Asemptomatik Düşük Ejeksiyon Fraksiyonlu Hastalarda Koroner Arter Hastalığı Sıklığı

Amaç: Semptomu olmayan ve rastlantısal olarak ejeksiyon fraksiyonu (EF) düşük saptanan hastalarda etiyolojinin aydınlatılması için rutin olarak koroner anjiografi (KAG) önerilmemektedir. Ancak ejeksiyon fraksiyonunu düşüklüğü nedeninin iskemik kaynaklı olması kötü prognozla ilişkilidir ve etiyolojinin aydınlatılması amaçlı KAG yapılması faydalı olabilir. Çalışmamızda semptomu olmayan ve sol ventrikül EF si düşük olup KAG uygulanan hastalarda koroner arter hastalığı sıklığı araştırılmıştır. Yöntemler: Düşük ejeksiyon fraksiyonunun aydınlatılması amacıyla hastanemizde KAG yapılan 100 hasta çalışmaya alınmıştır. Bu hastaların hiçbirisinin kalp yetmezliği semptomu ya da göğüs ağrısı bulunmamaktaydı.Bulgular: Hastaların yaş ortalaması 61 ve erkek cinsiyet oranı %75'dir. Ortala EF %33,8 dır. KAG sonrası iskemik etiyoloji %26 olarak saptanmıştır. 19 hasta girişim yapılan tedavi grubuna alınmış ve bu hastaların 8 ine koroner arter bypass cerrahisi (KABG) uygulanmış, 11 hastaya ise stent implante edilmiştir.17 hastada koroner arterler normal saptanmıştır.64 hastada ise medikal tedavi kararı alınmıştır. Bu gruptaki hastaların 7 si iskemik olan gruba, 57 si ise iskemik olmayan gruba dahil edilmiştir. Sonuç: Çalışmamızda göğüs ağrısı ya da kalp yetersizliği semptomu olmayan, ejeksiyon fraksiyonu düşük hastalarda koroner arter hastalığı sıklığı değerlendirilmiştir.

Coronary Artery Disease Frequency in Asymptomatic Low Ejection Fraction Patients

Objective: In asymptomatic and incidentally detected low ejection fraction patients, performing a coronary angiography (CAG) is not recommended routinely. But the prognosis for patients with ischemic etiology remains worse and performing CAG for the elucidation of the etiology may be beneficial. In our study, in asymptomatic and low EF patients who underwent CAG, coronary artery disease frequency was investigated. Methods: Totally 100 coronary angiography were performed at our institution for the elucidation of the etiology. The patients do not have angina or heart failure symptoms. Results: The median age was 61 years with 75% male ratio. Mean ejection fraction was 33.8%. Ischemic etiology was 26% after coronary angiography. The prevalence of CABG was 8 and stenting was 11 patients, CABG and stenting group was defined as invasive therapy group with 19 patients. The prevalence of normally coronary artery was 17. The prevalence of medical therapy decision was 64 patients. The medical therapy patients were divided into two groups. 7 patients were in ischemic group and 57 patients were in non-ischemic group.Conclusion: In our study, in patients without chest pain or symptoms of heart failure with low ejection fraction, incidence of coronary artery disease were evaluated.

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1. Onat A, Ugur M, Tuncer M, et al. [Age at death in the Turkish Adult Risk Factor Study: temporal trend and regional distribution at 56,700 person-years' follow-up]. Turk Kardiyoloji Dernegi arşivi: Turk Kardiyoloji Derneginin yayin organidir 2009;37:155-60.
2. Gheorghiade M, Bonow RO: Chronic heart failure in the United States: a manifestation of coronary artery disease. Circulation 1998, 97:282-89.
3. Flegal KM, Carroll MD, Kuczmarski RJ, et al. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity 1998;22:39-47.
4. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European journal of heart failure 2012;14:803-69.
5. Bart BA, Shaw LK, McCants CB, et al. Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy. Journal of the American College of Cardiology 1997;30:1002-1008.
6. Felker GM, Shaw LK, O'Connor CM: A standardized definition of ischemic cardiomyopathy for use in clinical research. Journal of the American College of Cardiology 2002;39:210- 8.
7. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European heart journal 2012;33:1787-847.
8. Gianrossi R, Detrano R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation 1989;80:87-98.
9. Adams KF, Jr., Dunlap SH, Sueta CA, et al. Relation between gender, etiology and survival in patients with symptomatic heart failure. Journal of the American College of Cardiology 1996;28:1781-88.
10. Anderson LJ, Holden S, Davis B, et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. European heart journal 2001;22:2171-79.
11. Itoh-Satoh M, Hayashi T, Nishi H, et al. Titin mutations as the molecular basis for dilated cardiomyopathy. Biochemical and biophysical research communications 2002;291:385-93.
12. Figulla HR, Kellermann AB, Stille-Siegener M, et al. Significance of coronary angiography, left heart catheterization, and endomyocardial biopsy for the diagnosis of idiopathic dilated cardiomyopathy. American heart journal 1992;124:1251-57.
13. Melo RM, Melo EF, Biselli B, et al. Clinical usefulness of coronary angiography in patients with left ventricular dysfunction. Arquivos brasileiros de cardiologia 2012;98:437-41.
14. Kartal T, Yavuz A, Çetinçakmak MG, et al. Evaluation of the relationship between coronary artery calcium score and coronary artery disease by multislice computed tomography. Dicle Medical Journal 2013;40:632-6.
15. ten Kate GJ, Caliskan K, Dedic A, et al.Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology. European journal of heart failure 2013;15:1028-34.