الفهرس | Only 14 pages are availabe for public view |
Abstract Coronary artery disease (CAD) is one of the main causes of mortality and morbidity worldwide. Therefore, the predictive role of diagnostic tools is crucial in terms of prevention to CAD. Although exercise testing is a well-established noninvasive stress test for the evaluation of the patients with suspected CAD, its sensitivity and specificity are not satisfactory (67% and 71%, respectively). Duke treadmill score (DTS) is well recognized as a simple prognostic score in patients with suspected coronary artery disease (CAD). It is positioned as a valid clinical tool when clinicians need to make a decision about the catheterization of patients with suspected CAD The duke treadmill score (DTS) provides valuable diagnostic and prognostic knowledge for the evaluation of the patients with suspected CAD. DTS might be beneficial to evaluate prognosis in patients with a moderate to high-risk. DTS calculated by using parameters including ST-segment depression, chest pain, and exercise time [exercise time – (5 × ST deviation) – (4 × exercise angina)]. The aim of work is to reinforce the duke treadmill score of anginas during the treadmill stress test through a comparative study between the result of SPECT MPI study and the duke treadmill score of the suspected CAD, since many centers and cardiology units have no capability of MPI study and eventually that improve the early detection and the management of the high-risk cases in the limited units. A retrospectively reviewed of the studies patients underwent stress treadmill test MPI between January to October 2020 were consecutively included into our study. The study will be conducted in ALFA Scan Radiology Center, Cairo, Egypt. Summary 62 Results: All patients were selected according to the inclusion and exclusion criteria: Inclusion criteria: Patients with large perfusion defect ≥10% on semiquantitative analysis, Patients have low ,moderate and high risk Duke treadmill score. Exclusion criteria were: Patients with negative SPECT myocardial perfusion imaging. Patients with large perfusion defect ≥10% or more but with predominant scar. Patients who had pharmacological stress test. Abnormal basic ECG abnormalities Lt&Rt BBB,WPW etc.. For every patient the following was done: History taking for the following data: Age, Sex, Diabetes Mellitus, Hypertension, Dyslipidemia and Smoking, all patients who met the inclusion criteria were compared through the results of SPECT Myocardial Perfusion Imaging and Duke score value. Results of the current study were summarized as follows: The mean of age, weight, height of the studied patients was (51.14±8.81 year, 91.06±14.08 kg, 170.18±7.68 cm), respectively. Most of the studied patients (80%) were males. More than half of them (51 %) were non-smokers. The patients were classified as low-, intermediate-, or high-risk according to the scores (low risk DTS ≥ +5, intermediate-risk –10 ≤ DTS ≤ +4, and high-risk DTS ≤ –11). According to the DTS, patients categorized as follows, low risk (LR);<0.5%/year, intermediate risk; 0.5% to 5%/year and high risk; >5%/year of cardiovascular events Summary 63 Most of the studied patients (78 %, 80 %, 93%, 61 %, 95 % and 71) hadn’t previous interventions, obesity, previous MI, DM, Familial hypercholesterolemia and CAD, respectively. While, (37 %, 36 % and 23%) of them had chest Pain, HTN and dyslipidemia, respectively. The mean resting of heart rate, SBP and DBP were (87.77±14.77, 129.90±10.68 and 80.40±5.49), respectively. Most of the studied patients (63 %) had restingelectrocardiogram. While, the mean peak of heart Rate, SBP and DBP of the studied patients were (153.85±19.26, 156.70±12.31 and 88.40±7.88), respectively. The mean of duration, metabolic equivalents, duke treadmill score of the studied patients were (390.70±138.41, 8.14±2.41, -4.6±10.51), respectively. While, (45%) of them were in third stage of examination. Also, (64%) of them were negative chest pain. Age, Previous MI and previous intervention were significantly increased among high-risk group than low and moderate risk groups (P<0.05). On the other hand, there were no significant differences between the studied groups regarding gender, weight, smoking, obesity, chest Pain, HTN, DM, dyslipidemia, familial hypercholesterolemia CAD and OHD (P>0.05). Ending stage : high risk group were earlier to discontinue the test (2nd stage ending) unlikely the moderate and low DTS risk group. (P< 0.05). While, duration, METS and DTS were highly significantly increased among low-risk group than moderate and high-risk groups(P<0.001). There was significant relation between the risk value of Duke treadmill score and Aston summed stress score among the studied patients (P= 0.018). |