Related Experiment Video
Updated: Jul 9, 2025
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of
George C Drosos1, George Konstantonis1, Petros P Sfikakis1,2
1Cardiovascular Risk Research Laboratory, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Insights
Cardiovascular risk prediction models often underestimate atherosclerotic cardiovascular risk in antiphospholipid syndrome (APS) patients. Vascular ultrasound (VUS) can improve risk assessment and management in these high-risk individuals.
Area of Science:
- Rheumatology and Cardiology
- Vascular Medicine
- Risk Prediction Modeling
Background:
- Antiphospholipid syndrome (APS) is associated with a high risk of atherosclerotic cardiovascular disease (ASCVR).
- Existing cardiovascular risk (CVR) prediction models may not accurately identify high-ASCVR in APS patients.
- Accurate risk stratification is crucial for timely intervention and management in APS.
Purpose of the Study:
- To evaluate the performance of established CVR prediction models in identifying high ASCVR in APS patients.
- To compare the accuracy of first-event and recurrent-event CVR prediction models.
- To assess the utility of vascular ultrasound (VUS) in reclassifying cardiovascular risk in APS.
Main Methods:
- Cross-sectional study involving 121 APS patients.
- Evaluated six first-CVD and three recurrent-CVD risk prediction models.
- Utilized carotid/femoral artery vascular ultrasound (VUS) to detect atherosclerotic plaques.
Main Results:
- All tested CVR prediction models demonstrated moderate calibration, poor-to-acceptable discrimination, and negligible-to-moderate classification accuracy.
- SMART and aGAPSSCVD models showed better performance among recurrent-CVD tools.
- VUS reclassified a significant proportion of patients (34.2%-52.6%) from non-high to high ASCVR categories.
Conclusions:
- Current clinical CVR prediction tools underestimate the actual high ASCVR in APS patients.
- Vascular ultrasound (VUS) shows promise in enhancing CVR assessment in APS.
- Improved risk assessment via VUS can facilitate optimal risk factor management.
Objectives:
This study aimed to assess the performance of cardiovascular risk (CVR) prediction models reported by European Alliance of Associations for Rheumatology and European Society of Cardiology recommendations to identify high-atherosclerotic CVR (ASCVR) patients with antiphospholipid syndrome (APS).
Methods:
Six models predicting the risk of a first cardiovascular disease event (first-CVD) (Systematic Coronary Risk Evaluation (SCORE); modified-SCORE; Framingham risk score; Pooled Cohorts Risk Equation; Prospective Cardiovascular Münster calculator; Globorisk), three risk prediction models for patients with a history of prior arterial events (recurrent-CVD) (adjusted Global APS Score (aGAPSS); aGAPSSCVD; Secondary Manifestations of Arterial Disease (SMART)) and carotid/femoral artery vascular ultrasound (VUS) were used to assess ASCVR in 121 APS patients (mean age: 45.8±11.8 years; women: 68.6%). We cross-sectionally examined the calibration, discrimination and classification accuracy of all prediction models to identify high ASCVR due to VUS-detected atherosclerotic plaques, and risk reclassification of patients classified as non high-risk according to first-CVD/recurrent-CVD tools to actual high risk based on VUS.
Results:
Spiegelhalter's z-test p values 0.47-0.57, area under the receiver-operating characteristics curve (AUROC) 0.56-0.75 and Matthews correlation coefficient (MCC) 0.01-0.35 indicated moderate calibration, poor-to-acceptable discrimination and negligible-to-moderate classification accuracy, respectively, for all risk models. Among recurrent-CVD tools, SMART and aGAPSSCVD (for non-triple antiphospholipid antibody-positive patients) performed better (z/AUROC/MCC: 0.47/0.64/0.29 and 0.52/0.69/0.29, respectively) than aGAPSS. VUS reclassified 34.2%-47.9% and 40.5%-52.6% of patients classified as non-high-ASCVR by first-CVD and recurrent-CVD prediction models, respectively. In patients aged 40-54 years, >40% VUS-guided reclassification was observed for first-CVD risk tools and >50% for recurrent-CVD prediction models.
Conclusion:
Clinical CVR prediction tools underestimate actual high ASCVR in APS. VUS may help to improve CVR assessment and optimal risk factor management.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
05:15Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Related Concept Videos
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure