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

Year 2015, Volume: 18 Issue: 1, 6 - 9, 06.04.2015

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. 

References

  • 1. Task force members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003.
  • 2. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004;17:1086-119.
  • 3. Genders TS, Steyerberg EW, Alkadhi H, Leschka S, Desbiolles L, Nieman K, et al. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J 2011;32:1316-30.
  • 4. Maffei E, Seitun S, Martini C, Palumbo A, Tarantini G, Berti E, et al. CT coronary angiography and exercise ECG in a population with chest pain and low to intermediate pre-test likelihood of coronary artery disease. Heart 2010;96:1973-9.
  • 5. Gökdeniz T, Turan T, Aykan AÇ, Gül I, Boyacı F, Hatem E, et al. Relation of epicardial fat thickness and cardio-ankle vascular index to complexity of coronary artery disease in nondiabetic patients. Cardiology 2013;124:41-8.
  • 6. Aykan AÇ, Gül I, Gökdeniz T, Hatem E, Arslan AO, Kalaycıoğlu E, et al. Ankle brachial index intensifies the diagnostic accuracy of epicardial fat thickness for the prediction of coronary artery disease complexity. Heart Lung Circ 2014;23:764-71.
  • 7. Aykan AC, Hatem E, Karabay CY, Gül I, Gökdeniz T, Kalaycıoğlu E, et al. Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease. Vascular 2014. Sep 10. pii 1708538114550738 (Epub ahead of print).
  • 8. Aykan AC, Gül I, Kalaycıoğlu E, Gökdeniz T, Hatem E, Menteşe U, et al. Is metabolic syndrome related with coronary artery disease severity and complexity: An observational study about IDF and AHA/NHLBI metabolic syndrome definitions. Cardiol J 2014;21:245-51.
  • 9. Gökdeniz T, Kalaycıoğlu E, Aykan AÇ, Boyacı F, Turan T, Gül İ, et al. Value of coronary artery calcium score to predict severity or complexity of coronary artery disease. Arq Bras Cardiol 2014;102:120-7.
  • 10. Turan T, Menteşe U, Ağaç MT, Akyüz AR, Kul S, Aykan AC, et al. The relation between intensity and complexity of coronary artery lesion and oxidative stress in patients with acute coronary syndrome. Anadolu Kardiyol Derg 2014 Oct 15. doi:10.5152/akd.2014.5761 (Epub ahead of print).
  • 11. Aykan AC, Gökdeniz T, Gül I, Boyacı F, Turan T, Aykan AD, et al. Assessment of cardio-ankle vascular index in patients with cardiac syndrome-X: an observational study. Anadolu Kardiyol Derg 2013;13:766-71.
  • 12. Chow BJ, Abraham A, Wells GA, Chen L, Ruddy TD, Yam Y, et al. Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography. Circ Cardiovasc Imaging. 2009;2:16-23.
  • 13. Dewey M, Hamm B. Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease. Eur Radiol 2007;17:1301-9.
  • 14. Sousa PJ, Goncalves PA, Marques H, Raposo L, Calé R, Brito J, et al. Radiation in cardiac CT: Predictors of higher dose and its reduction over time. Rev Port Cardiol 2010;29:1655-65.

Computed Tomography Angiography Approach in Low-Intermediate Test Probability with Positive Exercise Electrocardiography Test in Young Women

Year 2015, Volume: 18 Issue: 1, 6 - 9, 06.04.2015

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.

References

  • 1. Task force members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003.
  • 2. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004;17:1086-119.
  • 3. Genders TS, Steyerberg EW, Alkadhi H, Leschka S, Desbiolles L, Nieman K, et al. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J 2011;32:1316-30.
  • 4. Maffei E, Seitun S, Martini C, Palumbo A, Tarantini G, Berti E, et al. CT coronary angiography and exercise ECG in a population with chest pain and low to intermediate pre-test likelihood of coronary artery disease. Heart 2010;96:1973-9.
  • 5. Gökdeniz T, Turan T, Aykan AÇ, Gül I, Boyacı F, Hatem E, et al. Relation of epicardial fat thickness and cardio-ankle vascular index to complexity of coronary artery disease in nondiabetic patients. Cardiology 2013;124:41-8.
  • 6. Aykan AÇ, Gül I, Gökdeniz T, Hatem E, Arslan AO, Kalaycıoğlu E, et al. Ankle brachial index intensifies the diagnostic accuracy of epicardial fat thickness for the prediction of coronary artery disease complexity. Heart Lung Circ 2014;23:764-71.
  • 7. Aykan AC, Hatem E, Karabay CY, Gül I, Gökdeniz T, Kalaycıoğlu E, et al. Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease. Vascular 2014. Sep 10. pii 1708538114550738 (Epub ahead of print).
  • 8. Aykan AC, Gül I, Kalaycıoğlu E, Gökdeniz T, Hatem E, Menteşe U, et al. Is metabolic syndrome related with coronary artery disease severity and complexity: An observational study about IDF and AHA/NHLBI metabolic syndrome definitions. Cardiol J 2014;21:245-51.
  • 9. Gökdeniz T, Kalaycıoğlu E, Aykan AÇ, Boyacı F, Turan T, Gül İ, et al. Value of coronary artery calcium score to predict severity or complexity of coronary artery disease. Arq Bras Cardiol 2014;102:120-7.
  • 10. Turan T, Menteşe U, Ağaç MT, Akyüz AR, Kul S, Aykan AC, et al. The relation between intensity and complexity of coronary artery lesion and oxidative stress in patients with acute coronary syndrome. Anadolu Kardiyol Derg 2014 Oct 15. doi:10.5152/akd.2014.5761 (Epub ahead of print).
  • 11. Aykan AC, Gökdeniz T, Gül I, Boyacı F, Turan T, Aykan AD, et al. Assessment of cardio-ankle vascular index in patients with cardiac syndrome-X: an observational study. Anadolu Kardiyol Derg 2013;13:766-71.
  • 12. Chow BJ, Abraham A, Wells GA, Chen L, Ruddy TD, Yam Y, et al. Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography. Circ Cardiovasc Imaging. 2009;2:16-23.
  • 13. Dewey M, Hamm B. Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease. Eur Radiol 2007;17:1301-9.
  • 14. Sousa PJ, Goncalves PA, Marques H, Raposo L, Calé R, Brito J, et al. Radiation in cardiac CT: Predictors of higher dose and its reduction over time. Rev Port Cardiol 2010;29:1655-65.
There are 14 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Ahmet Çağrı Aykan

Ezgi Kalaycıoğlu This is me

Tayyar Gökdeniz This is me

Duygun Altıntaş Aykan This is me

İsmail Gökhan Çavuşoglu This is me

Abdulkadir Uslu This is me

Ahmet Oğuz Aslan This is me

Ömer Faruk Çırakoğlu This is me

Banu Şahin Yıldız This is me

Şükrü Çelik This is me

Publication Date April 6, 2015
Published in Issue Year 2015 Volume: 18 Issue: 1

Cite

Vancouver Aykan AÇ, Kalaycıoğlu E, Gökdeniz T, Altıntaş Aykan D, Çavuşoglu İG, Uslu A, Aslan AO, Çırakoğlu ÖF, Şahin Yıldız B, Çelik Ş. Computed Tomography Angiography Approach in Low-Intermediate Test Probability with Positive Exercise Electrocardiography Test in Young Women. Koşuyolu Heart Journal. 2015;18(1):6-9.