الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 174 |  |  |
| | | from | 174 | | |
Abstract
Hypertensive heart diseases affect a major portion of the Egyptian population. Clinical hypertension can result from the interplay between several factors, such as consistent psychological stress, sedentary lifestyles, genetics, and poor dietary habits. It is clear that hypertension is directly linked to a variety of coronary heart diseases. Patients suffering from hypertension are predisposed to the occurrence of coronary thrombosis and stenosis which can lead to episodes of acute chest pain. CT angiography proved to be an effective diagnostic approach in that it can effectively delineate the plaque burden in the coronary system. Our objective was to shed more light on whether CT angiography is useful in acute chest pain patients suffering from hypertension. In our study, we investigated 30 hypertensive patients presenting with acute chest pain. Multi slice CT angiography was then performed at Tanta university hospital to identify abnormalities in the coronary system. Written consent was obtained and full explanation was given. Patients who had renal impairment, arrhythmias, contrast hypersensitivity were excluded from the study. The study involved the injection of Ultravist contrast agent followed by a multi detector CT AP and lateral projection scan. Automatic bolus tracking technique was also used to visualize the descending aorta. Prospective ECG gating was used alongside with volume scanning method. Image reconstruction was done at 0.5 mm slice thickness using smooth and sharp reconstruction kernels. Post-processing was done to form multiplanar images in the axial, sagittal and coronal planes. Statistical analysis was done. Our results showed that indeed CT angiography can distinguish cases which suffer from coronary stenosis and myocardial ischemia. Most of patients in the study suffered from typical chest pain (56.7%). There were 23 patients who had CT abnormalities, 20 of them had coronary lesions , abnormal CT finding is significantly correlated with the existence of typical chest pain. The most affected site of the coronaries was the LAD (60%) witch also was the most significally stenosed by 26.7 %. It is followed by the RCA (35%) and it was significally stenosed by 13.3%. Lm coronary came next with (20%) and significally stenosed by 6.7%. LCx site was affected by (15%) with no significant stenosis. D1,D2,Ramus sites were affected by 5% each with significant stenosis found in the first two and non in the last. It has also been demonstrated that clinical hypertension is an important predisposing factor for coronary pathology. For example, it has been shown that a positive correlation exists between positive CT findings and clinical hypertension. More research is needed because the sample size (30 subjects) is rather small, There were also positive correlations between positive CT findings and patients suffer from DM or hyperlipidemia. A larger sample size can further enhance our scientific conclusions by reducing the uncertainty. It can be recommended that patients suffering from clinical hypertension to undergo cardiac coronary CT angiography. However, the cost of the test can be a deterrent. Furthermore, the test involves the injection of a contrast agent and might be time-consuming. However, recent advances in hardware technology and data analysis methodologies can make CT coronary angiography more feasible for patients suffering from hypertension. An early intervention can prove crucial in saving the patient from more severe consequences of coronary diseases, such as myocardial infarction, arrhythmia, or death. In conclusion: CTA is a good fast reliable noninvasive diagnostic tool for patients with acute chest pain . There is a strong correlation between uncontrolled hypertension and abnormal coronary CT findings in patients with acute chest pain. Study Limitations Despite the several important findings and clinical implications for the role of CTA in evaluation of chest pain the present study has several limitations: First, the sample size was relatively small and thus did not allow for separate analyses by age or sex. Second, this study had an observational design and was performed at single Centre, which makes it uncertain whether the results can be equally applied to other populations. Third, there were male dominance in the study so the baseline characteristics contributed to the higher risk of CAD would be present. Fourth, patients with chronic kidney disease have higher risk for CAD but using ionized dye in performing MSCT carries high risk for developing contrast induced nephropathy or even renal failure, so those population was excluded from our study making us to miss a group of subjects with high prevalence of CAD. Fifth, patients with any types of arrhythmias are excluded from our study due to motion artifaction which can be due to prospective ECG triggered CT to lower radiation exposure, those patients may be part of CAD inducing arrhythmia. Sixth, there were patients with combined risk factors of hypertension, idcbunuG, isGedodiumdc cii Gmdkdig, Gd n u Gneis adeeii’n jeigu n u uffuan df hypertension alone in these patients and its correlation with the coronary CTA results. Study Recommendations: 1- We recommend that patients suffering from clinical uncontrolled hypertension and acute chest pain to undergo cardiac coronary CT angiography. 2- Further large-scale studies are needed to confirm the findings of the current study. 3- Comparative studies of CT angiography with other diagnostic modalities for more accurate results. 4- CT angiography may be used as an imaging modality for detection or exclusion of CAD in low and intermediate-low risk patients as guided by ESC guidelines.