Perfuziona scintigrafija miokarda u detekciji bolesti koronarnih arterija
Myocardial perfusion scintigraphy in detection of coronary artery disese
Author
Nikoletic, KatarinaMentor
Sakač, DejanMihailović, Jasna
Committee members
Šobić-Šaranović, DraganaKovačević, Dragan
Mitrović, Milena
Metadata
Show full item recordAbstract
Cilj istraživanja je procena značajnosti pojedinih faktora rizika i učestalosti ishemije miokarda dijagnostikovane perfuzionom scintigrafijom miokarda (PSM) među pacijentima koji imaju faktore rizika za nastanak koronarne bolesti, a kod kojih prethodno nije dokazana bolest koronarnih arterija. Osim pola i starosti ispitanika, definisani faktori rizika su: postojanje dijabetes melitusa tip 2 (DM tip 2), arterijske hipertenzije, hiperholesterolemije, gojaznosti i podatak o pušačkim navikama. Materijal i metode: istraživanjem je ukupno obuhvaćen 801 pacijent (451 žena, 350 muškaraca; prosečne starosti 61,9±7,7 godine, opsega od 28–83 godine) koji je u periodu od 2008. do 2012. upućen na PSM. Rezultati: pozitivan nalaz PSM registrovan je kod 18,1% ispitanika, dok je nalaz signifikantne ishemije (definisan kao zahvaćenost ishemijom preko 10% miokarda leve komore) nađen kod 10,7% ispitanika. Najčešći tip ishemije bio je reverzibilan (73,8%) dok je po lokalizaciji najčešće registrovana antero...septalna ishemija (44,1%). Prosečan SSS (sumirani stres skor) iznosio je 9,76±7,17, prosečan SDS (sumirani skor razlike vrednosti SSS i SRS) bio je 7,16±6,01. Kao nezavisni prediktori pozitivnog nalaza PSM izdvojili su se muški pol, DM tip 2, pušačka navika, povišena vrednost ukupnog holesterola i povišeni indeks telesne mase (BMI). Multivarijantnom logističkom regresijom je svakom faktoru rizika pridružena težinska vrednost i izračunata je statistička signifikantnost uticaja svakog pojedinačnog faktora ukupnom modelu predikcije. Kreiran je model predikcije pozitivnog nalaza PSM kod pacijenata bez prethodno dijagnostikovane koronarne bolesti, čija je senzitivnost 77,9%, specifičnost 62,2% dok je vrednost predikcije 65,0%. Zaključak: model predikcije baziran na polu i prisutnim faktorima rizika (DM tip 2, vrednosti ukupnog holesterola, BMI i pušačka navika) može da predikuje pozitivan nalaz PSM kod pacijenata koji imaju faktore rizika ali kod kojih koronarna bolest nije ranije dijagnostikovana sa visokom senzitivnošću i zadovoljavajućom specifičnošću.
Aim of the study is to assess the significance of individual risk actors and the incidence of myocardial ischemia diagnosed with myocardial perfusion scintigraphy (MPS) among patients with risk factors for coronary artery disease (CAD), but without previously proven CAD. In addition to sex and age, defined risk actors are: presence of type 2 diabetes mellitus (DM), arterial hypertension, hypercholesterolemia, obesity and smoking habits. Materials and Methods: The study included a total 0 801 patients (451 women, 350 men, average age 61.9 ± 7.7 years, range of 28-83 years) who were in the period since 2008. by 2012. referred to the PSM. Results: A positive result MPS was present at 18.1 percents of all patients, while the finding 0 significant ischemia (defined as involvement of ischemia over 10 percents of the left ventricle) was found in 10.7 percents of patients. The most common type was reversible ischemia (73.8 percents), while the most usual localization site was anteroseptal wall... (44.1 percents). Average SSS (summed stress score) was 9.76 ± 7.17, mean SDS (summed difference score) was 7.16 ± 6.01. Independent predictors of positive MPS findings were found to be male gender, type 2 DM, smoking habit, elevated total cholesterol and obesity. For each risk factor multivariate logistic regression was used to calculate the statistical significance on total model prediction. We created a model predicting positive MPS findings in patients without previously diagnosed coronary artery disease, whose sensitivity is 77.9 percents, specificity 62.2 percents, while the predictive value is 65.0 percents. Conclusion: The prediction model based on gender and risk factors (type 2 DM, total cholesterol, 8MI - body mass index and smoking habit) may predict the positive findings of MPS in patients who have risk actors but in whom coronary artery disease has not been previously diagnosed with high sensitivity and moderate specificity.