Ciddi koroner arter hastalığının tanısında katmana özgü strain ekokardiyografinin yeri
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Koroner arter hastalığından şüphelenilen hastalarda tanı ve risk değerlendirmesi amaçlı ekokardiyografi, miyokart perfüzyon sintigrafisi, stres görüntüleme testleri gibi bir takım görüntüleme teknikleri kullanılmaktadır. Bu tekniklerden biri olan transtorasik ekokardiyografide sol ventrikül sistolik ve diyastolik fonksiyonların değerlendirilmesini sağlamaktadır. Ancak bu testlere rağmen elektif koroner anjiyografi uygulanan hastalarda kritik olmayan lezyonlar oldukça sık görülmektedir. 2 boyutlu benek takibi yöntemi kullanılarak global longitüdinal strain hesaplanması, sol ventrikül fonksiyonlarının değerlendirilmesinde transtorasik ekokardiyografi 'ye göre daha doğru ve güvenilir sonuçlar veren bir tekniktir. Küresel ve katmana özgü strain analizleri miyokardiyal segmentlerin ayrı ayrı değerlendirilip, bölgesel işlevlerin kantitatif ölçülmesini sağlamaktadırlar. Bu çalışmanın amacı şüpheli kararlı koroner arter hastalığı olgularında, istirahat longitüdinal strain analizlerinin ciddi koroner lezyonları ile ilişkisini saptamak ve koroner anjiyografi öncesi hasta seçiminde bize yol göstermesidir. Stabil koroner hastalığından şüphelenilen, elektif anjiyografi planlanan, çalışma kriterlerine ve strain analizleri için uygun olan 242 hasta çalışmaya dahil edilmiştir. Hastalar ciddi koroner arter hastalığına sahip olanlar ve olmayanlar olarak temel iki gruba ayrılmıştır. Koroner anjiyografiler sonucunda herhangi bir damarda ya da birden fazla damarda %70 veya fazla darlık saptananlar ciddi koroner arter hastalığı grubuna dahil edilmiştir. Alınan hastaların %48,3'ü (117) ciddi koroner arter hastalığı saptanan grubu oluşturdu. Ciddi koroner arter hastalığı saptanmayan 125 hasta ise kontrol grubunu oluşturmuştur. 2- boyutlu benek takibi yöntemi ile katmana spesifik global longitüdinal strainler mid-miyokardiyal, endokardiyal ve epikardiyal olarak gruplar arası karşılaştırılmıştır. Ciddi koroner arter hastalığı saptanan gruptaki hastalarda tüm katmanların global longitüdinal strain değerlerinin anlamlı derecede düşük olduğu gözlendi (GLSmid: -21,68 ± 2,27 vs -18,25 ± 2,92 p<0,001, GLSendo: -24,58 ± 2,57 vs -20,78 ± 3,31p<0,001, GLSepi: -19,18 ± 2,05 vs -16,07 ± 2,72 p<0,001). Hastaların Syntax skorları hesaplandığında çoklu karşılaştırma testlerine göre <22 puana sahip olanlar ile 22-32 puana sahip gruplar arasında global longitudinal strain değerlerinde anlamlı olarak düşük saptandı (GLSmid: -18,80 (16,63-20,28) vs -15,80 (14,15-18,50) p<0,019, GLSendo: -21,45(18,93-22,98) vs -18,50(15,75-21,25) p<0,009, GLSepi: -16,30(14,80-18,20) vs -14,10(12,30-16,40) p<0,034). Ayrıca miyokart perfüzyon sintigrafisi yalancı pozitif ve gerçek pozitif hastaların global longitudinal strain ölçümleri karşılaştırıldığında, gerçek pozitif grupta global longitüdinal strain değerlerinin anlamlı ölçüde düşük olduğu görüldü (GLSmid: -18,42 ± 2,81 vs 21,66 ± 2,23 p <0,001, GLSendo: -20,97 ± 3,18 vs 24,51 ± 2,60 p<0,001, GLSepi: -16,16 ± 2,67 vs 19,17 ± 1,93 p<0,001). Sonuç olarak 2 boyutlu benek takibi ile yapılan global longitüdinal strain değerlendirmesinde transtorasik ekokardiyografi 'ye duvar hareket bozukluğu olmayan ve ciddi koroner arter hastalığı saptanan olgularda tüm katmanlardaki strain analizlerinin kontrol grubuna göre düşük olduğu saptandı. Katmana özgü strain değerlendirmenin ciddi koroner arter hastalığı saptanmasında hasta seçimi açısından fayda sağlamaktadır. Ancak alt gruplarda daha homojen dağılım gösteren ve daha kapsamlı çalışmalarla bu konu araştırılmalı ve geliştirilmelidir.
A number of imaging techniques such as echocardiography, myocardial perfusion scintigraphy, stress imaging tests are used for diagnostic and risk assessment in patients with suspected coronary artery disease. Transthoracic echocardiography is one of these techniques which allows the evaluation of the left ventricular systolic and diastolic functions. However, non-critical lesions are often observed in elective coronary angiography applied patients despite these tests. The calculation of global longitudinal strain, via 2-dimensional speckle tracking method, is more accurate and reliable technique in contrast to 2- dimensional transthoracic echocardiography for the evaluation of left ventricular functions. Global and layer-specific strain analyses are used for the evaluation of myocardial segments on an individual basis and it provides quantitative measurement of regional functions. The aim of this study was to determine the relationship between resting longitudinal strain analysis and severe coronary lesions in patients with suspected stable coronary artery disease and to guide us before coronary angiography in patient selection. A total of 242 patients with suspected stable coronary disease who are planned to be performed selective coronary angiography and are suitable for inclusion criteria were included in this study. Patients were divided into two main groups as those with and without severe coronary artery disease. After coronary angiography, patients who have 70% or more stenosis of any vessel or multiple vessels were included in the severe coronary artery disease group. In the study, 48.3 % (117) of the patients were taken part in the group with severe coronary artery disease and the rest of the patients (42.7 %) (125) were constituted in the group without severe coronary artery disease. Layer-specific global longitudinal strains were compared between the groups as mid-myocardial, endocardial and epicardial layer by using 2-dimensional speckle tracking method. This study revealed that the global longitudinal strain values of all layers were significantly lower in the patient group with severe coronary artery disease compared with control group. (GLSmid: -21.68 ± 2.27 vs -18.25 ± 2.92 p <0.001, GLSendo: -24.58 ± 2.57 vs -20.78 ± 3.31p <0.001, GLSepi: -19, 18 ± 2.05 vs -16.07 ± 2.72 p <0.001). When the Syntax scores of the patients were calculated according to the multiple comparison tests, it was determined that global longitudinal strain values were significantly low between those groups with <22 points and with 22-32 points. (GLSmid: -18,80 (16,63-20,28) vs -15,80 ( 14.15-18.50) p <0.019, GLSendo: -21.45 (18.93-22.98) vs -18.50 (15.75-21.25) p <0.009, GLSepi: -16, 30 (14,80-18,20) vs -14,10 (12,30-16,40) p <0.034). Moreover, global longitudinal strain measurements of myocardial perfusion scintigraphy false positive and true positive patients were compared, and it was found that global longitudinal strain values were significantly lower in the true positive group than false positive group. (GLSmid: -18,42 ± 2,81 vs 21,66 ± 2,23 p <0,001, GLSendo: -20, 97 ± 3.18 vs 24.51 ± 2.60 p <0.001, GLSepi: -16.16 ± 2.67 vs 19.17 ± 1.93 p <0.001). As a result, in the global longitudinal strain evaluation assessed by 2-dimensional speckle tracking method, global longitudinal strain values were reported lower in all layers of the myocardium with severe coronary artery disease and with no wall motion abnormalities in comparison with the control groups. Layer-specific strain assessment is useful for the detection of severe coronary artery disease in terms of the patient selection. However, these findings should be investigated and improved comprehensively in subgroups which exhibit more homogenous distribution.
A number of imaging techniques such as echocardiography, myocardial perfusion scintigraphy, stress imaging tests are used for diagnostic and risk assessment in patients with suspected coronary artery disease. Transthoracic echocardiography is one of these techniques which allows the evaluation of the left ventricular systolic and diastolic functions. However, non-critical lesions are often observed in elective coronary angiography applied patients despite these tests. The calculation of global longitudinal strain, via 2-dimensional speckle tracking method, is more accurate and reliable technique in contrast to 2- dimensional transthoracic echocardiography for the evaluation of left ventricular functions. Global and layer-specific strain analyses are used for the evaluation of myocardial segments on an individual basis and it provides quantitative measurement of regional functions. The aim of this study was to determine the relationship between resting longitudinal strain analysis and severe coronary lesions in patients with suspected stable coronary artery disease and to guide us before coronary angiography in patient selection. A total of 242 patients with suspected stable coronary disease who are planned to be performed selective coronary angiography and are suitable for inclusion criteria were included in this study. Patients were divided into two main groups as those with and without severe coronary artery disease. After coronary angiography, patients who have 70% or more stenosis of any vessel or multiple vessels were included in the severe coronary artery disease group. In the study, 48.3 % (117) of the patients were taken part in the group with severe coronary artery disease and the rest of the patients (42.7 %) (125) were constituted in the group without severe coronary artery disease. Layer-specific global longitudinal strains were compared between the groups as mid-myocardial, endocardial and epicardial layer by using 2-dimensional speckle tracking method. This study revealed that the global longitudinal strain values of all layers were significantly lower in the patient group with severe coronary artery disease compared with control group. (GLSmid: -21.68 ± 2.27 vs -18.25 ± 2.92 p <0.001, GLSendo: -24.58 ± 2.57 vs -20.78 ± 3.31p <0.001, GLSepi: -19, 18 ± 2.05 vs -16.07 ± 2.72 p <0.001). When the Syntax scores of the patients were calculated according to the multiple comparison tests, it was determined that global longitudinal strain values were significantly low between those groups with <22 points and with 22-32 points. (GLSmid: -18,80 (16,63-20,28) vs -15,80 ( 14.15-18.50) p <0.019, GLSendo: -21.45 (18.93-22.98) vs -18.50 (15.75-21.25) p <0.009, GLSepi: -16, 30 (14,80-18,20) vs -14,10 (12,30-16,40) p <0.034). Moreover, global longitudinal strain measurements of myocardial perfusion scintigraphy false positive and true positive patients were compared, and it was found that global longitudinal strain values were significantly lower in the true positive group than false positive group. (GLSmid: -18,42 ± 2,81 vs 21,66 ± 2,23 p <0,001, GLSendo: -20, 97 ± 3.18 vs 24.51 ± 2.60 p <0.001, GLSepi: -16.16 ± 2.67 vs 19.17 ± 1.93 p <0.001). As a result, in the global longitudinal strain evaluation assessed by 2-dimensional speckle tracking method, global longitudinal strain values were reported lower in all layers of the myocardium with severe coronary artery disease and with no wall motion abnormalities in comparison with the control groups. Layer-specific strain assessment is useful for the detection of severe coronary artery disease in terms of the patient selection. However, these findings should be investigated and improved comprehensively in subgroups which exhibit more homogenous distribution.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Kardiyoloji, Cardiology
