Publication: Myokardiyal perfüzyon SPECT görüntülemede dipiridamol stres EKG bulgularının klinik önemi
Abstract
Amaç: Bu çalışmada koroner anjiyografi sonuçları “Altın standart” olarak kabul edilerek, dipiridamol infüzyonu sırasında ve sonrasında EKG’de izlenen anlamlı ST segment depresyonunun klinik önemi araştırıldı. Gereç ve Yöntemler: Bu çalışmaya 5 yıllık bir dönem içinde bölümümüze MPS ile değerlendirilmesi için refere edilen ve bu tetkik sırasında dipiridamol ile farmakolojik stres uygulanan hastalar alındı. Değerlendirme kriterlerine uygun olduğu saptanan toplam 76 olguya dipiridamol infüzyonu standart bir protokol ile uygulandı. Dipiridamol infüzyonu sırasında ve takibinde olguların EKG bulguları, kalp atım hızı ve kan basıncı değerleri kayıt altına alındı. Bulgular: Diagnostik koroner anjiyografi bulguları pozitif olarak değerlendirilen 60 hastanın 23’ünde (%38) IV dipiridamol infüzyonu sonrası ³1 mm ST segment depresyonu gelişti. Dipiridamol infüzyonu sonrası anlamlı ST segment depresyonu 3 damar hastası olan olgularda daha sık izlenmiştir. Dipiridamol infüzyonu sırasında ve sonrasında EKG’de izlenen ST segment depresyonu için sensitivite, spesifite, pozitif ve negatif öngörü değerleri sırasıyla %38, %81, %89 ve %26 olarak bulundu. Hipertansiyonun eşlik ettiği sol ventriküler hipertrofi varlığında ise spesifite değeri daha düşük bulunmuştur (%50). Sonuç: Dipiridamol infüzyonu sonrası oluşan ST segment depresyonu koroner arter hastalığı için sensitif olmasa da spesifik bir belirteçtir. Literatürdeki araştırmalar ışığında, dipiridamol ile farmakolojik stres sonrası anlamlı ST depresyonu izlenen ancak MPS sonucu normal raporlanan olgular yakın klinik takibe alınmalı ve bu olgu grubunda klinik gereklilik halinde ek diagnostik testlerden (koroner anjiyografi gibi) kaçınılmamalıdır.
Objective: The results of the coronary angiography were accepted as a “Gold Standard” in this study and the clinical importance of significant ST-segment depression on the ECG during and after dipyridamole infusion was evaluated. Material and Methods: During a 5-year period, the patients who were referred for evaluation with MPS and underwent dipyridamole pharmacological stress were included in this study. Total 76 patients who fullfilled the evaluation criteria, underwent dipyridamole infusion according to a standard protocol. The cardiac rhythm was monitored continuously and ECG findings, heart rate and blood pressure were recorded during and after dipyridamole infusion. Results: Of 60 patients with a diagnostic positive coronary angiography, 23 (38%) developed 1 mm ST-segment depression after IV dipyridamole. Dipyridamole induced ST-segment depression occured more frequently in patients with three-vessel coronary artery disease. Sensitivity, specifity, positive predictive and negative predictive values for ST-segment depression on the ECG during and after dipyridamole infusion were 38%, 81%, 89% and 26% respectively. The specificity value was found lower in patients with left ventricular hypertrophy secondary to hypertension (50%). Conclusion: Although the ST-segment depression occuring after dipyridamole infusion is not sensitive for coronary artery disease, it is a specific marker. In the light of the research in the literature, close clinical follow-up and further diagnostic testing (ie, coronary angiography) should not be avoided in case of clinical necessity with normal MPS associated with significant ST-segment depression in patients undergoing dipyridamole pharmacologic stress testing.
Objective: The results of the coronary angiography were accepted as a “Gold Standard” in this study and the clinical importance of significant ST-segment depression on the ECG during and after dipyridamole infusion was evaluated. Material and Methods: During a 5-year period, the patients who were referred for evaluation with MPS and underwent dipyridamole pharmacological stress were included in this study. Total 76 patients who fullfilled the evaluation criteria, underwent dipyridamole infusion according to a standard protocol. The cardiac rhythm was monitored continuously and ECG findings, heart rate and blood pressure were recorded during and after dipyridamole infusion. Results: Of 60 patients with a diagnostic positive coronary angiography, 23 (38%) developed 1 mm ST-segment depression after IV dipyridamole. Dipyridamole induced ST-segment depression occured more frequently in patients with three-vessel coronary artery disease. Sensitivity, specifity, positive predictive and negative predictive values for ST-segment depression on the ECG during and after dipyridamole infusion were 38%, 81%, 89% and 26% respectively. The specificity value was found lower in patients with left ventricular hypertrophy secondary to hypertension (50%). Conclusion: Although the ST-segment depression occuring after dipyridamole infusion is not sensitive for coronary artery disease, it is a specific marker. In the light of the research in the literature, close clinical follow-up and further diagnostic testing (ie, coronary angiography) should not be avoided in case of clinical necessity with normal MPS associated with significant ST-segment depression in patients undergoing dipyridamole pharmacologic stress testing.