Dijagnostička vrednost sveobuhvatne neinvazivne procene morfoloških i funkcionalnih karakteristika koronarne bolesti
Sažetak
Apstrakt
Uvod/Cilj. Nedavno usvojena tehnika, Transtorakalna Doppler Ehokardiografija (TDE) omogućava procenu funkcionalne značajnosti suženja koronarne arterije. Koronarografija putem “multi-slice” kompjuterizovane tomografije (MSCT) nam pruža informacije o morfološkim karakteristikama koronarne arterijske bolesti. Cilj istraživanja je bio da se proceni najpouzdaniji neinvazivni dijagnostički pristup u cilju detekcije značajnih stenoza na prednjoj descedentnoj arteriji (LAD) i desnoj koronarnoj arteriji (RCA). Metode. Studijom je obuhvaćeno 84 bolesnika, sa prethodno detektovanim aterosklerotskim lezijama na LAD i/ili RCA putem MSCT. Procena koronarne rezerve protoka (CFR) putem TDE sa adenozinom sprovedena je na LAD (n = 75) i RCA (n = 61), sa ukupno 136 koronarnih arterija za analizu. Invazivna koronarografija (ICA) je urađena kod svih bolesnika 24 do 48 sati posle CFR. Rezultati. Cochrans Q testom je dokazana je statistički značajna razlika između tehnika pri detekciji značajnih koronarnih lezija na LAD i RCA (p < 0,01). Dalje analize su ukazale na značajnu razliku između MSCT i CFR (p < 0,05), MSCT i ICA (p < 0,01), dok između CFR i ICA nije uočena statistički značajna razlika (p > 0,05). Najveća diskrepanca u rezultatima uočena je između CFR, ICA i MSCT kada su analizirane interemdijarne teške stenoze. Dijagnostičku pouzdanost MSCT za LAD je bila 66,67%, za RCA 75 %, a CFR za LAD 90% i za RCA 81,67%, pri detekciji značajnih aterosklerotskih lezija. Kada su rezultati obe tehnike bili u saglasnosti dijagnostička pouzdanost je unapređena i za LAD (97,33%) i za RCA (90%). Zaključak. Sveobuhvatna neinvazivna procena, kako morfoloških, tako i funkcionalnih karakteristika koronarne bolesti je optimalan pristup za neinvazivnu i preciznu procenu značajnosti aterosklerotskih lezija na koronarnim arterijama.
Reference
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