الفهرس | Only 14 pages are availabe for public view |
Abstract Introduction: Coronary atherosclerosis develops earlier in diabetic patients than in other subjects and accounts for excess morbidity and mortality in these patients. In patients with Acute Coronary Syndrome (ACS), addition of gating to routine myocardial perfusion SPECT provides additional information that can not be obtained by perfusion imaging alone. It provides accurate and reproducible information on left ventricular function and volume. Aim of the study: To assess the difference between the resting and post-stress gated SPECT functional parameters and transient ischemic dilatation as independent non perfusion risk markers for the evaluation of the severity of coronary artery disease in diabetic patients with acute coronary syndrome. Patients and methods: This study included 30 consecutive diabetic patients referred to the CCU Department of Ain Shams University Hospital & Beni-suef University Hospital with one of the acute coronary syndromes including ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. Each patient was subjected to the following: - Clinical assessment. - 12-lead resting ECG. - Echocardiographic examination. Summary 72 - Gated SPECT: Using dual head CardioMD gamma camera linked to SMV power station , Stress and rest Technetium-99m Sestamibi GSPECT myocardial perfusion imaging was performed to all patients included in the study . - Coronary angiography: Coronary angiography was done only for patients with stress myocardial perfusion imaging showing reversible defects and either post stress depression of ejection fraction (EF) or transient ischemic dilatation (TID). The results of coronary angiography were compared with those predicted by Technetium -99m SPECT imaging as well as the post stress changes in functional indices or transient ischemic dilatation. Results: Our results showed that Post-exercise worsening of LVEF or TID is more likely to detect multivessel CAD than reversible perfusion defects alone. The worsening of the LVEF(worsening of EF ≥ 5% ) or Transient Ischemic Dilatation (TID ratio ≥ 1.2 ) had significantly increased sensitivity in detecting multivessel CAD over Tc-99 m perfusion defects (100% ,95% Vs 80.9% , respectively ). However, the specificity between both was not significantly different (95%, 100% Vs 100%). Our results also showed that the magnitude of the post-stress global dysfunction correlates with the severity of the ischemia: the sensitivity for detection of multivessel CAD at TID ratio ≥1.2 was higher than that at ≥1.4 (95% Vs 80.9%). Also the sensitivity for detection of multivessel CAD in patient with post stress worsening of EF ≥ 5%was higher than at ≥6% (100% Vs 95%). |