MiYOKARD ENFARKTÜSÜ GEÇİRMİŞ HASTALARDA CANLI DOKUNUN ARAŞTIRILMASINDA, AKUT TRİMETAZİDİN VE NİTRAT UYGULAMASI SONRASI YAPILAN Tc-99m-TETROFOSMİN GATED SPECT’İN TANI DEĞERİ

Öz

ÖZET

Amaç: Miyokard enfarktüsü geçiren hastalarda, canlı miyokard dokusunun araştırılması amacıyla nitrat infüzyonu ve akut Trimetazidin (TMZ) sonrası Tc-99m-tetrofosmin gated SPECT sonuçlarının karşılaştırılmasıdır.

Metod: Çalışmaya revaskülarizasyon işlemi planlanan, MI geçirmiş 30 hasta alındı. Hastalara ayrı günlerde bazal, nitrat infuzyonu ve akut TMZ sonrası Tc-99m-tetrofosmin gated SPECT yapıldı. Perfuzyon görüntülerinden elde edilen veriler kantitatif olarak, hareket görüntüleri ise görsel olarak skorlandı. Maksimum aktivitenin % 55’inden fazlasını tutan segmentler ile normal hareket eden veya hipokinetik olan segmentler canlı olarak yorumlandı. Elde edilen veriler “paired samples” ve “chi-square” testleri ile değerlendirildi.

Bulgular: Bazal çalışmada cansız olarak değerlendirilen 206 segmentin 41 ’i (% 19.9), nitrat sonrası canlı olarak değerlendiriürken, TMZ sonrası 42 segment (% 20) canlı olarak değerlendirildi. Nitrat sonrası 117 segmentin (% 30) hareketleri düzelirken, TMZ sonrası 43 segmentin (% 10) hareketlerinde düzelme izlendi. Nitrat sonrası hesaplanan sol ventrikül EF’larında bazal çalışmaya göre anlamlı (% 36.5±11.3, % 42.1±12.7, p<0.05) bir artış izlenirken, TMZ sonrası anlamlı bir değişiklik izlenmedi (% 36.5±11.3, % 38.3±10.9, p>0.05). Ayrıca, nitrat infuzyonu sonrası hastaların kan basınçlarında düşme izlenirken, akut TMZ sonrası hastaların hemodinamik parametrelerinde anlamlı değişiklik gözlenmedi. TMZ ve nitrat çalışmalarının perfuzyon görüntülerinin, canlılığı belirlemedeki uyumu % 87 olarak hesaplandı.

Sonuç: Hiberne miyokardın tespitinde; hem hareketleri düzelen segment sayısının, hem de tüm segmentlerin ortalama aktivite tutulum oranlarının, TMZ çalışmasına göre daha fazla olması nedeniyle, nitrat infuzyonu daha iyi olarak bulunmuştur. Ancak, akut TMZ sonrası Tc-99m-tetrofosmin görüntülemenin, özellikle hemodinamik paramatreleri kötü olan hastalarda kullanılabileceği sonucuna varılmıştır.

 

Anahtar Kelimeler

• Miyokard sintigrafisi,canlı doku,trimetazidin

DIAGNOSTIC VALUE of Tc-99m TETROFOSMİN GATED SPECT IN MYOCARDIAL VIABILITY INVESTIGATION AFTER ADMINISTRATION TRIMETAZIDINE and NITRATE IN THE PATIENTS WITH MYOCARDIAL INFARCTION

Öz

ABSTRACT

 

Aim: With the aim of investigating of the myocardial viability on the patients with MI, the results obtained from Tc-99m-tetrofosmin gated SPECT following the nitrate infusion and acute TMZ were compared.

Method: For this study, 30 patients who had MI and were be planned of revascularization process were taken. The patients were applied Tc-99m-tetrofosmin gated SPECT basally and following nitrate infusion and acute TMZ separately each day. The data from perfusion were quantitatively evaluated whilst wall motion images were visually scored. The segments having more than 55% of maximum activity and moving normally or being hypo-kinetic were concluded as viable. The data obtained were statistically evaluated by “t” and “chi-square” tests.

Results: While the 41 segments (19.9%) of non-viable 206 segments from the basal study were considered as viable after nitrate study, 42 segments (20%) were considered as viable after TMZ study. While the wall motions of 117 segments improved in the nitrate study, wall-motions of 43 segments improved in the TMZ study. Although there were more significant increases (36.5% ± 11.3, 42.1% + 12.7, p<0.05) in the post-nitrate left ventricule EFs than basal study, no significant changes (36.5% ± 11.3, 38.3% ± 10.9, p>0.05) occurred in the TMZ study. Moreover, while the blood pressures of the patients decreased after nitrate, the hemodynamic parameters of patients did not change significantly after acute TMZ.

Conclusion: The concordance of perfusion images from TMZ and nitrate studies in determining the myocardial viability was calculated as 87%. In the evaluation of HM, nitrate infusion was found better since both the number of segments whose wall-motions improved and the mean activity uptake ratios of all segments were many more than the results of TMZ studies. However, it was concluded that post-TMZ Tc-99m-tetrofosmin imaging can be especially useful for the patients whose hemodynamic parameters are not well. 

Anahtar Kelimeler

• Myocardial scintigraphy,viability,trimetazidine

Kaynakça

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