Predição de rigidez aórtica elevada através do escore sage em uma amostra de pacientes ambulatoriais

Abstract

Background: This study aimed to identify the ideal cutoff point of the SAGE score, which indicates a high risk of pulse wave velocity (PWV) ≥10 m/s, in a sample of outpatients with and without systemic arterial hypertension (SAH), in the city of Santa Maria, RS. Because the SAGE score has not been validated so far in populations without the diagnosis of SAH, the applicability of sage in the sample of non-hypertensive individuals involved a hypothesis analysis. Materials and Methods: An analysis was performed in individuals with and without diagnosis of SAH, who underwent follow-up in a private cardiology service. The PWV was measured by oscillometric device (Dyna-MAPA-AOP®, Cardios, São Paulo, Brazil). A total of 307 individuals were included, who had data collected from medical records. After applying the SAGE score, the results were compared with the PWV. The ROC curve was elaborated using the Youden index in order to establish the best score that identifies patients at high risk of high PWV. Results: Age ranged from 30 to 92 years. PWV ≥ 10 m/s occurred only in patients aged ≥ 66 years. The ideal cutoff point in the SAGE score, according to the Youden Index, was identified in 6. In individuals with SAH (n=212), the ROC curve presented an area under the curve (AUC) with accuracy of 93.8% (95% CI from 90.8% to 96.8%, p ≤0.001). Of the 95 non-hypertensives, the cutoff point ≥ 6 was found to be the most accurate. The AUC determined the accuracy of the SAGE score of 96.9% (95% CI from 94.0% to 99.8%, p≤0.001). Analyzing the total population (with and without SAH, n=307), it was observed the accuracy of the SAGE score in predicting VOP ≥ 10 m/s of 94.8% (95% CI from 92.9% to 97.0%, p≤0.001). A qualitative analysis was performed, also seeking the best specificity of the method. A cutoff point 7 in the group with SAH (n=212) decreased sensitivity to 68%, but increased specificity to 92%, with a negative likelihood ratio (LR-) of 0.3467. This ensured that those with SAGE score <7 likely would not have high PWV. In the non-hypertensive group (n=95), the cutoff point adjustment to 7 decreased the sensitivity to 70% and increased the specificity to 95%, with an LR- of 0.3169. Conclusion: In a cross-sectional analysis of patients with and without SAH, a cutoff point ≥ 6 by Youden´s statistics was predictive of those individuals with PWV ≥ 10m/s. The qualitative analysis determined the best cutoff point as ≥ 7 to predict PWV ≥ 10m/s.