Sadık SERVER, Memduh DURSUN, Bülent ACUNAŞ

Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi

Amaç: Diyabetli hastalarda başlıca ölüm nedeni olan koroner arter hastalığı (KAH) hastaların bir bölümünde sessiz seyreder. Bu çalışmanın amacı asemptomatik tip II diyabetli hastalarda gizli KAH prevalansını, mevcut plakların yaygınlığını, lokalizasyonunu ve özelliklerini çok kesitli bilgisayarlı tomografi anjiografi (ÇKBTA) ile değerlendirmektir. Gereç ve Yöntem: Tip II diyabet tanılı KAH açısından asemptomatik olan 100 hasta ÇKBTA ile prospektif değerlendirildi. Kalsiyum skorlama amacıyla kontrastsız görüntüler elde edildikten sonra i.v. kontrast madde verilerek 64 dedektörlü BT ile koroner anjiografik görüntüler alındı. Kontrastsız görüntüler üzerinden koroner arter kalsiyum skoru hesaplandı ve plakların kalsiyum içeriği incelendi. Koroner angiografik görüntülerden elde edilen reformat görüntülerden ise plakların yaygınlığı, lokalizasyonu ve oluşturdukları darlık dereceleri değerlendirildi. Kategorik değişkenlerin istatistiksel değerlendirilmesinde Pearson ki-kare testi ve Fisher gerçeklik testi kullanıldı. Bulgular: Çalışmaya dahil edilen 80 hastanın %72’si erkek (n=58) ve %27’si (n=22) kadındı. Ortalama yaşları 53±8 ve çekim esnasında kalp hızları ise 64±7 idi. 49 hastada (%61) aterosklerotik plak saptandı; Kalsifik plak en çok saptanan aterosklerotik plak tipiydi (%35), soft plak 9 (%11.3) hastanın en az bir koroner arter segmentinde saptandı. 14 (%17.5) hastada orta darlık, 11 (%13.7) hastada ciddi darlık ve böylelikle 25 (%31.3) hastada anlamlı darlık (≥ %50) saptandı. Tek damar hastalığı (19, %23.7), iki damar hastalığı (15, %18.7), üç damar hastalığı (15, %18.7) saptandı. Sonuç: Diyabetli hastalarda asemptomatik KAH’ın ortaya konmasında ÇKBTA noninvazif ve güvenilir bir yöntem olarak kullanılabilir

Anahtar Kelimeler:

diyabetes mellitus, koroner arter hastalığı

PDF

___

Referans 1. Csilla Celeng, Pa ́Maurovich-Horvat, Brian B. Ghoshhajra, Be ́la Merkely, Tim Leiner, and Richard A.P. Takx , Prognostic Value of Coronary Computed Tomography Angiography in Patients With Diabetes: A Meta-analysis. Diabetes Care 2016;39:1274–1280
Referans2. SarwarN,GaoP,SeshasaiSR,etal.;Emerg- ing Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010;375:2215– 2222
Referans3. Mezzetti A., Cipollane F., Cuccurullo F.: “Oxidative stress and cardiovascular complications in diabetes; isoprostanes as new markers on an old paradigm" Cardiovascular Res. 2000;47: 475-488
Referans4. Paolisso G., Giugliano D., "Oxidative stress and insulin action: is there a relationship?" Diabetologia 1996; 39: 357-363
Referans5. Vanizör B., Örem A., Karahan SC., and et al., "Decreased nitirc oxide end-products its relationship with high density lipoprotein and oxidative stress in people with type II diabetes without complications" Diabetes Res. Clin.Prac. 2001;54: 33-39
Referans6. Giugliano D., Ceriello A., Paolissa G., "Diabetes mellitus, hypertension and cardiovasculer diseases. The role of oxidative stress" Metabolism 1995; 44: 363-368
Referans7.Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ, Kim HK, Choi DJ, Blumenthal RS, Chang HJ: Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 2008, 52:357–65
Referans8. Katada K. Half-second, half millimeter real time multislice helical CT: CT diagnosis using Aquillon. Medical Review 1999;68: 1–8
Referans9. Pannu HK, Flohr TG, Corl FM, Fishman EK. Current concepts in multi-detector row CT evaluation of the coronary arteries: principles, techniques, and anatomy. Radiographics 2003; 23: 111–125
Referans10. De Feyter PJ, Nieman K. New coronary imaging techniques: what to expect? Heart 2002; 87: 195–197
Referans11. Cademartiri F, Mollet N, van der Lugt A, et al. Noninvasive 16-row multislice CT coronary angiography: usefulness of saline chaser. Eur Radiol 2004; 14: 178–183
Referans12. Hu H, He HD, Foley WD, Fox SH. Four multidetector-row helical CT: image quality and volume coverage speed. Radiology 2000; 215: 55–62
Referans13. Napel S, Marks MP, Rubin GD et al. CT angiography with spiral CT and maximum intensity projection. Radiology 1992; 185: 607-610
Referans14. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–832
Referans15. Ross R. The pathogenesis of atherosclerosis. Nature 1993; 362: 801–809
Referans16. Schoepf UJ, Becker CR, Hofmann LK, Yucel EK. Multidetector-row CT of the heart. Radiol Clin North Am 2003; 41: 491–505
Referans17. Herzog C, Britten M, Balzer JO, Mack MG, Zangos S, Ackermann H, Schaechinger V, Schaller S, Flohr T, Vogl TJ. Multidetector-row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic, but atypical, chest pain. Eur Radiol 2004; 14: 169–177.
Referans18. Leiner T, Gerretsen S, Botnar R, Lutgens E, Cappendijk V, Kooi E, van Engelshoven J. Magnetic resonance imaging of atherosclerosis. Eur Radiol 2005; 15: 1087–1099
Referans19. Bernhard L. Gerber, Emmanuel Coche, Agnès Pasquet, Etienne Ketelslegers; Coronary Artery Stenosis: Direct Comparison of Four-Section Multi–Detector Row CT and 3D Navigator MR Imaging for Detection—Initial Radiology 2005; 234: 98–108
Referans20. Expert Panel of Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486 –97.
Referans21. Fox CS, Golden SH, Anderson C, et al.; American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research; American Diabetes Association. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 2015;38:1777–1803
Referans22. Bax JJ, Bonow RO, Tschope D, Inzucchi SE, Barrett EJ. Global dialogue group for the evaluation of cardiovascular risk in patients with diabetes: The potential of myocardial perfusion scintigraphy for risk stratification of asymptomatic patients with type 2 diabetes. J Am Coll Cardiol 2006;48:754-60
Referans23. Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed to- mography. J Am Coll Cardiol 2005;46:552–557
Referans24.Mollet NR, Cademartiri F, van Mieghem CA, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 2005;112:2318–2323
Referans25. Jakobs TF, Becker CR, Ohnesorge B, et al. Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur Radiol 2002;12:1081–1086
Referans26. Cody DD, Mahesh M. AAPM/RSNA Physics Tutorial for Residents: Physics of Cardiac Imaging with Multiple-Row Detector CT. Radiographics 2007;2:1829-37
Referans27. Gerber TC, Kuzo RS, Morin RL. Techniques and parameters for estimating radiation exposure and dose in cardiac computed tomography. Int J Cardiovasc Imaging 2005; 21: 165–176
Referans28. Mieres JH, Shaw LJ, Arai A, et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 2005;111:682–96