title: Can a novel scoring system derived from hemodynamic and anthropometric variables predict sympathetic drive in young patients?
abstract: OBJECTIVE
  Sympathetic overdrive is generally the main pathophysiological abnormality in cardiovascular disease. However, its grading is not easy in clinical practice because of its complex interactions and differences in phenotypical expression. We proposed an easy, feasible, and global scaling system for sympathetic activity level. 'Sympathetic activity index' (SAI) is based on scores of heart rate, BMI, and blood pressure categories, which are the major representatives of sympathetic activity.
  
  
  METHODS
  Respectively, 1, 2, and 3 points were determined for heart rate below 69, 70-89, and above 90 bpm; -1, 1, and 2 points for BMI less than 20, 20-24.9, and at least 25 kg/m; and 1, 2, and 3 points for normal, prehypertension, and hypertension categories. Demographic and echocardiographic parameters, and left ventricular (LV) mass and mass indexes (LVMIBSA and LVMIHeight) of 545 young males were compared among groups with SAI 1-8.
  
  
  RESULTS
  We observed that LVM, LVMIBSA, and LVMIHeight, left atrial diameter were significantly increased in association with SAI (P<0.001). SAI was correlated with LVM (R=0.314, P<0.001), LVMIBSA (R=193, P<0.001), and LVMIHeight (R=0.316, P<0.001). SAI of at least 5.5 could determine the left ventricular hypertrophy with a sensitivity and a specificity of 57 and 70%, respectively (AUC=682, 95% confidence interval 0.610-0.753, P<0.001).
  
  
  CONCLUSIONS
  Integration of clinical, anthropometric, and hemodynamic variables in a novel index such as SAI may provide an objective and noninvasive means of grading actual sympathetic drive. SAI may be used to follow-up sympathetic activity and to predict clinical events in the management of young patients with cardiovascular and metabolic abnormalities.
authors.affiliation: aDepartment of Cardiology, Kasimpasa Military Hospital bDepartment of Cardiology, Haydarpasa Training Hospital, Istanbul cDepartment of Cardiology, Gulhane School of Medicine, Gulhane Military Medical Academy dDepartment of Internal Medicine, Etimesgut Military Hospital, Ankara Turkey eClinica Medica, Università Milano-Bicocca, Milan, Italy.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Aparci
authors.forename: Cengiz
authors.initials: C
authors.lastname: Ozturk
authors.forename: Turgay
authors.initials: T
authors.lastname: Celik
authors.forename: Sevket
authors.initials: S
authors.lastname: Balta
authors.forename: Zafer
authors.initials: Z
authors.lastname: Isilak
authors.forename: Mehmet
authors.initials: M
authors.lastname: Karaduman
authors.forename: Ejder
authors.initials: E
authors.lastname: Kardesoglu
authors.forename: Atilla
authors.initials: A
authors.lastname: Iyisoy
authors.forename: Francesco
authors.initials: F
authors.lastname: Fici
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D015992:Body Mass Index; D004452:Echocardiography; D006339:Heart Rate; D006352:Heart Ventricles / Q000294:innervation / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D055815:Young Adult