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

Year 2019, Volume: 9 Issue: 1, 74 - 79, 27.03.2019
https://doi.org/10.16899/gopctd.419200

Abstract

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

References

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  • 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
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  • 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
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  • 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
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  • 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
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  • 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
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  • 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
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  • 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
Year 2019, Volume: 9 Issue: 1, 74 - 79, 27.03.2019
https://doi.org/10.16899/gopctd.419200

Abstract

References

  • 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
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Sadık Server

Memduh Dursun This is me

Bülent Acunaş This is me

Publication Date March 27, 2019
Acceptance Date February 4, 2019
Published in Issue Year 2019 Volume: 9 Issue: 1

Cite

APA Server, S., Dursun, M., & Acunaş, B. (2019). Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi. Çağdaş Tıp Dergisi, 9(1), 74-79. https://doi.org/10.16899/gopctd.419200
AMA Server S, Dursun M, Acunaş B. Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi. J Contemp Med. March 2019;9(1):74-79. doi:10.16899/gopctd.419200
Chicago Server, Sadık, Memduh Dursun, and Bülent Acunaş. “Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi”. Çağdaş Tıp Dergisi 9, no. 1 (March 2019): 74-79. https://doi.org/10.16899/gopctd.419200.
EndNote Server S, Dursun M, Acunaş B (March 1, 2019) Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi. Çağdaş Tıp Dergisi 9 1 74–79.
IEEE S. Server, M. Dursun, and B. Acunaş, “Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi”, J Contemp Med, vol. 9, no. 1, pp. 74–79, 2019, doi: 10.16899/gopctd.419200.
ISNAD Server, Sadık et al. “Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi”. Çağdaş Tıp Dergisi 9/1 (March 2019), 74-79. https://doi.org/10.16899/gopctd.419200.
JAMA Server S, Dursun M, Acunaş B. Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi. J Contemp Med. 2019;9:74–79.
MLA Server, Sadık et al. “Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi”. Çağdaş Tıp Dergisi, vol. 9, no. 1, 2019, pp. 74-79, doi:10.16899/gopctd.419200.
Vancouver Server S, Dursun M, Acunaş B. Asemptomatik Tip 2 Diyabetes Mellitus Tanılı Hastalarda Koroner Arterlerin 64-Dedektörlü Bilgisayarlı Tomografi İie Değerlendirilmesi. J Contemp Med. 2019;9(1):74-9.