Koroner kalsiyum skorlamanın, 64- Kesitli Bilgisayarlı Tomografi Anjiografi ile belirlenen koroner arter hastalığını öngörme değerinin koroner arter hastalığının geleneksel risk faktörleri ile karşılaştırılması

Year 2012, Volume: 19 Issue: 4, 131 - 138, 30.12.2012

Fatma Koç Elif Ergün , Ömer Yılmaz , Pınar Koşar Uğur Koşar

Abstract

Amaç: Çalışmanın amacı koroner kalsiyum skorlamanın , 64- kesitli Bilgisayarlı tomografi anjiografi (BTA) ile belirlenen koroner arter hastalığının (KAH) varlığını ve yaygınlığını öngörmedeki değerini belirlemek ve gelenkesel risk faktörleri ile karşılaştırmaktır.
Gereç Yöntem: Çalışmaya 545 hasta dahil edildi. Tüm hastalara koroner BTA' den hemen önce koroner kalsiyum skorlama gerçekleştirildi. Koroner BT çekimleri 64-kesitli BT cihazı (Toshiba, Aquillon 64, Toshiba Medical Systems, Otowara, Japonya) ile yapıldı. Koroner kalsiyum skorunun BTA ile belirlenen KAH'ını ön görme değeri ROC analizi ile değerlendirlirken geleneksel risk faktörleri ile çoklu değişkenli regresyon analizi ile karşılaştırıldı.
Bulgular: ROC analizie, koroner kalsiyum skorlamanın BTA ile belirlenen tıkayıcı hastalığı ön görmede değerli olduğunu göstermiş olup eğri altında kalan alan 0.833 bulunmuştur. Yaş, erkek cinsiyet, menapoz, DM ve HT'nun tıkayıcı KAH'ı ön görme değeri istatistiksel olarak analamlı bulunurken, kalsiyum skorlamanın prediktif değeri bu değişkenlerden bağımsız bulunmuştur. Kalsiyum skoru 0 olan 302 hastanın 83'ünde (%27.6%) koroner BTA'ya göre hasyalık tespit edilmiştir.
Sonuç: Koroner kalsiyum skorlama 64- kesitli BTA ile tespit edilen KAH varlığı ve yaygınlığının belirlenmesinde etkili bir yöntem olup bu anlamda etkisi geleneksel risk faktörlerinden bağımsız ve onlara üstündür. Bu etki kadın ve erkeklerde eşit düzeydedir. Ancak 0 skor hastalığı tümüyle dışlamamaktadır.

Keywords

Koroner kalsiyum skorlama, 64- Kesitli Bilgisayarlý Tomografi Anjiografi, Koroner arterhastalýðý

References

• Wong ND, Hsu JC, Detrano RC, Diamond G, Eisenberg H, Gardin JM. Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol 2000; 86:495-8
• Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary Artery Calcium Score Combined With Framingham Score for Risk Prediction in Asymptomatic Individuals. JAMA 2004; 291:210-5
• Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognnostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003; 228: 826–33
• Hazýrolan T. Koroner ve kardiak BT anjiyografi: güncel
• uygulamalar ve endikasyonlar. Hacettepe Týp Dergisi 2008; 39:153-61
• Bonow RO. Clinical Practice. Should coronary calcium screening be used in cardiovascular prevention strategies?. N Engl J Med 2009; 361:990-7
• Budoff MJ, Gul KM. Expert review on coronary calcium. Vasc Health Risk Manag 2008; 4: 315-24
• Detrano R,Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnics grups. N Engl J Med 2008; 358:1336-45
• Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronar calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol 2005; 46:158-65
• Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohort of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA 2000; 284:311-8
• Jhonson KM, Dowe DA, Brink JA. Traditional clinical risk assessment tools do not accuractely predict coronary atherosclerotic plaque burden: A CT angiography study. AJR 2009; 192:235-43
• Agatson AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary arter calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15:827-32
• Henneman M, Shuijf JD, Pundziute G, van Werkhoven JM, van der Wall EE, Jukema JW, et al. Noninvasive evaluation with multislice computed tomography in suspected acute coronary syndrome: plaqu morphology on multislice computeed tomography versus coronary calcium score. Am Coll Cardiol 2008; 52:216-22
• Raggi PG, Gongora MC, Gopal A, Callister TQ, Budoff
• M, Shaw LJ. Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol 2008; 1:17-23
• Oei HH, Vliegenthart S, Hofman A, Oedkerk M, Witteman JJ. Risk factors for coronary calcification in older subjects: The Rotterdam Coronary Calcification Study. Eur Heart J 2004; 25:48-55
• Nasir K, Raggi P, Rumberger JA, Budoff MJ, Blumenthal RS. Electron beam tomography in women. Is it valuable test? Cardiol Rev 2005; 13:174-83
• Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. J Am Coll Cardiol 2007; 20: 1230-50
• Mýchos ED, Nasýr K,Braunstein JB, Rumberger JA, Budoff MJ, Post WS, et al. Framingham risk equation underestimates subclinical atherosclerosis risk in asemptomatic women. Atherosclerosis 2006; 184:201- 6
• Eroðlu E, Bayrak F, Gemici G, Güneysu T, Mutlu B, Kalkan AK, et al. Prevalance of coronary artery disease in low to moderate-risk asymptomatic women: a multislice computed tomography study. Turk Kardiyol Dern Ars 2008; 36:439-45
• Raggi P, Shaw LJ, Berman DS, Callister TQ. Gender- based differences in the prognostic value of coronary calcification. J Womens Health 2004, 13: 273–83
• Bellasi A, Lacey C, Taylor AJ, Raggi P, Wilson PW, Budoff MJ, et al. Comparison of prognostic usefulness of coronary artery calcium in men versus women (results from a meta- and pooled analysis estimating all-cause mortality and coronary heart disease death or myocardial infarction). Am J Cardiol 2007; 100:409–14
• Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98:731-3
• Bild DE, Detrano R, Peterson D, Guerci A, Liu K, Shahar E, et al. Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2005; 111:1313–20
• Nasir K, Shaw LJ, Liu ST, Weinstein SR, Mosler TR, Flores PR, et al. Ethnic differences in the prognostic value of coronary artery calcifi cation for allcause mortality. J Am Coll Cardiol 2007;50: 953–60.
• Raggi P, Khan A, Arepali C, Stillman AE. Coronary arter calcium scoring in the age of CT Angiography: What is its role?. Curr Atheroscler Rep 2008; 10:438- 443
• Herzog C, Britten M, Balzer JO, Mack MG, Zangos S, Ackermann H, et al. Multidedector–row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic, but atipical, chest pain. Eur Radiol 2004; 14:169-77
• Rubinshtein R, Gaspar T, Halon DA, Goldstein J, Peled N, Lewis BS. Prevalance and extend of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrom. Am J Cardiol 2007; 99:472-5
• Budoff MJ, McClelland RL, Nasir K, Greenland P, Kronmal RA, Kondos GT, et al. Cardiovascular events with absent or minimal coronary calcification: The Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 2009; 158:554-61
• Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Cury RC, et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging 2009; 2:692-700
• Blaha M, Budoff MJ, Shaw LJ, Khosa F, Rumberger JA, Berman D, et al. Absence of coronaryartery calcification and all-cause mortality. JACC Cardiovasc Imaging 2009; 53:345-52