Non-obstruktif Koroner Arter Hasta Grubunda Miyokardiyal İskeminin Miyokard Perfüzyon Sintigrafisi ve Speckle Tracking Ekokardiyografi ile Değerlendirilmesi

Year 2022, Volume: 3 Issue: 3, 269 - 275, 30.11.2022

Mehmet Arslan , Ahmet Barutçu , Şeyda Ferah Arslan , Ali Duygu

https://doi.org/10.48176/esmj.2022.85

Abstract

Giriş: 2D speckle tracking ekokardiyografi ile yapılan strain analizinin ciddi koroner arter hastalığı tanısında kullanılabileceği diğer çalışmalarla gösterilmiştir. Bu çalışmada amaç, miyokard Perfüzyon Sintigrafisi (MPS) pozitif olan fakat ciddi koroner arter hastalığı (KAH) olmayan hasta grubunda, 2D speckle tracking ekokardiyografinin etkinliği değerlendirmektir. Yöntemler: Çalışmaya kararlı anjina pektoris ön tanısıyla tetkik edilip MPS‟de iskemi saptanan ve yapılan koroner anjiografide non-obsrüktif KAH (<%50 darlık) izlenen 40 (25‟i kadın, yaş:58,85±9,73) hasta dahil edildi. Tüm hastalarda 2D speckle tracking ekokardiyografi yöntemiyle strain analizi yapıldı. 17 LV miyokard segmenti için longitudinal strain ölçüldü. Sol ventrikül segmentleri MPS sonuçlarına göre iskemik ve iskemik olmayan segmentler olarak gruplandırıldı ve elde edilen 680 segmentin strain parametreleri karşılaştırıldı. Bulgular: İskemi saptanan segmentlerin ortalama longitudinal strain değerleri % -20,24±6,00, iskemi saptanmayan segmentlerin ise %-20,11±6,46 olarak bulundu ve istatistiksel olarak anlamlı fark gözlenmedi (p>0,05). Cinsiyet, hipertansiyon, diabetes mellitus, hiperlipidemi, hipertrigliseridemiye göre yapılan alt grup analizlerinde de iskemik olan ve olmayan segmentler arasında longitudinal strain açısından fark olmadığı izlendi. Sonuç: Ciddi koroner arter hastalığı olmayan hasta grubunda MPS pozitif olan segmentler ile MPS negatif olan segmentler açısından sol ventrikül 2D longitudinal strain analizinde stain parametreleri arasında fark olmadığı izlendi. Daha önceki çalışmalar da göz önüne alındığında 2D strain analizi MPS ile kombine olarak kullanılarak böbrek yetmezliği, şüpheli MPS pozitifliği, gibi özel durumlarda gereksiz koroner anjiografiden kaçınılmasını sağlayabiliriz.

Keywords

koroner arter hastalığı, miyokard perfüzyon sintigrafisi, speckle tracking ekokardiyografi, longitudinal strain

Evaluation of Myocardial Ischemia with Myocardial Perfusion Scintigraphy and 2D- Speckle Tracking Echocardiography in Non-Obstructive Coronary Artery Patient Group

Abstract

Introduction: Strain analysis with 2D speckle tracking echocardiography could be used in the diagnosis of severe coronary artery disease. The aim of this study is to evaluate the effectiveness of 2D speckle tracking echocardiography in a group of patients with positive myocardial Perfusion Scintigraphy (MPS) but without severe coronary artery disease (CAD). Methods: Forty (25 female, age: 58.85±9.73) patients with the of angina pectoris and ischemia was found in MPS but non-obstructive CAD (<50% stenosis) was observed in coronary angiography was included. Strain analysis was performed in all patients using 2D speckle tracking echocardiography. Longitudinal strains weremeasured for 17 LV myocardial segments. LV segments were grouped as ischemic and non-ischemic segments according to MPS results and strain parameters of 680 segments were compared. Results: The mean longitudinal strain values of the segments with ischemia were -20.24±6.0%, and the segments without ischemia were found as -20.11±6.46%, and no statistically significant difference was observed (p>0.05). In subgroup analyzes based on gender, hypertension, diabetes mellitus, hyperlipidemia, and hypertriglyceridemia, no difference was observed between ischemic and non-ischemic segments in terms of longitudinal strain. Conclusion: In the patient group without severe coronary artery disease, no difference was observed between the staining parameters in the left ventricle 2D longitudinal strain analysis in terms of MPS positive segments and MPS negative segments. Considering previous studies, by using 2D strain analysis in combination with MPS, we can avoid unnecessary coronary artery angiography in special cases such as kidney failure, suspected MPS positivity.

Keywords

coronary artery disease, myocardial perfusion scintigraphy, speckle tracking echocardiography, longitudinal strain

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