Orta Dereceli Koroner Arter Lezyonlarında Dobutaminli Doku Doppler Ekokardiyografi İle Miyokard İskemisinin Gösterilmesi
Özet
Giriş: Koroner arterlerde %50-%69 oranında stenoz yaratan aterosklerotik plakların dobutamin stres ekokardiyografi ile saptanmasında duyarlılık %75 ile %92 arasında değişmekte olup lezyon yüzdesi azaldıkça duyarlılık azalmaktadır. Bu noktada sık karşılaşılan bir problem ise orta dereceli lezyonlar olarak bilinen %50-69 düzeyindeki koroner darlıkların klinik önemlerinin ortaya konmasıdır. Ayrıca dobutaminli ekokardiyografilerde etkinlik açısından en bilinen sorun değerlendirmenin öznel oluşudur. Amaç: Bu çalışmada öznelliği ortadan kaldırmak amacıyla dobutaminli doku doppler ekokardiyografinin orta dereceli koroner arter lezyonlarında miyokard iskemisinin belirlenmesine katkısı araştırıldı. Yöntem: Çalışmaya koroner anjiyografi ile koroner arterleri normal bulunan 50 gönüllü (grup1) ile kag sonucu tek dominant bir koroner arterde proksimal segmentte %50-69 arası stenotik lezyonu olan 50 hasta (grup2) alındı. Lezyonlar çoğunlukla sol ön inen arterdeydi. (34 hasta) Her iki gruba dobutamin stres ekokardiyografi uygulanırken doku Doppler ekokardiyografi ile miyokard akım hızları (Sm: Zirve sistolik kontraksiyon dalgası akım hızı, Em: Erken doluş dalgası akım hızı, Am: Atriyal kontraksiyon dalgası akım hızı), zaman intervalleri (İGZ: İzovolumetrik gevşeme zamanı, İKZ: İzovolumetrik kasılma zamanı, KZ: Kontraksiyon zamanı) kaydedildi. Miyokard Performans İndeksleri (MPİ) hesaplandı. Bulgular: Grup 1’e göre grup 2’de pik dobutamin dozunda mitral anulusda doku doppler akım hızları (Sm, Em, Am) ve MPİ ölçümleri (sırasıyla p<0,0001, p=0,003 p<0,0001) ve ek olarak interventriküler septum, lateral ve anteriyor duvarda Sm, Em ve Am dalgaları ile miyokard performans indeksi ölçümleri (her biri için p<0,05)) belirgin olarak düşük bulunmuştur. Sonuç: Bu çalışmada doku doppler inceleme eşliğinde yapılan dobutaminli stres ekokardiyografinin klasik stres testlerinin klinik değerlendirme için yetersiz olduğu orta dereceli lezyonlarda miyokard iskemisini gösterebileceği ve hatta kantitatif bilgi verebileceği belirlenmiştir.
Referanslar
The World Health Report 2001 Geneva World Health Organization 2001
World health statistics 2024: monitoring health for the SDGs, sustainable development goals. 21 May 2024 ISBN: 978-92-4-009470-3
Murray JCL, Lopez AD The Global burden of disease A comprehansive assessment of mortality and disability from disease, injuries and risk factors in 1990 and projected to 2020 Bostan Havard University Press, 1996 824 831
Yusuf S, Reddy S, Ounpuu S, Anand S. Global Burden Of Cardiovascular Disease Circulation 2001,104-2746-2752
American Heart Association, 2000 Heart And Stroke Update Dallas, TX American Heart Association 1999
Türkiye Kalp Raporu 2000, Türk Kardiyoloji Derneği, Yenilik Basımevi, İstanbul 2000, S 11-25
Schlant RC, Alexander RW Diagnosis and management of patients with chronic ischemic heart disease Hurst s The Heart 9 th ed New York Mc Graw Hill, 1998:1275-1306
WangS, Fleischmann KE The role echocardiographic evaluationin patients with acute chest pain to the emergency to the emergency room. In Otto Cm eds Otto The Practice of Clinical Echocardiography, 2nd ed by WB Saunders Company 2002 235 250
Secknus M, Marwick TH. Evaluation of Dobutamine echocardiography protocols and indications. Safety and side effects in 3011 studies over 5 years J Am Coll Cardiol 1997 29 1234 1239
Applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients. J Am Coll Cardiol 1996; 28:52-59.
Mairesse GH Vanoverschelde JL Robert A et al Patophysiologic mechanisms underlying dobultamine induced ischemia Am Heart J 1998 136 63 70
Afridi I, Grayburn P, Panza JA, Oh JK, Zoghbi WA, Marwick TH. Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction. JACC 1998; 32:921-927.
Beleslin BD, Ostojic M, Stepanovic J, et al. Stress echocardiography in the detection of myocardial ischemia. Head to head comparison of exercise, dobutamine and dipyridamole test. Circulation 1994 Supp;90(3): 1168-1176.
Gottdiener JS. Overview of stres echocardiography: Uses, advantages and limitation. Prog in Cardiovasc Dis 2001; 43:315-334.
Oğuzhan A. Stres ekokardiyografide kuantifikasyon. T Klin J Cardiol 2003; 16:519-523
Cain P, Baglin T, Case C, et al. Application of tissue doppler to interpretation of dobutamine echocardiography and comparison with quantitative coronary angiography. Am J Cardiol 2001; 87:525-531.
Nishino M, Tanouchi J, Tanaka K, et al. Dobutamine stress echocardiography at 7,5ug/kg/min using color tissue doppler imaging m-mode safely predicts reversible dysfunction early after reperfusion in patients with acute myocardial infarction. Am J Cardiol 1999; 83:340-344.
Marwick TH. Stress Echocardiography with NonexerciseTecniques;Principles, Protocols,Interpretation and Clinical Applications.In Otto CM eds. Otto The Practice of Clinical Echocardiography, 2nd ed by WB Saunders Company. 2002;301-339
Wilson RF. Assessing the severity of coronary artery stenosis. N EnglJ Med 1996; 334:1735-1737.
Little WC, Constantinescu M, Applegate RJ, et al. Can coronary giography predict the site of subsequent myocardial infarction in patients ith mild to moderate coronary artery. Circulation 1988;78:1157-1166.
Ischinger T, Gruentzig AG, Hollmann J, et al. Should coronary arteries ith less than 60% diameter stenosis be treated with angioplasty? Circulation 988;68.148-154.
Hamon M, Bauters C, Mc Fadden EP; et al. Six month quantitative ngiographic follow up of <50% diameter stenoses dilated during multilesion ansluminal coronary angioplasty. Am J Cardiol 1993; 71:1226-1229.
lyisoy A. Anjiyografik orta dereceli lezyonların fonksiyonel olarak değerlendirilmesi. Türk Kard Sem. 2002; 16:264-276
Shan DJ, De Maris A, Kisslo J, Weyman A, for the Committee on M-node Standardization of the American Society of Echocardiography.
Recommendation regarding quantitation in M-mode Echocardiograpic neasurements. Circulation 1978; 58: 1072-1083
Tei C. New non-invasive index for combined systolic and diastolic entricular function. J Cardiol 1995; 26: 135-136
Eidem BW, Tei C, O'Leary PW, Cetta F, Seward JB. Nongeometric quantitative assessment of right and left ventricular function: Myocardial erformance index in normal children and patients with Ebstein anomaly. J Am Soc Echocardiography 1998; 11: 849-856
Galiuto L, Ignore G, DeMaria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed-wave tissue Doppler echocardiography. Am J Cardiol 1998; 1: 609-614
Isaaz K, Cloez JL, Ethevenot G, et al. Analysis of left ventricular wall motion by pulsed Doppler echocardiography. Application to the assessment of myocardial function [Abstract]. J Am Coll Cardiol 1986; 7: 228A
Isaaz K, Munoz L, Lee E, et al. Quantitification of the cardiac base motion in normal man by Doppler echocardiography. J Am Soc Echocardiography 1993; 6: 166-176
Isaaz K. Pulsed Doppler tissue imaging. Am J Cardiol 1998; 81: 663-669
Dağdeviren B, Eren M, Görgülü Ş, et al. Value of tissue Doppler imaging in the determination of the right ventricular systolic function. Anatol J Cardiol 2001; 1: 85-89
Dağdeviren B, Bolca O, Eren M, Terzi S, Gürlertop Y, Tezel T.Görünürde sağlıklı bireylerde ve koroner arter hastalarında nabızlı doku Doppleri ile sol ventrikül fonksiyonlarının bölgesel analizi. Türk Kardiyoloji Derneği Arş 1998; 26: 469-474
Pai RG, Gill KS. Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities:l.Their normal pattern and coupling to ventricular filling and ejection. J Am Soc Echocardiography 1998; 11(2): 105-111
Geleijnse ML, Fioretti PM, Roelandt JR. Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography. JAm Coll Cardiol 1997; 30:595-606.
Hoffmann R, Lehten H, Marwick T, et al. Analysis of the interinstutional observer agreement in interpretation of dobutamine stress echocardiograms. J Am Coll Cardiol 1996; 27:330-336
Varga A, Picano E, Dodi C, et al. Madness and method in stres echo reading. Eur Hart J 1999; 20:1271-1275
Popp R, Agatson A, Armstrong W, et al. Recommendations for training in performance and interpretation of stress echocardiography. Committee on Physcian Training and Education of the American Society of echocardiography. JAm Soc Echocardiography 1998; 11:95-96.
Cain P, Baglin T, Case C, et al. Application of tissue doppler to interpretation of dobutamine echocardiography and comparison with quantitative coronary angiography. Am J Cardiol 2001; 87:525-531.
Nishino M, Tanouchi J, Tanaka K, et al. Dobutamine stress echocardiography at 7,5ug/kg/min using color tissue doppler imaging m-mode safely predicts reversible dysfunction early after reperfusion in patients with acute myocardial infarction. Am J Cardiol 1999; 83:340-344.
Comparative usefulness of myocardial velocity gradient in detecting ischemic myocardium by a dobutamine challenge. Tsutsui H, Uematsu M,Shimizu H, et al. J Am Coll Cardiol 1998; 31:89-93.Effect of tissue doppler on the accuracy of novice and expert interpreters of dobutamine echocardiography. Am J Cardiol 2001; 87:234-231
Effect of tissue doppler on the accuracy of novice and expert interpreters of dobutamine echocardiography. Am J Cardiol 2001;87:234-231
Desco M Antoranz JC Technical principles of Doppler tissue imaging In Garcia Fernandez MA Zamorano JL Azevedo J eds Technical principles of Doppler tissue imaging NewYork McGraw Hill 1997
Derumeaux G Ovize M Loufoua J et al Doppler tissue imaging quantitates regional wall motion during myocardial ischemia and reperfusion Circulation 1998 97 19701977
Marcos Alberca P Garcia Fernandez MA Desco M et al Intromyocardial analysis of regional sysolic and diastolic function in ischemic heart disease with Doppler tissue imaging Role of the different myocardial layers J am Soc Echocardiogr 2002 15 99 108
Bach Ds Armstrogn WF Donovan CL Muller DWN Quantitaive Doppler tissue imaging for assesment of regional myocardial velocities during transient ischemia and reperfusion Am Heart J 1996 132 721 725
Gorscan J Strum DP Mandarino WA Gultayı VK Pinsky MR Quantitative assesment of alteratins in regional left ventricular contractility with color coded tissue Doppier echocardiograhy comparison with sonomicrometry and pressure volüme relations. Circulation 1997 9524232433
Gorscan J, Deswal A, Mankad S, et al. Quantification of the myocardial response to low dose dobutamine using tissue Doppler echocardiographic measures of velocity and velocity gradient. Am J Cardiol 1998; 81:615-623
Tsutsui H. Uematsu M. Shimizu H, et al. Comparative usefulness of myocardial velocity gradient in detecting ischemic myocardium by a dobutamine challenge. JAm Coll Cardiol 1998; 31:89-93
Pelerin D, Berdeaux A, Cohen L, et al. Comparison of 2 myocardial velocity gradient assessments during dobutamine infusion Doppl myocardial imaging. JAm Soc Echocardiogr Echocardiogr 12:22-31.
Yamada E, Garcia M, Thomas JD, Marwick TH. Myocardial Doppler velocity imaging: a quantitative technique for interpretation of dobutamine echocardiography. Am J Cardiol1998; 82:806-809.
Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure cardiac function. A study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357-366
Tei C, Nishimura RA, Seward JB, Tajik AJ. Non-invasive Doppler derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiography 1997; 10: 169-178
Harada K Tamura M Toyono M Oyama K Takada G Assesment of global left ventricular funstion by issue doppler imaging AM J Cardiol 2001 88 927-932
Norager Betina, Husic Mirza, Schmidt Henrik, Egstrup Kenneth. The Doppler Tei index during dobutamine stress echocardiography: A powerful predictor of mortality after acute myocardial infarction March 2004, Journal of the American College of Cardiology; 43(5): A331 DOI:10.1016/S0735-1097(04)91403-9
