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

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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