Diabetes mellitus hastalarında koroner kan akımı rezervinin değerlendirilmesinde TC-99m sestamibi miyokart perfüzyon sintigrafisinin niceliksel analizi

Amaç: Bu çalışmada, diabetes mellitus (DM) hastalarında özel bir niceliksel analiz yöntemi uygulayarak, Tc-99m sestamibi miyokart perfüzyon sintigrafisi (MPS) verilerinden koroner kan akımı rezervinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Elli yaş üzerinde, en az 10 yıldır DM tanısı ile izlenen, hipertansiyonu, bilinen koroner arter hastalığı (KAH) veya geçirilmiş miyokart enfarktüsü olmayan ve sigara kullanmayan 38 DM hastası ile yaş bakımından hasta grubu ile eşdeğerde ve KAH yönünden düşük risk taşıyan 19 kontrol olgusuna tek gün istirahat-stres Tc-99m sestamibi MPS tetkiki uygulandı. Stres sırasında istirahat durumuna göre miyokart kan akımında meydana gelen artış, sol ventrikülden elde edilen sayımlar ve enjekte edilen radyoaktivite miktarları kullanılarak, artış oranı (%IR) biçiminde hesaplandı. Bulgular: Hesaplanan %IR değerleri diyabetli hastalarda kontrollere oranla istatiksel olarak anlamlı olmamakla birlikte (p = 0,27) düşük bulundu. Beş DM hastasında ve iki kontrol hastasında MPS’de miyokart iskemisi saptanması nedeniyle, bu hastalar dışarıda bırakılarak istatiksel analiz tekrarlandığında %IR değerleri yönünden bulgularda değişiklik olmadı (p = 0,27). Tüm grupta miyokart iskemisi saptananlarda %IR değerleri miyokart iskemisi saptanmayanlara oranla anlamlı ölçüde düşük bulundu (p = 0,02). Sonuç: DM hastaları ile kontrol grubu arasında %IR değerleri bakımından anlamlı bir farklılık saptanmamıstır. Buna rağmen hem DM hastalarında hem de miyokart iskemisi saptananlarda %IR değerlerinin daha düsük bulunmus olması, rutin MPS verilerinin niceliksel olarak değerlendirilmesinin uygulanabilirliği ve KAH tanısına katkısı yönünden ümit vericidir.

Quantitative analysis of TC-99m sestamibi myocardial perfusion scintigraphy in the evaluation of coronary blood flow reserve in diabetes mellitus patients

Purpose: To evaluate the additional diagnostic value of a specific quantification methodology applied to routine MPS in the evaluation of coronary blood flow reserve in a group of patients with type-2 DM. Materials and Methods: We applied single-day rest-stress MPS to 38 diabetic patients over 50 years of age, with DM durations longer than 10 years, and without hypertension, cigarette smoking, known coronary artery disease, or previous myocardial infarction; and to an age-matched control group of 19 patients with low risk for coronary artery disease. Using left ventricular myocardial counts obtained from SPECT data and the injected amounts of Tc-99m sestamibi, we calculated the relative increase in myocardial counts during exercise in comparison to rest conditions, as %IR, for each patient. Results: The calculated %IR values were lower in diabetic patients, although the difference was not statistically significant (p = 0.27). Because MPS revealed myocardial ischemia in 5 diabetic and 2 control patients, statistical analysis was repeated after exclusion of these ischemic patients. However, the result of this analysis was similar (p = 0.27). In the whole study groups, %IR values were significantly lower in patients with myocardial ischemia compared to patients with normal MPS findings (p = 0.02). Conclusion: With respect to %IR values, no significant difference was found between diabetic patients and the control group. However, the finding that %IR values were lower both in diabetics compared to controls and in ischemic patients compared to non-ischemic patients is promising for the applicability of quantitative analysis of routine MPS data and its possible contribution to the diagnosis of coronary artery disease.

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