Evaluation of the Relationship between Left Ventricular Ejection Fraction Value and Coronary Artery Diameters by Multi-Slice Computed Tomography

Öz

Objective: Multi-slice Computed Tomography (MSCT) provides a reliable and accurate calculation of left ventricular functions, as well as evaluating coronary artery anatomy and cardiac morphology. Our aim is to investigate the existence and degree of the relationship between the functional values of ejection fraction (EF) and coronary artery diameters.

Material and Methods: Thirty-six patients (25 men, 11 women) who underwent MSCT examination between January 2015 and September 2015 were retrospectively analyzed.

Age, gender, body mass index (BMI), interventricular septal thickness, left main coronary artery (LMA), left anterior descending artery (LAD), circumflex artery (Cx) proximal segment diameters, left ventricular end diastolic volume (EDV), left ventricular end systolic volume (ESV), left ventricular EF values were examined.

Results: The mean age of the patients included in our study was 45 (29-60). LMA, LAD and Cx artery diameters and interventricular septum thickness were 4.02 ± 0.54 mm, 3.47 ± 0.53 mm, 2.97 ± 0.48 mm, 10.80 ± 1.65 mm, respectively. The mean EDV, ESV, EF values were calculated as 153.89 ± 23.00 ml, 64.29 ± 11.64 ml, 57.95% ± 4.87, respectively. There was no statistically significant relationship between the age, gender, height, weight and BMI measurements of the patients and EF (%) measurements (p>0.05).

There was no statistically significant relationship between the LMA, LAD, Cx diameters and interventricular septal thickness with EF (%) measurements of the patients (p>0.05). There was no statistically significant relationship between EDV, ESV values and the diameter of the coronary arteries (p>0.05).

Conclusion: MSCT is an important technique for diagnosing the pathologies and variations of coronary arteries and evaluating the morphology of the heart. It also enables quantitative measurement of functions such as EDV, ESV, EF (%) values.

There is no statistically significant relationship between coronary artery diameters and cardiac functions in patients without coronary artery pathology.

Anahtar Kelimeler

• Multi-slice computed tomography
• coronary artery
• ejection fraction

SOL VENTRİKÜL EJEKSİYON FRAKSİYON DEĞERİNİN KORONER ARTER ÇAPLARI İLE İLİŞKİSİNİN ÇOK KESİTLİ BİLGİSAYARLI TOMOGRAFİ İLE DEĞERLENDİRİLMESİ

Öz

Amaç: Çok kesitli bilgisayarlı tomografi (ÇKBT) koroner arter anatomisini ve kardiyak morfolojiyi iyi bir şekilde değerlendirmekle beraber sol ventrikül fonksiyonlarının güvenilir ve doğru şekilde hesaplanmasını da sağlamaktadır. Bu çalışmada amacımız, fonksiyonel değerlerden olan ejeksiyon fraksiyon (EF) ile koroner arter çapları arasında ilişkinin varlığını ve derecesini araştırmaktır.

Gereç ve Yöntemler: Çalışmada Ocak 2015-Eylül 2015 tarihleri arasında ÇKBT tetkiki yapılan 36 hasta (25 erkek, 11 kadın) retrospektif olarak incelenmiştir. Yaş, cinsiyet, vücut kitle indeksi (VKİ), interventriküler septal kalınlık, sol ana koroner arter (LMA), sol ön inen arter (LAD), sirkümfleks (Cx) arter proksimal kesim çapları, sol ventrikül end diyastolik volüm (EDV), sol ventrikül end sistolik volüm (ESV), sol ventrikül EF değerleri incelendi.

Bulgular: Çalışmamıza dahil olan hastaların yaşları ortalama (minimum- maksimum) 45 yıl (29-60 yıl) idi. Çalışmamızda LMA çapı 4.02±0.54 mm, LAD çapı 3.47±0.53 mm, Cx arter çapı 2.97±0.48 mm olarak ölçüldü. İnterventriküler septal kalınlık ortalama 10.80±1.65 mm idi. EDV değerleri ortalama 153.89±23.00 ml, ESV değerleri ortalama 64.29±11,64 ml, EF (%) ortalama %57.95±4.87 olarak hesaplandı. Hastaların yaş, cinsiyet, boy, kilo ve VKİ ölçümleri ile EF (%) ölçümleri arasında istatistiksel olarak anlamlı bir ilişki yoktu (p> 0.05).

Hastaların LMA, LAD ve Cx arter çapları ile EF (%) ölçümleri arasında istatistiksel olarak anlamlı ilişki saptanmamıştır (p>0.05). EDV, ESV değerleri ile koroner arterlerin çapları arasında istatistiksel olarak anlamlı ilişki saptanmadı (p>0.05). Ayrıca interventriküler septal kalınlık ile EF (%) ölçümleri arasında istatistiksel olarak anlamlı ilişki saptanmamıştır (p>0.05).

Sonuç: ÇKBT, koroner arterlerin patolojileri, varyasyonlarının tanısı ve kalbin morfolojisinin değerlendirilebilmesi için önemli bir tekniktir. Ayrıca EDV, ESV, EF (%) değerleri gibi fonksiyonlarının kantitatif ölçümüne olanak sağlar. Koroner arter çapları ile kardiyak fonksiyonlar arasında koroner arter patolojisi olmayanlarda istatistiksel olarak anlamlı ilişki mevcut değildir.

Anahtar Kelimeler

• Çok kesitli bilgisayarlı tomografi
• koroner arter
• ejeksiyon fraksiyon

Kaynakça

1. 1. Leung WH, Stadius ML, Alderman EL. Determinants of normal coronary artery dimensions in humans. Circulation. 1991;84(6):2294-306.
2. 2. Ross R. The pathogenesis of atherosclerosis. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 4th ed. Philadelphia. Saunders, 1992;1106-22.
3. 3. Roberts WT, Bax JJ, Davies LC. Cardiac CT and CT coronary angiography: technology and application. Heart. 2008;94(6):781–92.
4. 4. Plazzuoli A, Cademartini F, Geleijnse ML, Meijboom B, Pugliese F, Osama S et al. Left ventricular remodelling and systolic function measurement with 64 multi-slice computed tomography versus second harmonic echocardiography in patients with coronary artery disease: A double blind study. Eur J Radio. 2008;73(1):82-8.
5. 5. Dodge JT, Brown BG, Bolson EL, Dodge HT. Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. Circulation. 1992;86(1):232-46.
6. 6. Vourvouri EC, Poldermans D, Bax JJ, Sianos G, Sozzi FB, Schinkel AF et al. Evaluation of left ventricular function and volumes in patients with ischaemic cardiomyopathy: Gated single photon emission computed tomography versus two-dimensional echocardiography. Eur J Nucl Med. 2001;28(1):1610–5.
7. 7. Van der Wall EE, Vliegen HW, De Roos A, Bruschke AV. Magnetic resonance imaging in coronary artery disease. Circulation. 1995;92(9):2723–39.
8. 8. Arai K, Hozumi T, Matsumura Y, Sugioka K, Takemoto Y, Yamagishi H et al. Accuracy of measurement of left ventricular volume and ejection fraction by new real time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction. Am J Cardiol. 2004;94(5):552-8.

9. 9. Keenan NG, Pennell DJ. CMR of ventricular function. Echocardiography. 2007;24(2):185-93.
10. 10. Juergens KU, Grude M, Maintz D, Fallenberg EM, Wichter T, Heindel W et al. Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. Radiology. 2004;230(2):403-10.
11. 11. Schuijf JD, Beck T, Burgstahler C, Wouter Jukema J, Dirksen MS, De Roos A et al. Differences in plaque composition and distribution in stable coronary artery disease versus acute coronary syndromes; non-invasive evaluation with multi-slice computed tomography. Acute Cardiac Care. 2007;9(1):48–53.
12. 12. Liu YC, Sun Z, Tsay PK, Chan T, Hsieh IC, Chen CC et al. Significance of coronary calcification for prediction of coronary artery disease and cardiac events based on 64-slice coronary computed tomography angiography. Biomed Research International. 2013;2013(1):1-9.
13. 13. Dewey M, Muller M, Teige F, Hamm B. Evaluation of a semiautomatic software tool for left ventricular function analysis with 16-slice computed tomography. Eur Radiol. 2006;16(2):25-31.
14. 14. White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987;76(1):44–51.
15. 15. Standring S. Gray’s Anatomy. 40th ed. Spain. Churchill Livingstone, Elsevier, 2008.
16. 16. Juergens KU, Grude M, Fallenberg EM, Opitz C, Whicter T, Heindel W et al. Using ECG-gated multidetector CT to evaluate global left ventricular myocardial function in patients with coronary artery disease. AJR. 2002;179(6):1545–50.
17. 17. Koşar P, Ergun E, Oztürk C, Koşar U. Anatomic variations and anomalies of the coronary arteries: 64-slice CT angiographic appearance. Diagn Interv Radiol. 2009;15(4):275-83.
18. 18. Patel S. Normal and anomalous anatomy of the coronary arteries. Semin Roentgenol 2008;43(2):100-12.
19. 19. Schmitt R, Froehner S, Brunn J, Wagner M, Brunner H, Cherevatyy O et al. Congenital anomalies of the coronary arteries: imaging with contrast enhanced, multidedector computed tomography. Eur Radiol. 2005;15(6):1110-21.
20. 20. Yeşildağ A, Munduz M, Kayan M, Köroğlu M, Özden A. Koroner arter hastalıklarının belirlenmesinde 128-çok kesitli BT'nin değeri. SDÜ Tıp Fakültesi Dergisi. 2010;17(4):5-8.
21. 21. Kayan M, Yavuz T, Munduz M, Türker Y, Yeşildağ A, Etli M et al. Evaluation of coronary artery anomalies using 128-Slice computed tomography. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2012;20(3):480-7.
22. 22. Cademartiri F, La Grutta L, Malagò R, Alberghina F, Meijboom WB, Pugliese F et al. Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography. Eur Radiol. 2008;18(1):781-91.
23. 23. Jovin IS, Ebisu K, Liu YH, Finta LA, Oprea AD, Brandt CA et al. Left ventricular ejection fraction and left ventricular end-diastolic volume in patients with diastolic dysfunction. Congest Heart Fail. 2013;19(3):130-4.
24. 24. Sugeng L, Mor-Avi V, Weinert L, Johannes N, Christian E, Regina SM et al. Quantitative assessment of left ventricular size and function: side-by-side comparison of real-time three-dimensional echocardiography and computed tomography with magnetic resonance reference. Circulation. 2006;114(4):654-61.
25. 25. Vulgar H. Sol ventrikül fonksiyonunun çok kesitli bilgisayarlı tomografi ile değerlendirilmesi ve bulguların 3 boyutlu ekokardiyografi ile karşılaştırılması. Radyoloji tezi. GATA Tıp Fakültesi. 2011;36-9.
26. 26. Salm LP, Schuijf JD, Lamb HJ, Vliegen HW, Jukema JW, Joemai R et al. Global and regional left ventricular function assessment with 16-detector row CT: comparison with echocardiography and cardiovascular magnetic resonance. Eur J Echocardiogr. 2005;7 (4):308-14.