., BALLI, M., KÖKSAL, F., YILMAZ, M. ., ERTURK SAG, F., ERTURK TEKIN, E., YESILTAS, M. A., VEZIR, Özden, AYDINLI, B., & OZKAN, B. (2021). A New Current to The Armamentarium: Is the CHA2DS2-Vasc-HS Score Predictive of Low Left Internal Mammary Artery (LIMA) Flow in Patients Underwent Coronary Bypass Surgery? LIMA flow and CHA2DS2-Vasc-HS score. The Heart Surgery Forum, 24(4), E631-E636. https://doi.org/10.1532/hsf.3837

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