Ö. ÖMÜR, A. AKGÜN, Z. ÖZCAN, İ. T. ÇALKAVUR, O. YAVUZGİL, H. ÖZKILIÇ

Rest-nitrat Tc-99m MIBI Gated SPECT’in viabilite ve sol ventrikül fonksiyonlarının degerlendirilmesindeki yeri

Amaç: Koroner arter hastalığında viabl miyokardı infarkt dokusundan ayırt etmek, revaskülarizasyon sonuçlarının öngörülmesi ve tedavi yaklaşımının belirlenmesinde çok önemlidir. Bu çalışmada sublingual nitrat uygulaması ile yapılan Tc-99m MIBI Gated SPECT’in viabilite tanısındaki yerini araştırmak amaçlandı. Yöntem ve Gereç: Koroner arter hastalığı tanısı olan 50 hasta (11 kadın, 39 erkek; ortalama yaş: 61.7±8.3) çalışmaya alındı. Tüm olgular rest-nitrat Tc-99m MIBI Gated SPECT, ekokardiyografi ve anjiyografi ile değerlendirildi. Elli hastada sol ventrikül (LV) myokardına ait toplam 250 segmentin fonksiyonel parametreleri vizüel ve kantitatif olarak incelendi. Bulgular: İkiyüzelli segmentin 165’inde normal perfüzyon saptanırken, 44’ünde reversibl, 41’inde irreversibl perfüzyon defekti mevcuttu. >%50 koroner arter darlığı anlamlı kabul edildiginde, perfüzyon defekti saptanan toplam 85 segmentin 59’unda segmenti besleyen koroner arterde anlamlı darlık saptandı. Myokard perfüzyon sintigrafisinde (MPS) perfüzyon defekti olmayan 165 segmentin 105’inde anlamlı koroner arter stenozu yoktu. Gated SPECT ile ekokardiyografi bulguları karşılaştırıldığında, QPS/QGS programıyla hesaplanan ortalama Ejeksiyon Fraksiyonu (EF) değeri (43.8±29.5) ile ekokardiyografik verilerden elde edilen (46.3±29.5) arasında anlamlı fark saptanmadı. MPS’de irreversibl perfüzyon defektleri olan olgularda ortalama EF (39.2±9.4) genel grup ortalamasından (43.8±29.5) anlamlı düşüktü. 250 segmentin 219’unda Gated SPECT ve EKO ile elde edilen LV fonksiyonel verileri uyumlu bulundu. Sonuç: Rest-Nitrat Tc-99m MIBI Gated SPECT’in viable myokardiyumun araştırılmasında perfüzyon ve LV fonksiyonlarının bir arada değerlendirilebilme avantajı sunan, güvenilir bir yöntem olduğu sonucuna varıldı.

Nitrate-enhanced Tc-99m MIBI Gated SPECT for evaluating viable myocardium and left ventricular functions in patients with coronary artery disease

Aim: In this study, we aimed to research the place of Tc-99m MIBI Gated SPECT used with the sublingual nitrate application in the viability diagnosis. Material and Methods: Fifty patients diagnosed with a coronary artery disease were included in the study. All subjects were evaluated with rest-nitrate Tc-99m MIBI Gated SPECT, echocardiography and angiography. In 50 patients, myocardial perfusion and functional parameters were examined. The five segments myocardial model was used. Results: Normal perfusion was determined in 165 of the 250 segments, there were reversible perfusion defects in 44 and irreversible perfusion defects in 41 segments. If >%50 coronary artery narrowness is accepted as significant stenosis, in 59 of the 85 segments in total in which a perfusion defect was detected, we have detected a significant narrowness in the feeding coronary artery. In the myocardial perfusion scintigraphy (MPS) there was not any significant coronary artery stenosis in 105 of the 165 segments with no perfusion defect. When the findings of the Gated SPECT and echocardiography findings were compared, no statistically significant difference was found between the average EF value (43.8+-29.5) calculated with the QPS/QGS programme and the value obtained from the echocardiographic data (46.3+-29.5). In the subjects with irreversible perfusion defects in MPS, the average EF (39.2±9.4) was lower than the general group average (43.8±29.5). LV functional data obtained with Gated SPECT and echocardiography were found compatible in 219 of the 250 segments. Conclusion: We have concluded that Rest-Nitrate Tc-99m MIBI Gated SPECT is a reliable method in viable myocardium research which gives an advantage ın evauatıng LV functions.

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