Which Biomarker(s) Augment the Diagnostic Value of the Positive Exercise Electrocardiography Test: Systemic
Gokhan Ergun1, Selami Demirelli1
1Department of Cardiology, Kayseri City Training and Research Hospital, 38080 Kayseri, Turkey.
Insights
A positive exercise electrocardiography test (EET) combined with a high monocyte/HDL-C ratio (MHR) can help identify obstructive coronary artery disease (CAD). This finding aids in diagnosing chronic coronary syndromes more effectively.
Area of Science:
- Cardiology
- Diagnostic Medicine
- Inflammation Biomarkers
Background:
- The exercise electrocardiography test (EET) is a standard diagnostic tool for chronic coronary syndromes.
- Accurate diagnosis of obstructive coronary artery disease (CAD) is crucial for effective patient management.
Purpose of the Study:
- To evaluate the combined diagnostic value of a positive EET with inflammatory markers (Systemic Inflammatory Index - SII, Plasma Atherogenic Index - PAI, Monocyte/HDL-C Ratio - MHR) for obstructive CAD.
- To identify predictors of obstructive CAD in patients undergoing coronary angiography.
Main Methods:
- Retrospective analysis of 540 patients who underwent EET and coronary angiography.
- Comparison of clinical and laboratory parameters between patients with and without obstructive CAD.
- Multivariate logistic regression and Receiver Operating Characteristic (ROC) curve analysis to determine independent predictors and diagnostic accuracy.
Main Results:
- Patients with obstructive CAD showed significantly higher levels of glucose, low-density lipoprotein, white blood cells, and MHR.
- Age, gender, diabetes mellitus, and low-density lipoprotein were identified as independent predictors of CAD.
- A MHR cut-off value of 12 demonstrated 60.4% sensitivity and 53.0% specificity for detecting obstructive CAD.
Conclusions:
- A high MHR is a significant indicator of obstructive CAD in patients with a positive EET and suspected CAD.
- The combination of EET and MHR may enhance the diagnostic accuracy for obstructive CAD.
Abstract:
The exercise electrocardiography test (EET) is still used before coronary angiography in the diagnosis of chronic coronary syndromes. This study aimed to demonstrate the value of the combination of a positive EET with the systemic inflammatory index (SII), the plasma atherogenic index (PAI), and the monocyte/HDL-C ratio (MHR) in the determination of obstructive coronary artery disease (CAD). This single-center, retrospective study included 540 patients who underwent coronary angiography after ETT. The patients were separated into Group 1, comprising 434 patients with normal coronary arteries and non-obstructive CAD, and Group 2, including 106 with obstructive CAD. In Group 2, the patients were separated into SYNTAX ≤ 22 or ≥23. Glucose, low-density lipoprotein, white blood cells, and MHR were determined to be significantly higher in Group 2 (p < 0.05). According to the multivariate logistic regression analysis, age, gender, diabetes mellitus, and low-density lipoprotein were determined to be independent predictors of CAD. In the ROC curve analysis, a cut-off value of 12 for the MHR in the determination of obstructive CAD had a sensitivity of 60.4% and a specificity of 53.0%. The main result of this study was that a high MHR is an indicator of obstructive CAD in patients with positive EET and suspected CAD.
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