Kardiyak sendrom x`li hastalarda sol ventrikül global ve bölgesel sistolik fonksiyonlarının kolor kinesis dobutamin stres ekokardiyografi ile incelenmesi

Abstract

ÖZET Sendrom X; tanımlandığı günden bu yana etyolojisi ve patofızyolojisi aydınlatıiamamış, üzerinde tartışmaların devam ettiği konuların başında gelmektedir. Bu hastalarda gerçekten miyokardial iskemi varmıdır, varsa neden gösterilenıemektedir ve alışılmış anti anginal ilaçlarla göğüs ağrısı neden kontrol edilememektedir gibi aydınlatılmayı bekleyen pek çok soru mevcuttur. Sendrom X'li hastalarda, iskeminin dolaylı göstergesi sayılabilecek, stresle indüklenen sol ventrikül global yada bölgesel sistolik disfonksiyonunu araştırmak amacıyla, sendrom X tanısı konmuş 14 hasta ile 10 kontrol vakasının kolor kinesis dobutamin strese yanıtları karşılaştırıldı. Sendrom X'li hasta grubunda DSE esnasında hastaların % 57'sinde angina, % 50 sinde de ST segment depresyonu gelişirken; kontrol grubunda angina ve ST segment depresyonu tespit edilmedi. Sendrom X'li hastalarda dobutamin strese yanıt olarak; kontrol grubuyla benzer şekilde sol ventrikül diastol sonu volümü ile sistol sonu volümü azalırken, ejeksiyon fraksiyon değişmedi ve hiçbir segmentte disfonksiyon gelişmedi. Sonuç olarak kolor kinesiz dobutamin stres ekokardiyografı ile sendrom X'li hiçbir hastada iskeminin dolaylı göstergesi olan sol ventrikülün global yada bölgesel sistolik disfonksiyonu tespit edilememiştir. 37

SUMMARY Investigation Of The Left Ventricular Global And Regional Systolic Functions In Patients with Cardiac Syndrome X Using Color Kinesis Dobutamine Stress Echocardiography Syndrome X is the leading topic which is contiunously argued about it's aetiology and pathophysiology since the day it is defined. So many questions that are raised to be enlighted that if it is a real myocardial ischemia and if so than why can't it be demonstrated and why not the chest pain be controlled by the usual antianginal medication. We compared 14 patients who were diagnosed as Syndrome X and 10 control patients' reactions to the color kinesis dobutamin stress to observe the stress induced global or regional systolic dysfunction of left ventricule which can be attributed to the indirect effect of ischemia. While Syndrome X patients were performing DSE, we observed angina 57 % and ST segment depression in 50 % of patients but the control subjects developed neigther angina nor ST segment depression. In patients with Syndrome X, while the left ventricular end diastolic volume and the end systolic volume were decreased as a reaction to the dobutamine stress test, similar to the control group, the ejection fraction did not change and any dysfunction observed in the segments of the left ventricule. As a result; in any cases with Syndrome X, the left ventricular global or regional dysfunction which are the indirect parameters of ischemia are observed by color kinesis dobutamine stress echocardiography. 389. Geltman EM, Henes CG, SennefFMJ, Sobel BE, Bergmann SR: Increased myocardial perfusion at rest and diminished perfusion reserve in patients with angina and angiographically normal coronary arteries. J Am Coll Cardiol 1990 ; 16 : 586 - 595. 10. Egashira K, Inou T, Hirooka Y: Evidence of impaired enthotelium-dependet coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Eng J Med 1993; 328: 1659-1664. 11. Camici PG, Marraccini P, Lorenzoni R: Coronary haemodinamics and myocardial metabolisms in patients with syndrome X: response to pacing stress. J Am Coll Cardioll 1991; 17: 1461-1470. 12. Tweddel AC, Hutton WM: Thallium scans in syndrome X. Br Heart J 1992 ; 68 : 48 - 50. 13. Berger HJ, Sands MJ, Davies RA: Exercise left ventricular performance in patients with chest pain ischaemic appearing exercise electrocardiograms, and angiographycally normal coronary arteries. Ann Intern Med 1981 ; 94 : 186-191. 14. Kaul S, Newell JB, Chesler DA, Pohost GM, Okada RD: Quantitative thallium imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects. Am J Cardiol 1986 ; 57 : 509 - 512. 15. Rosana G, Poole- Wilson PA, Collins P, Hisada K. Prevalance of syndrome X amongst 189 consecutive patients with angina and normal coronary arteries. ( Abst ) J Am Coll Cardiol 1994 ( suppl ) 265 A. 16. Taki J, Nakajima K, Muramori A, Yoshi H, Shimizu M: Left ventricular disfunction during exercise in patients with angina pectoris and angiographically normal coronary arteries ( syndrome X ). Eur J Nucl Med 1994 ; 21 : 98 - 102. 17. Legrand V, Hodgson J, Bates ER: Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms. Am J Cardiol ;6: 1245-1253 18. Rozanski A, Diamond GA, Berman D, Forrester JS, Morris D: The declining specifity of exercise radionuclide ventriculography. New Engl J Med 1983 ; 309 : 518 - 522 19. Henein MY, Rosano GMC, Underwood R, Poole Wilson PA, Gibson D: Relations between resting ventricular long axis function the electrocardiogram and myocardial perfusion imaging in syndrome X. Br Heart J 1994 ; 71 : 541 - 547. 40