#2531 AGATSTON INDEX AS A PREDICTOR OF PREDICTION OF THE DEGREE OF HEART VASCULAR DAMAGE IN STAGE 5 CKD PATIENTS RECEIVING PROGRAM HEMODIALYSIS
Authors: Rasulev Yorkin , Daminov Botir 
Published: June 2023

Abstract

Background and Aims
Cardiovascular events (CVEs) are the leading cause of death in patients with chronic kidney disease (CKD). A retrospective analysis of the causes of death of a large group of nephrological patients shows that the mortality of patients from cardiovascular events is more than 4.1 higher than the number of deaths from all kidney diseases, including end-stage chronic kidney disease [1]. Aim of the study: to evaluate the possibility of CI for predicting the degree of damage to the coronary arteries of the heart in patients with CKD.

Method
In a prospective study for MSCT, 60 patients were selected (30 patients each from groups 1 and 2 (15 patients in subgroups) with CKD stage 5 of various etiologies receiving PG. The results of multispiral CT-coronary angiography in 60 consecutive patients/clients of a multidisciplinary clinic were analyzed. Among them were: 41 men (68.3%) and 19 women (31.6), the age ranged from 28 to 74 years (mean age - 53.4 ± 11.89 years). The mean age of the woman was 55.05 ± 11.92 years; men 52.63 ± 11.61 years old, there were no statistically significant differences between the age, heart rate, SBP and DBP of women and men, which indicates the representativeness of the groups.

Results
To assess coronary calcification, MSCT of the chest was performed to determine the mass and volume of coronary calcium. When compared in group 1 patients, in relation to group 2 patients in all coronary basins, there is a significant increase in the content of coronary calcium (p&lt;0.05 for all indicators). The Agatston index in the examined patients ranged from 0 to 790 units (units). Patients with CI ranging from 101 to 400 units. were older - from 34 to 54 years (mean age 42.77 years). Among them, males clearly predominated. In 50% of patients, there was a multivascular lesion of the coronary arteries with significant stenosis in the anterior interventricular branch (LAD) and the right coronary artery (RCA), and without significant stenosis in the circumflex branch of the left coronary artery. With CI over 400 units. all 30 examined patients had multiple coronary artery stenoses, the maximum of which exceeded 70%. At the same time, 5 patients (8.3%) had 4 stenoses of the coronary arteries of the heart. This is consistent with evidence that increased cardiovascular risk is associated with total coronary artery calcium load. Taking into account the fact that according to the results of the study it was found that in many patients with coronary artery stenosis from 20 to 49%, belonging to the group of patients with high cardiovascular risk and with stenosis of more than 50%, to the group of very high risk, having an increased CI, then this indicator can be used as an additional indicator for cardiovascular risk stratification to predict cardiovascular events.

Conclusion
The Agatston index or CI, determined using multislice CT, can be used as a screening method for detecting coronary artery atherosclerosis and determining cardiovascular risk. With CI over 100 units. the vast majority of the surveyed revealed multiple stenoses of the coronary arteries, with an indicator of more than 400 units. hemodynamically significant arterial damage is expected. Such patients should undergo an additional examination: functional tests (bicycle ergometry, treadmill test, daily ECG monitoring) or contrast coronary angiography to verify the main diagnosis and to decide on further tactics for managing patients.