Abdullah GÜVEN, Ömer Çağlar YILMAZ, Yusuf SELÇOKİ, Muhammed Bora DEMİRÇELİK, Özgür Gürel MALÇOK

Geniş hasta popülasyonunda çok kesitli bilgisayarlı tomografik anjiyografi ile saptanan miyokardiyal köprü prevelansı

Amaç: Göğüs ağrısı ile başvuran 1696 hastada Multi-dedektör bilgisayarlı tomografi (MDCT) ile miyokardiyal köprü insidansını saptamak Materyal ve Metot: Temmuz 2007 ile Ocak 2010 arasında koroner arter hastalığı ön tanısı ile veya postoperatif koroner bypass cerrahisi geçiren ya da stent takılan göğüs ağrısı olan 1696 sıralı hasta çalışmaya alındı. Kalp hızı dakikada 65 atım üzeri olan hastalara işlemden 1 saat önce 50-100 mg oral metoprolol süksinat veya 2,5- 5 mg iv metoprolol verildi. BT koroner anjiyografi 64 kesitli MDCT ile uygulandı. Hasta bilgilerini bilmeyen bir radyolog tarafından görüntüler değerlendirildi. Klinik korelasyon miyokardiyal köprü varlığına göre uygulandı. Bulgular: 1696 hastanın 198inde (%11,6) miyokardiyal köprü saptandı ve bunların 167sinde (%84) köprü sol anteriyor inen arter (LAD)nin orta 1/3lük kısmında, 13 ünde (%6,5), proksimal 1/3ünde, 15inde (%7,5) distal 1/3ünde, 1inde obtus marjin (OM) de, 2sinde (%1) RCAda saptandı. Tünel arterin uzunluğu 5 ile 50 mm (ortanca 20,3 mm) arası hesaplandı. Köprüsü olan 12 hastada göğüs ağrısının nedeninin miyokardiyal köprü ile ilişkili olduğu düşünüldü. Diğer 186 hastada ise göğüs ağrısının başka nedenleri mevcuttu. Sonuçlar: Miyokardiyal köprü insidansını %11,6 olarak bulduk. Göğüs ağrısı olan bir hastada miyokardiyal köprü bir sebep olabilir. MDCT miyokardiyal köprüyü saptamada faydalı bir tanısal araç olabilir.

Prevalence of myocardial bridging detected with multidetector CT coronary angiography in a large patient population

Background: To evaluate the prevalence of myocardial bridging in 1696 patients with chest pain examined with 64-row Multidetector CT (MDCT) coronary angiography. Material and Methods: A total of 1696 consecutive patients followed with coronary artery disease or postoperative stent and bypass, underwent CTA performed by 64-MDCT scanner between July 2007 and Janury 2010. Patients with heart rates 65 beats/min received 25-50 mg metoprolol orally or 2,5-5 mg iv 1 h before the scan. A CT coronary angiography was performed with a 64-row MDCT scanner. CT coronary angiographic images were evaluated by one radiologist, who was blinded to the clinical information. Clinical correlation was performed with the presence of myocardial bridging on MDCT. Results: Among 1696 patients, 198 (11.6%) cases of myocardial bridging were detected, and 167 (84%) cases of myocardial bridging were located at the middle third of the left anterior descending coronary artery (LAD), 13 (6.5%) cases were situated at the proximal third of the LAD. Also 15 (7.5%) cases at the distal third of the LAD. 1 (0.5%) case on the obtuse marginal, and 2 (1.0%) cases on the right coronary arteries were detected. The length of the tunneled artery was between 5 and 50 mm (median: 20.3 mm). Chest pain of 12 patients was assumed to be associated with myocardial bridging. In the other 186 patients with bridging, alternative causes of chest pain were present. Conclusions: We found that the prevalence of myocardial bridging in this patient group was 11.6%. Myocardial bridging may be considered in patients with chest pain. MDCT coronary angiography may be a useful diagnostic tool for detecting myocardial bridging.

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