Stabil angina pektorisli hastalarda arteriyel sertlik ve AORT augmentasyon indeksinin koroner arter hastalığı ile ilişkisi
Loading...
Files
Date
2016
Authors
Uysal, Ali
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Arteriyel sertliğin birçok çalışmada hipertansiyon, inme, kardiyovasküler olaylar ve mortalitenin bağımsız bir prediktörü olduğu gösterilmiştir. Arteriyel sertliği gösteren parametrelerden biri olan augmentasyon indeksi; kardiyovasküler hastalıkların bir prediktörü olarak farklı hasta gruplarında çalışılmıştır. Direkt olarak koroner arter hastalığının yaygınlığı ve augmentasyon indeksi arasındaki ilişki ile ilgili yayınlar çok fazla olmasada; klinik çalışmalar augmentasyon indeksi ile koroner arter hastalığı mevcudiyeti arasındaki ciddi klinik bağlantıyı ortaya koymaktadır. Bizim çalışmamızdaki amaç augmentasyon indeksi ile koroner arter hastalığı ve yaygınlığı arasındaki ilişkiyi incelemektir. Çalışmaya semptom, bulgu ve koroner risk profilleri değerlendirilerek koroner arter hastalığı şüphesi ile koroner anjiyografi planlanan 22'si kadın, 58'i erkek olmak üzere toplam 80 hasta (yaş ortalaması 59 ± 8) ve herhangi bir kronik hastalık öyküsü olmayan 20 sağlıklı olgu dahil edildi. Uscom marka arteriograf cihazı ile tüm hastaların augmentasyon indeksi hesaplandı. Tüm hastalara koroner arter hastalığı öntanısı ile koroner anjiyografi uygulandı. Hastalar koroner arter hastalığı açısından klinik olarak anlamlı olan ve olmayan gruplar adı altında değerlendirildi. Koroner arter hastalığı saptanan grupta koroner arter hastalığının ciddiyeti açısından her hastanın Gensini skoru hesaplandı. Augmentasyon indeksi hasta grubunda [% 131 (79-198)] kontrol grubuna [% 72.5 (69-96)] göre anlamlı olarak düşük saptandı (p<0,001). Hasta grubunda; augmentasyon indeksi ile Gensini skoru, LDL-kolesterol, vücut kitle indeksi ve HbA1c arasında pozitif korelasyon olduğu saptandı. Yapılan ROC analizinde augmentasyon indeksi için eğri altında kalan alan (AUC) 0,701 (p<0,001) hesaplandı. AIX %121 üzerinde iken %94,8 duyarlılık ve %80,9 özgüllük ile koroner arter hastalığını öngörmekteydi. Koroner arter hastalığını öngörmede çeşitli non-invaziv tetkikler kullanılmaktadır. Bu tetkiklerin basit olması yanında korener arter hastalığını tahmin etmede doğruluk oranı yüksek olması gerekmektedir. Günümüzde koroner arter hastalığını öngörmede kullanılan tetkiklerde ciddi mesafeler katedilmiştir ancak halen hiçbir testin duyarlılığı ve özgüllüğü tüm hasta grubunu tahmin etmede yeterli değildir. Bu nedenle her zaman tanıyı öngörmede yeni destekleyici yöntemlere ihtiyaç vardır. Bu açıdan bakıldığında augmentasyon indeksi; poliklinik şartlarında arteriyograf cihazı ile maliyet etkin bir şekilde hastalardan non invaziv ölçüm alınabilen bir yöntem olarak önem kazanmaktadır.
It was shown in several studies that arterial stiffness is a predictor of hypertension, stroke, cardiovascular events and mortality. Augmentation index (AIX), one of the parameters showing arterial stiffness, was studied in many different patient groups. Even though there are few publications about relationship between extent of coronary artery disease (CAD) and AIX, clinical studies indicate a relation between AIX and presence of coronary artery disease. Purpose of this study is to demonstrate a relationship between AIX and presence and extent of coronary artery disease. 80 consecutive patients for whom coronary angiography planned because of symptoms and risk profiles were included in this study. 58 were male and the patients were between 33-73 years old (mean age: 59 ± 8), AIX of all pateints were calculated by using Uscom arteriograph. Coronary angiography was performed for all patients due to coronary artery disease suspicion. Patients were subdivided into two groups as patients with coronary artery disease and patients without coronary artery disease. Gensini score showing the severity of coronary artery disease was calculated in patients with coronary artery disease. Mean AIX of control group was 72.5% (69-96). Mean AIX of patients with coronary artery disease was 131% (79-198). The difference was statistically significant (p< 0,001) while there was a significant relationship between presence of coronary artery disease and AIX (r=0,910, p<0,001). We examined a positive correlation between augmentation index with body mass index, LDL-cholesterole and HbA1c. Sensitivity and specificity of AIX in determination of coronary artery disease were calculated by ROC curve. When the cut off value of AIX was taken as 121%, the senstivity was 94,8% and specificity was 80,9% Several non invasive techniques are being used to detect coronary artery disease. These tecniques are required to be easily applicable and to have a high positive predictive values. Remarkable achievements are carried out in predicting coronary artery disease but still no tests are effective enough to predict coronary artery disease in all patients. Therefore, at each time, supporting new methods are needed to predict diagnosis. By this view AIX calculated by using arteriograph in daily practice represents a valuable and non invasive method.
It was shown in several studies that arterial stiffness is a predictor of hypertension, stroke, cardiovascular events and mortality. Augmentation index (AIX), one of the parameters showing arterial stiffness, was studied in many different patient groups. Even though there are few publications about relationship between extent of coronary artery disease (CAD) and AIX, clinical studies indicate a relation between AIX and presence of coronary artery disease. Purpose of this study is to demonstrate a relationship between AIX and presence and extent of coronary artery disease. 80 consecutive patients for whom coronary angiography planned because of symptoms and risk profiles were included in this study. 58 were male and the patients were between 33-73 years old (mean age: 59 ± 8), AIX of all pateints were calculated by using Uscom arteriograph. Coronary angiography was performed for all patients due to coronary artery disease suspicion. Patients were subdivided into two groups as patients with coronary artery disease and patients without coronary artery disease. Gensini score showing the severity of coronary artery disease was calculated in patients with coronary artery disease. Mean AIX of control group was 72.5% (69-96). Mean AIX of patients with coronary artery disease was 131% (79-198). The difference was statistically significant (p< 0,001) while there was a significant relationship between presence of coronary artery disease and AIX (r=0,910, p<0,001). We examined a positive correlation between augmentation index with body mass index, LDL-cholesterole and HbA1c. Sensitivity and specificity of AIX in determination of coronary artery disease were calculated by ROC curve. When the cut off value of AIX was taken as 121%, the senstivity was 94,8% and specificity was 80,9% Several non invasive techniques are being used to detect coronary artery disease. These tecniques are required to be easily applicable and to have a high positive predictive values. Remarkable achievements are carried out in predicting coronary artery disease but still no tests are effective enough to predict coronary artery disease in all patients. Therefore, at each time, supporting new methods are needed to predict diagnosis. By this view AIX calculated by using arteriograph in daily practice represents a valuable and non invasive method.
Description
Keywords
Koroner arter hastalığı, Augmentasyon indeksi, Arteryel sertlik, Gensini skoru, Coronary artery disease, Augmentation index, Arterial stiffness, Gensini score
Citation
Uysal, A. (2016). Stabil angina pektorisli hastalarda arteriyel sertlik ve AORT augmentasyon indeksinin koroner arter hastalığı ile ilişkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.