Myokard perfüzyon sintigrafisi için klinisyenlerin endikasyonları

AMAÇ: Bu çalışmada hangi klinik endikasyonlarla hastaların myokard perfüzyon sintigrafisine MPS sevk edildiğini araştırmayı amaçladık. YÖNTEMLER: Bölümümüze MPS için gönderilen hastaları, koroner arter hastalığı KAH öyküsü, KAH için risk faktörleri, yaş ve cinsiyete göre retrospektif olarak inceledik. MPS için endikasyonlar şu şekilde beş kategoriye ayrıldı: KAH tanısı; koroner stenozun etkisinin araştırılması; canlılık tayini; kardiak-dışı cerrahi için cerrahi öncesi risk tayini; tedavi etkinliğinin araştırılması. BULGULAR: 770 hasta çalışmaya dahil edildi. Hastaların çoğunluğu 531 hasta, %69 KAH tanısı için MPS' ye sevkedildi ve bunların çoğunluğu KAH için düşük riskli hastalardı 369 hasta, %69,5 . 531 hastanın 128'i KAH için orta riskli, 34'ü ise yüksek riskli hasta grubundaydı. MPS için diğer endikasyonlar, tedavi etkinliğinin belirlenmesi %24,9 , koroner stenozun etkisinin tayini % 3,8 , cerrahi öncesi risk değerlendirmesi % 1,7 ve canlılık tayini %0,6 idi. SONUÇ: Bulgularımız MPS' nin bölgemizde etkin bir şekilde kullanılmadığını göstermektedir. Cerrahi öncesi risk değerlendirmesi, canlılık ve koroner stenozun fonksiyonelliğinin araştırılmasını içeren birçok endikasyon nadiren kullanılmaktadır. KAH için düşük risk grubundaki hastalar ise uygunsuz olarak MPS'ye gönderilen hastaların çoğunluğunu oluşturmaktadır.

Anahtar Kelimeler:

Myokard perfüzyon sintigrafisi, koroner arter hastalığı, risk faktörleri

Referral physicians' indications for myocardial perfusion scintigraphy

OBJECTIVE: We aim to investigate which clinical indications led to referrals for myocardial perfusion scintigraphy MPS METHODS: We retrospectively analyzed patients referred to our department for MPS based on previous history of coronary artery disease CAD , risk factors for CAD, age, and gender. Clinical indications for MPS were sorted into the following five categories: diagnosis of CAD; assessment of the impact of coronary stenosis; viability assessment; preoperative risk assessment of non-cardiac surgery; estimation of treatment effects. RESULTS: 770 patients were included in the study. Most of the patients were referred for MPS for diagnosis of CAD 531 patients, 69% , and most had a low probability of CAD 369 patients, 69.5% . Of the 531 patients, 128 patients had an intermediate probability and 34 patients had high probability of CAD. Other indications for MPS included estimation of treatment effects 24.9% , assessment of the impact of coronary stenosis 3.8% , preoperative risk assessment 1.7% , and viability assessment 0.6% . CONCLUSION: Based on our results, MPS is not used effectively in our region. Most of the indications, including preoperative risk assessment and viability were rarely used. In a high proportion of cases, MPS was used inappropriately to evaluate patients with a low probability of CAD.

Keywords:

Myocardial perfusion imaging, coronary disease, risk factors,

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1. The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects). Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet 2013; 21: S0140-6736(13)61836-X.
2. Lloyd-Jones DM, Wilson PW, Larson MG, Beiser A, Leip EP, D'Agostino RB et al. Framingham risk score and prediction of lifetime risk for coronary heart disease. Am J Cardiol 2004; 94(1): 20-24.
3. Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico JA, Wang FP, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1995; 26(3): 639-47.
4. Akıncıoğlu Ç, Atasever T, Caner B, Kaya GÇ, Kıraç S, Ünlü M. Nükleer Kardiyoloji Uygulama Kılavuzu. Turk J Nucl Med 2001; 10(Supp): S42- S56 (Article in Turkish).
5. Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol 2009; 53(23): 2201- 2229.
6. Yapıcı O. Patient selection criteria in myocardial perfusion scintigraphy: a retrospecttive analysis of 990 regionally referred and single center reported ceses. Turk J Nucl Med 2010; 19(3):110-117 (Article in Turkish with an abstract in English).
7. Gulati M, Cooper-DeHoff RM, McClure C, Johnson BD, Shaw LJ, Handberg EM, et al . Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women's Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med 2009; 169(9):843-850 .
8. Iskandar A, Limone B, Parker MW, Perugini A, Kim H, Jones C, et al. Gender differences in the diagnostic accuracy of SPECT myocardial perfusion imaging: A bivariate meta-analysis. J Nucl Cardiol 2013; 20(1):53-63.
9. Hachamovitch R, Hayes S, Friedman JD, Cohen I, Shaw LJ, Germano G, et al. Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: What is the warranty period of a normal scan? J Am Coll Cardiol 2003; 41:1329-1340.
10. Simonsen JA, Gerke O, Rask CK, Tamadoni, M, Thomassen A, Hess S, et al. Prognosis in patients with suspected or known ischemic heart disease and normal myocardial perfusion: long-term outcome and temporal risk variations. J Nucl Cardiol 2013; 20(3):347- 357.
11. Elhendy A, Schinkel A, Bax JJ, van Domburg RT, Poldermans D. Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study. J Nucl Cardiol 2003; 10(3):261-266.
12. Khawaja FJ, Jouni H, Miller TD, Hodge DO and Gibbons RJ. Downstream clinical implications of abnormal myocardial perfusion single-photon emission computed tomography based on appropriate use criteria. J Nucl Cardiol 2013; 20(6):1041-1048.