Koroner anjiografi sinde hafi f aterosklerotik koroner lezyonu olan hastalarda miyokard perfüzyon sintigrafi bulguları

Amaç: Miyokard perfuzyon sintigrafi si (MPS) miyokard perfuzyonunun fonksiyonel değerlendirmesinde yaygın olarak kullanılmaktadır. Fakat bazı calısma sonucları koroner anjiografi ile tespit edilen koroner arter hastalığının siddeti ile zıtlık gosterir. Koroner anjiografi tamamen normalken MPS\'nde iskemiden bahsedilmesi sık karsılasılan bir durumdur. Bu calısmada, hafi fterosklerotik lezyonların iskemiye sebep olup olmadıklarını arastırmayı amacladık. Yöntem ve Gereç: Kardiyoloji Polikliniğine goğus ağrısı sikayeti ile basvuran ve 3 ay icerisinde koroner anjiografi yapılmıs olan 52 hastaya 99mTc-MIBI ile miyokard perfuyon sintigrafi si yapıldı. Bulgular: Hafi f derecede aterosklerotik lezyonu olan 52 hastanın 22\'sinde MPS\'de değisik derecelerde iskemi bulguları gozlendi. Yapılan istatistik analizde iskemi ile cinsiyet, hipertansiyon, DM, dislipidemi, sigara icme,mitral kapak yetmezliği, sol ventrikul hipertrofi si, efor test sonucu ve aterosklerotik lezyonun bulunduğu damar arasında anlamlı bir iliski tespit edilmedi. Sonuç: Calısma bulgularımız koroner arterlerdeki hafi f aterosklerotik lezyonların, cok erken donemlerde bile olsa, miyokardda iskemiye sebep olabileceğini gostermektedir.

Myocardial perfusion scintigraphy fi ndings in patients with mild coronary atherosclerotic lesions on coronary angiography

Objectives : Myocardial perfusion scintigraphy (MPS) iswidely used in functional assessment of myocardial perfusion. But, some study results are in contradiction with severity of coronary artery disease detected by coronary angiography (CA). It is frequently encountered case that CA is completely normal whereas MPS describes ischemia. In this study, we aimed to investigate whether mild atherosclerotic lesions cause ischemia. Materials and methods: MPS with 99mTc-MIBI was performed in 52 patients who applied to cardiology clinics for history of chest pain and underwent diagnostic CA within 3 months. Results: In 22 of 52 patients with mild atherosclerotic lesions, ischemia in various degrees was detected on MPS.In statistical analysis, any signifi cant relationship was not found between ischemia and gender, hypertension, DM, dyslipidemia, smoking, mitral valve insuffi ciency, left ventricular hypertrophy, exercise testing result and affected coronary artery. Conclusion: Our study fi ndings have shown that mild atherosclerotic lesions even at very early stage may cause myocardial ischemia

___

  • Alqaisi F, Albadarin F, Jaffery Z, et al. Prognostic predictors and outcomes in patients with abnormal myocardial perfu- sion imaging and angiographically insignifi cant coronary artery disease. J Nucl Cardiol 2008;15:754-61.
  • Ammann P, Naegeli B, Rickli H, et al. Characteristics of pa- tients with abnormal stress technetium Tc 99m sestamibi SPECT studies without signifi cant coronary artery diameter stenoses. Clin Cardiol 2003;26:521-4.
  • Rodés-Cabau J, Candell-Riera J, Angel J, et al. Relation of myocardial perfusion defects and nonsignifi cant coronary lesions by angiography with insights from intravascular ul- trasound and coronary pressure measurements. Am J Car- diol 2005;96:1621-6.
  • Wiedermann JG, Schwartz A, Apfelbaum M. Anatomic and physiologic heterogeneity in patients with syndrome X: An intra-vascular ultrasound study. J Am Coll Cardiol 1995;25:1310-7.
  • Verna E, Ceriani L, Giovanella L, Binaghi G, Garancini S. “False-positive” myocardial perfusion scintigraphy fi nd- ings in patients with angiographically normal coronary arteries: Insights from intravascular sonography studies. J Nucl Med 2000;41:1935-40.
  • Erbel R, Ge J, Bockisch A, et al. Value of intracoronary ultra- sound and Doppler in the differentiation of angiographical- ly normal coronary arteries: A prospective study in patients with angina pectoris. Eur Heart J 1996;17:880-9.
  • Kemp HGJ. Left ventricular function in patients with the an- ginal syndrome and normal coronary arteriograms. Am J Cardiol 1973;32:375-6.
  • Beller GA, Zaret BL. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation 2000;101:1465-78.
  • Vrints CJ, Bult H, Hitter E, Herman AG, Snoeck JP. Impaired endothelium-dependent cholinergic coronary vasodilation in pa-tients with angina and normal coronary arteriograms. J Am Coll Cardiol 1992;19:21-31.
  • Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshita A. Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993;328:1659-64.
  • Quyyumi AA, Cannon RO, Panza JA, Diodati JG, Epstein SE. Endothelial dysfunction in patients with chest pain and normal coronary arteries. Circulation 1992;86:1864-71.
  • Reis SE, Holubkov R, Lee JS, et al. Coronary fl ow velocity response to adenosine characterizes coronary microvascu- lar func-tion in women with chest pain and no obstructive coronary disease. Results from the pilot phase of the Wom- en’s Ischemia Syndrome Evaluation (WISE) study. J Am Coll Cardiol 1999;33:1469-75.
  • Johnson BD, Shaw LJ, Buchthal SD, et al. Prognosis in women with myocardial ischemia in the absence of obstruc- tive coro-nary disease: Results from the National Institutes of Health-National Heart, Lung, and Blood Institute-Spon- sored Women’s Ischemia Syndrome Evaluation (WISE). Circulation 2004;109:2993-9.
  • Buchthal SD, den Hollander JA, Merz CN, Rogers WJ, Pep- ine CJ, Reichek N. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain bu normal coronary angiograms. N Engl J Med 2000;342:829-35.
  • Ammann P, Naegeli B, Rickli H, et al. Characteristics of patients with abnormal stress technetium Tc-99m sestamibi SPECT studies without signifi cant coronary artery diameter stenosis. Clin Cardiol 2003;26:521-4.
  • Widlansky ME, Gokce N, Keaney JF,Vita JA. The Clinical Implications of Endothelial Dysfunction. J Am Coll Cardiol 2003;42:1149–60.
  • Picano E, Palinkas A, Amyot R. Diagnosis of myo- cardial ischemia in hypertensive patients. J Hypertens 2001;19:1177-83.
  • Fragasso G, Chierchia SL, Arioli F, et al. Coronary slow- fl ow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: long-term clinical and functional prognosis. Int J Cardiol 2009;137:137-44.
  • Di Carli MF, Janisse J, Grunberger G, Ager J. Role of chronic hyperglycemia in the pathogenesis of coronary microvascular dysfunction in diabetes. Am Coll Cardiol 2003;16: 1387-93.
  • Camici PG. Coronary microvascular dysfunction in patients with cardiomyopathies. Circ Heart Fail 2008;1:150-2.
  • Husmann L, Wiegand M, Valenta I, et al. Diagnostic ac- curacy of myocardial perfusion imaging with single photon emission computed tomography and positron emission to- mography: a comparison with coronary angiography. Int J Cardiovasc Imaging 2008;24:511-8.
Dicle Tıp Dergisi-Cover
  • ISSN: 1300-2945
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1963
  • Yayıncı: Cahfer GÜLOĞLU
Sayıdaki Diğer Makaleler

Psöriazis hastalarında yama testinin duyarlılığı

Yavuz YEŞİLOVA, Engin YAVUZ, Bilal SULA

Aynı fabrikadan yemek alan iki inşaat firması işçilerinde meydana gelen toplu besin zehirlenmesi

Vedat DORMAN, Selda ASLAN, Ali CEYLAN, Seher Nacar KÜÇÜK, Ahmet GÜNEL, Hıdır SARI, Nedim YAŞLI, Demet YALIM

Anne sütüne bağlı hipernatremik dehidratasyonun klinik bulguları ve tedavi önerileri

Cüneyt TAYMAN, Alparslan TONBUL, SALİH AYDEMİR, Aydın KÖŞÜŞ, Mustafa Mansur TATLI

Akut miyokard infarktüslü hastalarda trombolitik tedavi sonrası ST segment gerilemesi üzerine metabolik sendromun etkisi

Ayşe Saatcı YAŞAR, Nurcan BAŞAR, Ahmet KASAPKARA, İsa Öner YĞKSEL, Göktürk İPEK, Mehmet BİLGE

Endothelial dysfunction in high fructose containing diet fed rats: Increased nitric oxide and decreased endothelin-1 levels in liver tissue

Mustafa ALTAŞ, Ahmet VAR, Can KÖSE, Kemal ÖZBİLGİN, ZEKİ ARI

Çocukluk çağı inmeleri

Gülhis DEDA, Serap TEBER

Myocardial perfusion scintigraphy fi ndings in patients with mild coronary atherosclerotic lesions on coronary angiography

Zeki DOSTBİL, Çil HABİB, Ebru Özgür TEKBAŞ, Zuhal Arıtürk ATILGAN, Yahya İSLAMOĞLU, Bekir TAŞDEMİR, Yusuf DAĞ

Helikobakter pilori eradikasyonun fonksiyonel dispepsi semptomları üzerine kısa dönem etkileri

Esen AĞBABA, Yaşar NAZLIGÜL, ABDULLAH ÖZGÜR YENİOVA, Mehmet YILDIZ, Oktay BULUR, Ayla TEZER, Heyecan ÖKTEN

Kronik Hepatit C hastalarında pegile interferon-ribavirin kombinasyon tedavisinin tiroid fonksiyonları ve tiroid otoimmunitesi üzerine etkileri

Mehmet VATANSEVER, CÜNEYT ARDIÇ, Mehmet ZORLU, Muharrem KISKAÇ, Ferhat YILMAZ, Mustafa YENİGÜN

Tissue necrosis following intramuscular diclofenac injection

Halit BAYKAN, Samet Vasfi KUVAT, Mehmet BOZKURT, Emin KAPI, Feyzi ÇELİK