The MAPH Score Predicts Coronary Slow Flow. A Retrospective Case-Controlled Study

Aim. The MAPH score is a new score that combines mean platelet volume (MPV), hematocrit, and total protein, which are markers of whole blood viscosity (WBV). We aimed to investigate the relationship between the MAPH score and the coronary slow flow phenomenon (CSF).

Material and methods. A total of 201 patients were included in the study. 105 had CSF and 96 had normal coronary flow (NCF). Coronary flow was measured by the Thrombolysis in Myocardial Infarction frame count (TFC) method. The patients’ MPV, age, hematocrit, and total protein were recorded. High (HSR) and low shear rates (LSR) were calculated, based on total protein and hematocrit values. Cut-off values for CSF were determined using the Youden’s index, and the score was determined as 0 or 1 according to the cut-off values. The sum of these scores was the MAPH score.

Results. The mean age of the patients included in the study was 51.1±7.9 (n=201, 54.2 % male). Hyperlipidemia, DM, and HT rates of both groups were similar, but the mean age of the CSF group was higher (p=0.773; p=0.549; p=0.848; p <0.001, respectively). Total protein, MPV, hematocrit, HSR and LSR were higher in the CSF group (p< 0.001, for all values). Comparative receiver operating characteristic (ROC) curve analysis showed that the performance of the MAPH score in predicting CSF is better than the performance of these parameters separately.

Conclusion. A new score, the MAPH score, may be used to identify the presence of CSF.

1.

2. Zivanic A, Stankovic I, Ilic I, Putnikovic B, Neskovic AN. Prognosis of patients with previous myocardial infarction, coronary slow flow, and normal coronary angiogram. Herz. 2020;45(S1):88–94. DOI: 10.1007/s00059-019-4817-4

3. Li N, Tian L, Ren J, Li Y, Liu Y. Evaluation of homocysteine in the diagnosis and prognosis of coronary slow flow syndrome. Biomarkers in Medicine. 2019;13(17):1439–46. DOI: 10.2217/bmm-2018-0446

4. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries – A new angiographic finding. American Heart Journal. 1972;84(1):66–71. DOI: 10.1016/0002-8703(72)90307-9

5. Buber I, Nar R, Kaya D, Senol H, Adali MK, Nar G. Assessment of triglyceride/glucose index with respect to coronary slow flow. Bratislava Medical Journal. 2022;123(8):585–8. DOI: 10.4149/BLL_2022_095

6. Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R et al. Vascular endothelial function in patients with slow coronary flow. Coronary Artery Disease. 2003;14(2):155–61. DOI: 10.1097/00019501-200304000-00008

7. Cin VG, Pekdemir H, Ahmet Camsar, Dilek Cicek, Akkus MN, Parmakýz T et al. Diffuse Intimal Thickening of Coronary Arteries in Slow Coronary Flow. Japanese Heart Journal. 2003;44(6):907–19. DOI: 10.1536/jhj.44.907

8. Cetin MS, Ozcan Cetin EH, Canpolat U, Aydın S, Temizhan A, Topaloglu S et al. An overlooked parameter in coronary slow flow phenomenon: whole blood viscosity. Biomarkers in Medicine. 2015;9(12):1311–21. DOI: 10.2217/bmm.15.92

9. Mahfouz HM, Yassen IAEF, Mahgoub KAM. Noninvasive Predictors of Coronary Slow Flow Phenomenon in Patients Presenting with Chronic Coronary Syndrome. Cardiology and Angiology: An International Journal. 2022;11(1):11–20. DOI: 10.9734/ca/2022/v11i130185

10. Zhu X, Shen H, Gao F, Wu S, Ma Q, Jia S et al. Clinical Profile and Outcome in Patients with Coronary Slow Flow Phenomenon. Cardiology Research and Practice. 2019;2019:9168153. DOI: 10.1155/2019/9168153

11. Abacioglu OO, Yildirim A, Karadeniz M, Abacioglu S, Koyunsever NY, Dindas F et al. A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score. Clinical and Applied Thrombosis/Hemostasis. 2022;28:107602962110737. DOI: 10.1177/10760296211073767

12. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal. 2020;41(1):111–88. DOI: 10.1093/eurheartj/ehz455

13. Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669–701. DOI: 10.2337/dci18-0033

14. Aciksari G, Cetinkal G, Kocak M, Atici A, Celik FB, Caliskan M. The relationship between triglyceride/high-density lipoprotein cholesterol ratio and coronary slow-flow phenomenon. The International Journal of Cardiovascular Imaging. 2022;38(1):5–13. DOI: 10.1007/s10554-021-02387-w

15. Sloop G, Holsworth RE, Weidman JJ, St Cyr JA. The role of chronic hyperviscosity in vascular disease. Therapeutic Advances in Cardiovascular Disease. 2015;9(1):19–25. DOI: 10.1177/1753944714553226

16. Pepe MS. The statistical evaluation of medical tests for classification and prediction. -Oxford ; New York: Oxford University Press;2003. - 302 p. ISBN 978-0-19-850984-4

17. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5. DOI: 10.1002/1097-0142(1950)3:13.0.CO;2-3

18. Candemir M, Şahinarslan A, Yazol M, Öner YA, Boyaci B. Determination of myocardial scar tissue in coronary slow flow phenomenon and the relationship between amount of scar tissue and NT-proBNP. Arquivos Brasileiros de Cardiologia. 2020;114(3):540–51. DOI: 10.36660/abc.2018149

19. Nwose EU. Cardiovascular risk assessment and support techniques: Whole blood viscosity assessment issues I: Extrapolation chart and reference values. North American Journal of Medical Sciences. 2010;2(4):165–9. DOI: 10.4297/najms.2010.2165

20. Pekdemir H, Cin VG, Cicek D, Camsari A, Akkus N, Döven O et al. Slow coronary flow may be a sign o diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiologica. 2004;59(2):127–33. DOI: 10.2143/AC.59.2.2005166

21. Ugwoke CK, Cvetko E, Umek N. Skeletal Muscle Microvascular Dysfunction in Obesity-Related Insulin Resistance: Pathophysiological Mechanisms and Therapeutic Perspectives. International Journal of Molecular Sciences. 2022;23(2):847. DOI: 10.3390/ijms23020847

22. Beltrame JF. Defining the Coronary Slow Flow Phenomenon. Circulation Journal. 2012;76(4):818–20. DOI: 10.1253/circj.CJ-12-0205

23. Yaylali YT, Susam I, Demir E, Bor-Kucukatay M, Uludag B, Kilic-Toprak E et al. Increased red blood cell deformability and decreased aggregation as potential adaptive mechanisms in the slow coronary flow phenomenon. Coronary Artery Disease. 2013;24(1):11–5. DOI: 10.1097/MCA.0b013e32835b0bdf

24. Cutri N, Zeitz C, Kucia AM, Beltrame JF. ST/T wave changes during acute coronary syndrome presentation in patients with the coronary slow flow phenomenon. International Journal of Cardiology. 2011;146(3):457–8. DOI: 10.1016/j.ijcard.2010.10.120

25. De Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation. 1990;81(1):107–17. DOI: 10.1161/01.CIR.81.1.107

26. Dormandy JA, Hoare E, Colley J, Arrowsmith DE, Dormandy TL. Clinical, Haemodynamic, Rheological, and Biochemical Findings in 126 Patients with Intermittent Claudication. BMJ. 1973;4(5892):576–81. DOI: 10.1136/bmj.4.5892.576

27. Cho YI, Cho DJ, Rosenson RS. Endothelial Shear Stress and Blood Viscosity in Peripheral Arterial Disease. Current Atherosclerosis Reports. 2014;16(4):404. DOI: 10.1007/s11883-014-0404-6

28. Ösken A, Haci R, Dinç Asarcikli L, Arikan ME, Onuk T, Ünal Dayi Ş et al. Mean platelet volume/platelet count ratio as a predictor of stent thrombosis in patients with ST-segment–elevation myocardial infarction. Irish Journal of Medical Science (1971 -). 2021;190(3):1095– 102. DOI: 10.1007/s11845-021-02626-y

29. Korkmaz L, Ata Korkmaz A, Akyuz AR, Agac MT, Acar Z, Kiris A et al. Association between mean platelet volume and coronary artery calcification in patients without overt cardiovascular disease: an observational study. The Anatolian Journal of Cardiology. 2012;12(1):35–9. DOI: 10.5152/akd.2012.007

30. Damaske A, Muxel S, Fasola F, Radmacher MC, Schaefer S, Jabs A et al. Peripheral hemorheological and vascular correlates of coronary blood flow. Clinical Hemorheology and Microcirculation. 2011;49(1–4):261–9. DOI: 10.3233/CH-2011-1476

31. Rao AK, Goldberg RE, Walsh PN. Platelet coagulant activities in diabetes mellitus. Evidence for relationship between platelet coagulant hyperactivity and platelet volume. The Journal of Laboratory and Clinical Medicine. 1984;103(1):82–92. PMID: 6690642

32. Gunebakmaz O, Kaya MG, Kaya EG, Ardic I, Yarlioglues M, Dogdu O et al. Mean platelet volume predicts embolic complications and prognosis in infective endocarditis. International Journal of Infectious Diseases. 2010;14(11):e982–5. DOI: 10.1016/j.ijid.2010.05.019

33. Huang Q, Zhang F, Chen S, Dong Z, Liu W, Zhou X. Clinical characteristics in patients with coronary slow flow phenomenon: A retrospective study. Medicine. 2021;100(6):e24643. DOI: 10.1097/MD.0000000000024643

34. Herrera MD, Mingorance C, Rodríguez-Rodríguez R, Alvarez De Sotomayor M. Endothelial dysfunction and aging: An update. Ageing Research Reviews. 2010;9(2):142–52. DOI: 10.1016/j.arr.2009.07.002

35. Ghaffari S, Tajlil A, Aslanabadi N, Separham A, Sohrabi B, Saeidi G et al. Clinical and laboratory predictors of coronary slow flow in coronary angiography. Perfusion. 2017;32(1):13–9. DOI: 10.1177/0267659116659918