Düşük-Orta Test Öncesi Olasılığı Olan ve Efor Testi Pozitif Saptanan Genç Bayanlarda Koroner Bilgisayarlı Tomografik Anjiyografi Yaklaşımı

Year 2015, Volume: 18 Issue: 1, 6 - 9, 06.04.2015

Ahmet Çağrı Aykan , Ezgi Kalaycıoğlu Tayyar Gökdeniz Duygun Altıntaş Aykan İsmail Gökhan Çavuşoglu Abdulkadir Uslu Ahmet Oğuz Aslan Ömer Faruk Çırakoğlu Banu Şahin Yıldız Şükrü Çelik

Abstract

Giriş: Test öncesi olasılığı
orta olan ve egzersiz elektrokardiyografi testi (EEKT) pozitif saptanan
hastalarda stres görüntüleme yöntemi önerilmektedir. Ancak koroner bilgisayarlı
tomografik anjiyografinin (KBTA) test öncesi olasılığı orta olan ve efor testi
pozitif saptanan genç bayan hastalarda kullanımı halen tartışmalıdır. Bu
çalışmanın amacı düşük-orta test öncesi olasılığı olan ve EEKT pozitif saptanan
genç bayanlarda KBTA tanısal öneminin saptanmasıdır.

Hastalar ve Yöntem: Haziran 2011 ile haziran
2014 tarihleri arasında başvuran EEKT pozitif olan 67 genç bayan çalışmamıza
retrospektif olarak dahil edildi. Bu 67 hastanın 32’sine KBTA 35’ine MPS
yapıldı.

Bulgular: Hastaların
demografik ve kardiyovasküler risk profilleri benzerdi. Bütün hastaların
EEKT’si pozitifti. Hastaların efor kapasitesi ve Duke treadmil skorları
benzerdi. Kan biyokimyası benzerdi. Tıkayıcı koroner arter hastalığı (KAH)
açısından ortanca test öncesi olasılığı 
KBTA grubunda %28 (15-45%) MPS grubundan (15-50) daha düşüktü (p=
0.045). KBTA yapılan 3 hastada MPS yapılan 7 hastada ciddi lezyon tespit
edildi. KBTA’sı ciddi olan 3 hastanın hepsinde ciddi KAH saptandı. Ancak
MPS’sinde iskemi saptanan 7 hastanın 3’ünde ciddi KAH saptandı.

Sonuç: Test öncesi
olasılığı düşük-orta olan efor testi pozitif genç bayan hastalarda KBTA stres
görüntüleme yöntemlerine kullanışlı bir alternatif olabilir. 

Keywords

Egzersiz elektrokardiyografi, bilgisayarlı tomografi, anjiyografi, test öncesi olasılık, kadın, genç

Computed Tomography Angiography Approach in Low-Intermediate Test Probability with Positive Exercise Electrocardiography Test in Young Women

Abstract

Introduction: Stress imaging tests are
recommended in patients with positive exercise electrocardiography (EECG) and
intermediate pretest probability. However the role of coronary computed
tomography angiography (CCTA) in young women with intermediate pretest
probability and positive EECG is under debate. The aim of this study was to
assess the diagnostic value of CCTA in young women patients with
low-intermediate pretest probability and positive EECG results.

Patients and Methods: From a retrospective
registry of 67 young women with positive EECG between January 2011 and January
2014 were included in this study. Of these 67 patients 32 patients underwent
CCTA and 35 patients underwent MPS after EECG.

Results: There were no
statistically significant differences between groups in demographic variables,
or cardiovascular risk profile. The exercise test was positive in all patients.
Both groups were similar for exercise capacity and Duke treadmill score. Blood
chemistry of the patients were similar. The median pre-test probability of
obstructive coronary artery disease (CAD) was lower in CCTA group 28% (15-45%)
than in MPS group (15-50) (p= 0.045). Overall 3 patients in the CCTA  and 7 patients in the MPS group had
significant lesions. All patients in the CCTA positive group had significant
CAD, while 3 out of 7 patients with positive MPS findings had significant CAD
in coronary angiography.

Conclusion:
CCTA may be a valuable alternative of stress imaging tests in
women patients with low-intermediate pretest probability and positive EECG.

Keywords

Exercise electrocardiography, computed tomography, angiography, pretest probability, women, young

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