Negatif Koroner Bilgisayarlı Tomografi Anjiyografide Saptanan Ekstrakardiyak Anormalliklerin Sıklığı ve Klinik Semptomlarla İlişkisi

Abstract

Koroner bilgisayarlı tomografi anjiyografi (koroner BTA), hem koroner arterleri hem de ekstrakardiyak bulguları değerlendirmede kullanılan değerli bir görüntüleme yöntemidir. Göğüs ağrısı ve dispne gibi semptomların kardiyak olmayan nedenlerinin tanınması, tanısal etkinliği artırabilir. Bu çalışmanın amacı, normal veya non-obstrüktif koroner BTA bulguları olan hastalarda ekstrakardiyak bulguların prevalansını değerlendirmek ve bu bulguların hastaların başvuru semptomlarını (örneğin göğüs ağrısı veya efor dispnesi) açıklayıp açıklayamayacağını belirlemektir. Ocak 2021 ile Aralık 2024 tarihleri arasında göğüs ağrısı veya dispne şikayetleri nedeniyle koroner BTA yapılan 358 hastanın retrospektif analizi gerçekleştirildi. Obstrüktif koroner arter hastalığı, konjenital koroner anomaliler, kapak hastalığı veya akut koroner sendrom tanısı olan hastalar çalışma dışı bırakıldı. Tüm koroner BTA görüntüleri, iki deneyimli radyolog tarafından ekstrakardiyak anormallikler açısından değerlendirildi ve bu bulguların hastanın semptomları ile olası ilişkisi incelendi. Ekstrakardiyak bulgular 236 hastada (%65,9) saptandı. En sık görülen bulgu vertebral dejeneratif değişikliklerdi (%39,1), bunu atelektazi (%14,8) ve amfizem (%10,6) izledi. Göğüs ağrısı olan hastaların %56’sında, efor dispnesi olan hastaların ise %64’ünde semptomlarla ilişkili olabilecek ekstrakardiyak bulgular tespit edildi. Kadın cinsiyet (p<0,05) ve ileri yaş (p<0,001), ekstrakardiyak bulguların daha yüksek prevalansı ile anlamlı şekilde ilişkili bulundu. Göğüs ağrısı ya da efor dispnesi nedeniyle koroner BTA uygulanan hastaların önemli bir kısmında, şikayetleri açıklayabilecek ekstrakardiyak anormallikler mevcuttur. Koroner BTA sırasında görülebilen tüm anatomik yapıların dikkatli bir şekilde değerlendirilmesi, tanısal etkinliği ve hasta yönetimini artırabilir. Kardiyak olmayan göğüs ağrısı ve dispne değerlendirmesinde bu bulguların rolünü araştırmak için ileri çalışmalara ihtiyaç vardır.

Keywords

• Ekstrakardiyak bulgular
• kardiyak olmayan göğüs ağrısı
• efor dispnesi.
• koroner BTA

The Prevalence of Extracardiac Abnormalities Identified in Negative Coronary Computed Tomography Angiography and Its Association with Clinical Symptoms

Abstract

Coronary computed tomography angiography (CCTA) is valuable for assessing both coronary and incidental extracardiac findings. Recognizing non-cardiac causes of chest pain and dyspnea can improve diagnostic efficiency. This study aimed to assess the prevalence of extracardiac findings in patients with normal or non-obstructive CCTA and to determine whether these findings could account for their presenting symptoms, such as chest pain or exertional dyspnea. We retrospectively analyzed 358 patients who underwent coronary computed tomography angiography between January 2021 and December 2024 due to chest pain or dyspnea. Patients with obstructive coronary artery disease, congenital coronary anomalies, valvular disease, or acute coronary syndrome were excluded. Two experienced radiologists reviewed all scans for extracardiac abnormalities and evaluated their potential relationship with patient symptoms. Extracardiac findings were identified in 236 patients (65.9%), with vertebral degenerative changes (39.1%) being the most frequent, followed by atelectasis (14.8%) and emphysema (10.6%). Findings potentially explaining chest pain were noted in 56% of patients with this symptom, while 64% of those with exertional dyspnea had relevant extracardiac abnormalities. Female sex and older age were significantly associated with higher prevalence of extracardiac findings (p<0.05 and p<0.001, respectively). A substantial proportion of patients undergoing CCTA for chest pain or exertional dyspnea harbor extracardiac abnormalities that may explain their complaints. Careful evaluation of all structures visible on CCTA can improve diagnostic efficiency and patient management. Further studies are warranted to explore the role of these findings in non-cardiac chest pain and dyspnea.

Keywords

• Extracardiac findings
• coronary CT angiography
• CCTA
• non-cardiac chest pain
• exertional dyspnea.

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