Treadmill egzersiz elektrokardiyografi testinde izole inferiorbölge st çökmeleri saptanan hastalarda dobutamin stres ekokardiyografi testi ile iskeminin değerlendirilmesi

Assessment of ıschemia by using dobutamine stress echocardiography test in patients with solated st depression in ınferior leads demonstrated during channel treadmill exercise electrocardiography test

Özet

AMAÇ: Treadmill egzersiz stres testinde (TMET) izole inferior ST segment depresyonu olan hastalarda, koroner iskemiyi tanımada dobuamin stres ekokardiyografi testinin (DSET) uygunluğu ile duyarlılık, özgüllük, pozitif ve negatif öngörü değerlerini araștırmayı amaçladık. YÖNTEM: Çalıșmaya, TMETde inferior bölgede, ST segmentininnoktasından 80 ms sonra ≥1 mm down sloping veya horizontal çökmeleri olan, 70 erkek hasta alındı. Bütün hastalara yașa özgü maksimal kalp hızının en az %85ine ulașana kadar DSET uygulandı. DSET sonası 15 ± 5 gün içinde, koroner dolașımı değerlendirmek için altın standart test olarak selektif koroner anjiyografi ve ventrikülografi yapıldı. BULGULAR: Hastaların ortalama yașları 52 ± 9du. Koroner anjiyografide 28 hastada vasküler stenoz ( bir damarda ≥ %50) belirendi. DSET bunların 23ünde pozitif ve 5inde negatifti. DSET pozitif hastalar 16 tek damar ve 7 iki damar hastalığından olușuyordu. Koroner anjiyografi 42 hastada normaldi (stenoz yoktu ya%50den azdı). Bu hastaların 39unda DSET negatifti. Ancak, vas- küler stenozu olmayan (<%50) hastada DSET pozitifti. nferior kardiyak iskemiyi tanımada DSETin duyarlılığı, özgüllüğü, pozitif ve negatif öngörü değerleri sırasıyla %82, %93, %88 ve %93tü. SONUÇ: TMETde izole inferior segment ST çökmeleri saptanan hasalarda DSET kalp iskemisini saptamada yüksek tanısal değere sahiptir J da

Abstract

AIM: We aimed to evaluate the diagnostic sensitivity, specificity, positive and negative predictive value of dobutamine stress echocardiography test (DSET) in the diagnosis of cardiac ischemia in patients with isolated inferior ST segment depressions in treadmilexercise stress test (TMET). METHODS: Seventy male patients with horizontal or down sloping of ≥1 mm ST segment depressions, 80 msc after J point in inferior eads during TMET were included in the study. DSET was applied o all patients until at least an 85% of age specific maximal heart ate was reached. A selective coronary ventriculographic examinaion as a gold standard to evaluate the coronary circulation was performed within 15 ± 5 days of the DSET. RESULTS: The mean age of the patients was 52 ± 9 years. Vascular stenosis (≥ 50% of a vessel) was demonstrated in the angiographic examination of 28 patients. DSET was positive in 23 and negative in 5 of these cases. DSET positive patients consist of 16 single vessel and 7 two vessel diseases. Coronary angiography examination was normal in 42 of the paients (without stenosis or stenosis of <50%). DSET was negative n 39 of these patients. However, in 3 of patients without vascular stenosis (<50%) DSET was positive. The sensitivity, specificity, positive and negative predictive value of DSET in the diagnosis of inferior cardiac ischemia were 82%, 93%, 88% and 93%, respectively. CONCLUSION: DSET has a high diagnostic value and should be performed routinely in patients with isolated inferior ST segment depression in TMET.