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The Relationship Between Gated Myocardial Perfusion Scintigraphy Findings and Risk Factors for Coronary Artery Disease

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The Relationship Between Gated Myocardial Perfusion Scintigraphy Findings and Risk Factors for Coronary Artery Disease Original Article Acta Medica Anatolia Volume 2 Issue 3 2014 The relationship between gated myocardial perfusion scintigraphy findings and risk factors for coronary artery disease 1 1 2 2 2 2 Ayse Nurdan Korkmaz , Billur Caliskan , Melih Engin Erkan , Huri Tilla Ilce , Mustafa Yıldırım , Ahmet Semih Dogan 1 Department of Nuclear Medicine, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey. 2 Department of Nuclear Medicine, Duzce University, Faculty of Medicine, Duzce, Turkey. Abstract Objectives: Coronary artery disease risk factors to be considered are one of the important approaches in terms of early diagnosis and treatment. Gated SPECT provides important diagnostic and prognostic information for coronary artery disease. The aim of this retrospective study is to investigate the relationship between these risk factors for coronary artery disease and gated myocardial perfusion scintigraphy findings. Methods: Two hundred fifty-three (144 women, 109 men) referred to our clinic without a previously known coronary artery disease were included to this study. The mean age of the patients was 57.42 ± 10.71 years. Major cardiovascular risk factors (age, gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, family history) were investigated. Statistical analysis of the relationship between risk factors for coronary artery disease and myocardial perfusion scintigraphy findings was performed using SPSS 15.0. Results: A mild correlation was found between the myocardial perfusion findings and risk factors of the evaluated 253 patients. Significantly negative results were found in ischemia/scar findings (p=0.01), wall movement disorder (p=0.004), left ventricular ejection fractions (p=0.002), end-systolic volume and end-diastolic volume (p=0.001), total thickening and movement scores (p=0.001, p=0.002, respectively) in the group with more than 2 risk factors. Conclusions: Increased number of risk factors for coronary artery disease was found to be associated with more frequent positive findings in gated myocardial perfusion scintigraphy. Our findings show that accuracy of myocardial perfusion scintigraphy may increase with appropriate assessment of risk factors. Keywords: Myocardial perfusion scintigraphy, coronary artery disease, risk factors. Received: 19.05.2014 Accepted: 16.06.2014 Acta Medica Anatolia Introduction Coronary artery diseases (CAD) and related investigate the relationship between the risk factors complications are among the leading causes of death for coronary artery disease and Gated SPECT (Single (1, 2). The number of patients with CADs is increased Photon Emission Computerized Tomography) MPS by 6.4% each year and many patients die due to CAD findings (presence of defect, localization of defect, (3). and functional parameters such as wall movement, ejection fraction and left ventricle volume (LV). Classical risk factors include age, gender, family history, hypertension, hyperlipidemia, diabetes Materials and Methods mellitus and smoking (4). Several risk factors have been defined to identify risk groups and to early Data of a total of 253 patients (109 males and 144 diagnose this disease, which leads to serious females) aged between 24-83 years, who presented economic and social losses. to Duzce University Medical Faculty Training and Research Hospital, Department of Nuclear Medicine Ventricle wall movement is impaired and diastolic between January 2008 and March 2009 for and systolic dysfunction occurs along with myocardial perfusion scintigraphy, who had atypical progression of CAD, which causes decrease in blood chest pain, dyspnea and positive ECG signs, who had flow and impairment in myocardial perfusion (5). It is not been diagnosed with CAD or had been suspected important to diagnose ischemia prior to the for CAD, were retrospectively investigated. Detailed occurrence of these changes. anamnesis, physical examination findings and biochemical parameters of the patients were Myocardial perfusion scintigraphy (MPS) is a reliable evaluated. Risk factors of the patients including age, method used to detect myocardial ischemia and total cholesterol and triglyceride levels, smoking scars, evaluate the localization and extensiveness, status, blood pressure values, glucose concentrations and to assess physiological importance of and family history had been recorded based on the obstructions. The aim of this retrospective study is to Correspondence: Ayse Nurdan Korkmaz MD, Department of Nuclear Medicine, Bolu, Turkey. 97 [email protected] Original Article Korkmaz AN et al. anamnesis or measurements. Gated SPECT MPS scans Visual data obtained from Gated myocardial of these patients were reevaluated. perfusion SPECT images were divided into four groups as normal and three other, according to the vascular Table 1: Results of correlation analysis between MPS localization. Group without defect was considered as findings and number of risk factors Group 1 (normal), whereas LAD area was considered as Group 2 (anterior, septum, anteroseptal, apical), rho p* RCA area was considered as Group 3 (inferior, SEF - 0.187 0.003 inferobasal, inferoseptal), and LCx area was REF - 0.173 0.006 considered as Group 4 (lateral, inferolateral, SSTS 0.207 0.001 anterolateral). Relation between these groups, as RSTS 0.169 0.007 well as other MPS findings (gated parameters, some SSMS 0.195 0.002 data obtained by exercise test) and coronary artery RSMS 0.194 0.002 disease risk factors, was explored. SESV 0.203 0.001 RESV 0.208 0.001 Patients were divided into two groups based on the SEDV 0.189 0.002 number of risk factors: those having two or less risk REDV 0.194 0.002 factors and those having more than two risk factors. *Spearman’s correlation analysis; SEF: Stress Ejection Fraction, REF: Resting Ejection Fraction. STS: Sum Tablo 2: Comparison of MPS findings between risk Thickness Scores, SMS: Sum Movement Score, ESV: factor groups (Mean± SD) End-Systolic Volume, EDV: End-Diastolic Volume. MPS Risk Risk p* Patients diagnosed with CAD, patients underwent findings factor ≤ 2 factor > 2 PTCA or coronary artery bypass surgery, as well as the patients whose general status has been impaired SEF 57.48 ± 53.01 ± 0.002 during procedure (due to arrhythmia, hypertension or 9.99 13.10 acute coronary syndrome), and whose recordings REF 57.81 ± 53.69 ± 0.007 were incomplete, were excluded from the study. 10.11 13.72 Gated SPECT MPS was performed by using one day SSTS 4.34 ± 6.3 8.11 ± <0.001 stress-rest protocol with Tc-99m Sestamibi (MIBI) for 9.56 all patients in the study group. Stress study was RSTS 3.93 ± 6.45 ± 0.012 performed via pharmacological stress (dipyridamole 6.27 9.42 infusion) in 38 patients, in who exercise test was SSMS 7.11 ± 11.79 ± 0.001 contraindicated, or via physiological stress on 9.48 13.42 treadmill according to the Bruce or modified Bruce RSMS 6.30 ± 10.68 ± 0.003 protocol in 215 patients. MIBI was administered via 8.90 14.02 intravenous route at a dose of 296-370 MBq (8-10 SESV 39.11 ± 52.66 ± 0.001 mCi) during stress scan and 814-925 MBq (22-25 mCi) 19 39.21 during resting scan. Scanning was performed by RESV 38.96 ± 51.01 ± 0.001 single-head gamma camera (Siemens, E.CAM) 19.44 36.99 synchronous with ECG. Images were processed on SEDV 87.30 ± 102.21 ± 0.001 Siemens e.soft computer system using QGS 24.06 44.56 (Quantitative Gated SPECT) package program. Left REDV 87.92 ± 100.97 ± 0.004 ventricular volumetric and functional parameters, 27.20 42.14 QGS software package and semiquantitative visual *Student t test, p<0.05 was considered significant. analysis method were obtained from the stress and SEF: Stress Ejection Fraction, REF: Resting Ejection rest images. These parameters are stress left Fraction, STS: Sum Thickness Score, SMS: Sum ventricular ejection fraction (SEF), resting left Movement Score, ESV: End-systolic volume, EDV: ventricular ejection fraction (REF), stress end-systolic End-diastolic volume. volume (SESV), stress end-diastolic volume (SEDV), rest end-systolic volume (RESV), rest end-diastolic volume (REDV), stress sum thickness score (SSTS), resting sum thickness score (RSTS), stress sum movement score (SSMS) and rest sum movement score (RSMS) contained. Acta Med Anatol 2014;2(3):97-102 98 Original Article Korkmaz AN et al. Table 3: Comparison between defect localizations and numerical variables Group 1 Group 2 Group 3 Group 4 P (normal) (LAD) (RCA) (LCx) (n=97) (n=101) (n=43) (n=12) Age 55 ± 9 57 ± 11 59 ± 10 65 ± 10 0.012* SKB 133 ± 18 132 ± 18 138 ± 23 145 ± 24 0.071 DKB 82±13 82 ± 13 87 ± 10 85 ± 9 0.13 LDL 110 ± 32 120 ± 47 151 ± 52 125 ± 9 0.152 HDL 46 ± 12 47 ± 14 45 ± 9 57 ± 7 0.652 Triglycerides 198 ± 134 200 ± 158 200 ± 100 131 ± 41 0.924 Cholesterol 191 ± 29 200 ± 57 232 ± 69 209 ± 10 0.261 Glucose 111 ± 39 106 ± 21 110 ± 17 140 ± 28 0.518 One Way ANOVA test, posthoc sceffe*: significant age difference between group 1 and group 4. SBP: Systolic Blood Pressure, DBP: Diastolic blood pressure, LDL: Low Density Lipoprotein, HDL: High Density Lipoprotein Statistical Analysis Results Data were analyzed using SPSS 15.0 program. This study included 253 patients (the mean age 57 ± Correlation between wall thickness and movement 10 years, 144 (57%) females and 109 (43%) males). Of scores on stress and resting images obtained by using the patients underwent Gated SPECT MPS, 111 have QGS package program and the number of risk factors presented with typical chest pain, 107 have presented was analyzed by Spearman’s correlation analysis. with atypical chest pain, 33 have presented with dyspnea, and 2 have presented with positive ECG signs Table 4: Comparison of wall movement for CAD. characteristics between risk factor groups Normal Slightly severe Spearman’s correlation analysis performed for stress (n=168) hypokinetic hypokinetic and resting MPS signs; given risk factors revealed a (n=78) or akinetic negative correlation between increase in the number (n=7) of risk factors and SEF and REF of the patients, but a Risk 91 31 0 positive correlation between increase in the number factor of risk factors and SSTS, RSTS, SSMS, RSMS, SESV, ≤ 2 RESV, SEDV, and REDV values.
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