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

Yıl 2022, Cilt: 3 Sayı: 3, 269 - 275, 30.11.2022

Mehmet Arslan Ahmet Barutçu Şeyda Ferah Arslan Ali Duygu

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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Rigo P, Braat S. Radiopharmaceuticals for the study of heart. In: Murray I, Ell P, editors. Nuclear Medicine in Clinical Diagnosis and Treatment. Hong Kong: Churchill Livingstone; 1994. p. 1059–68.
• Van Train K, Garcia E, Cooke C, et al. Quantitative Analysis of SPECT Myocardial perfusion: 99mTc-sestamibi SPECT. In: Cardiac SPECT imaging. Hong Kong: Lippincott-Raven Publisher; 1996. p. 121–46.
• Dowsley T, Al-Mallah M, Ananthasubramaniam K, et al. The Role of Noninvasive Imaging in Coronary Artery Disease Detection, Prognosis, and Clinical Decision Making. Vol. 29, Canadian Journal of Cardiology. 2013. p. 285–96.
• Verna E, Ceriani L, Giovanella L, et al. “‘False-Positive’” Myocardial Perfusion Scintigraphy Findings in Patients with Angiographically Normal Coronary Arteries: Insights from Intravascular Sonography Studies. J Nucl Med. 2000;41:1935–40.
• Slart RHJA, Bax JJ, van Veldhuisen DJ, et al. Imaging techniques in nuclear cardiology for the assessment of myocardial viability. Vol. 22, International Journal of Cardiovascular Imaging. 2006. p. 63–80.
• Shimoni S, Gendelman G, Ayzenberg O, et al. Differential effects of coronary artery stenosis on myocardial function: The value of myocardial strain analysis for the detection of coronary artery disease. J Am Soc Echocardiogr. 2011 Jul;24(7):748–57.
• Liang HY, Cauduro S, Pellikka P, et al. Usefulness of Two-Dimensional Speckle Strain for Evaluation of Left Ventricular Diastolic Deformation in Patients With Coronary Artery Disease. Am J Cardiol. 2006 Dec 15;98(12):1581–6.
• Choi JO, Cho SW, Song Y Bin, et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. Eur J Echocardiogr. 2009 Jul;10(5):695–701.
• Nucifora G, Schuijf JD, Delgado V, et al. Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease. Am Heart J. 2010 Jan;159(1):148–57.
• Tsai WC, Liu YW, Huang YY, et al. Diagnostic value of segmental longitudinal strain by automated function imaging in coronary artery disease without left ventricular dysfunction. J Am Soc Echocardiogr. 2010 Nov;23(11):1183–9.
• Chan J, Hanekom L, Wong C, Leano R, et al. Differentiation of Subendocardial and Transmural Infarction Using Two-Dimensional Strain Rate Imaging to Assess Short-Axis and Long-Axis Myocardial Function. J Am Coll Cardiol. 2006 Nov 21;48(10):2026–33.
• Marques-Alves P, Espírito-Santo N, Baptista R, et al. Two-dimensional speckle-tracking global longitudinal strain in high-sensitivity troponin-negative low-risk patients with unstable angina: a “resting ischemia test”? Int J Cardiovasc Imaging [Internet]. 2018 Apr 1;34(4):561–8. Available from: http://dx.doi.org/10.1007/s10554-017-1269-x
• Moustafa S, Elrabat K, Swailem, et al.. The correlation between speckle tracking echocardiography and coronary artery disease in patients with suspected stable angina pectoris. Indian Heart J [Internet]. 2018 May 1;70(3):379–86. Available from: http://dx.doi.org/10.1016/j.ihj.2017.09.220
• Atici A, Barman HA, Durmaz E, et al. Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST-segment elevation. Echocardiography. 2019 Mar 1;36(3):512–20.
• Dahlslett T, Karlsen S, Grenne B, et al. Early assessment of strain echocardiography can accurately exclude significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary syndrome. J Am Soc Echocardiogr [Internet]. 2014;27(5):512–9. Available from: http://dx.doi.org/10.1016/j.echo.2014.01.019
• Biering-Sørensen T, Hoffmann S, Mogelvang R, et al. Myocardial strain analysis by 2-dimensional speckle tracking echocardiography improves diagnostics of coronary artery stenosis in stable angina pectoris. Circ Cardiovasc Imaging. 2014;7(1):58–65.
• Hubbard RT, Arciniegas Calle MC, Barros-Gomes S, et al. 2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function: A case-control study. BMC Cardiovasc Disord. 2017 Aug 24;17(1):1–7.