| Abstract | Cilj istraživanja: Neopstruktivna koronarna bolest unazad nekoliko godina prepoznata je kao
važan uzrok ishemije miokarda i velikih kardiovaskularnih događaja, osobito u ženskoj
populaciji, no još su uvijek nedovoljno istraženi patofiziološki mehanizmi i rizični čimbenici
za ovu bolest. Cilj ovog istraživanja je ispitati pojavnost neopstruktivne koronarne bolesti kod
bolesnika kojima je učinjena koronarografija zbog sumnje koronarnu bolest, utvrditi utjecaj
čimbenika rizika i psiholoških opterećenja u ovoj bolesti u odnosu na opstruktivnu koronarnu
bolest te ispitati utjecaj tortuoziteta koronarnih arterija i određenog tipa koronarne opskrbe u
neopstruktivnoj koronarnoj bolesti.
Nacrt studije: Studija je ustrojena kao presječna studija u kojoj je proučavana zastupljenost
čimbenika rizika i analizirana koronarna anatomija u ispitanika s neopstruktivnom koronarnom
bolesti u odnosu na ispitanike s opstruktivnom koronarnom bolesti.
Ispitanici i metode: U istraživanje je uključeno 160 ispitanika starijih od 18 godina s
dijagnosticiranom opstruktivnom ili neopstruktivnom koronarnom bolesti, ukupno 89
muškaraca i 71 žena, koji su se prezentirali kao AKS ili KKS. Svim ispitanicima učinjena je
anamneza, fizikalni pregled, analiza laboratorijskih nalaza (kolesterol, trigliceridi, HDL, LDL,
homocistein), ehokardiografsko ispitivanje i testiranje psihološkim upitnikom. Svakom
ispitaniku učinjena je analiza koronarograma što obuhvaća procjenu o kojem tipu opskrbe
koronarnih arterija se radi te prisutnost tortuoziteta koronarnih arterija. Za mjerenje tortuoziteta
koronarnih arterija koristile su se dvije metode - metoda izračuna indeksa tortuoziteta i metoda
mjerenja kuteva na koronarogramu. Kod bolesnika s KKS učinjena je analiza nalaza
ergometrijskog testiranja ili perfuzijske scintigrafije miokarda koji su učinjeni u kardiološkoj
obradi prije uključivanja u istraživanje.
Rezultati: Prosječna dob ispitanika bila je 61.6 (SD, 10.2) godina od kojih je 56.9 % bilo s
dijagnozom AKS, a 43.1 % KKS. Prema nalazu koronarografije ispitanici su podijeljeni na
ispitivanu skupinu s NOCAD i kontrolnu skupinu s OCAD. Tortuozitet koronarnih arterija
mjeren metodom mjerenja kutova kao i metodom izračuna indeksa tortuoziteta pokazao je
značajno više tortuoznih koronarnih arterija u skupini s NOCAD u odnosu na kontrolnu skupinu
za sve tri koronarne arterije – LCX, LAD i RCA. Rezultati su pokazali značajnu povezanost
indeksa tortuoziteta LCX i LAD sa znacima ishemije u specifičnim dijelovima miokarda koji
su irigirani tim žilama. Razina stresa bila je značajno veća u podskupini s NOCAD, pri čemu
je 18.8 % bolesnika s NOCAD imalo najvišu razinu stresa.
Zaključak: Ženski spol, tortuozitet koronarnih arterija, lijeva koronarna dominacija, izrazito
povišena razina stresa i povišen kolesterol nezavisni su prediktori neopstruktivne koronarne
bolesti. |
| Abstract (english) | Objectives: Non-obstructive coronary disease has been recognized for several years as an
important cause of myocardial ischemia and major cardiovascular events, especially in the
female population, but the pathophysiological mechanisms and risk factors for this disease are
still insufficiently investigated. The aim of this research is to examine the incidence of nonobstructive coronary disease in patients who underwent coronary angiography due to suspected
coronary disease, to determine the influence of traditional risk factors and psychological
burdens in this disease in relation to obstructive coronary disease, and to examine the influence
of tortuosity of the coronary arteries and a certain type of coronary supply in non-obstructive
coronary artery disease.
Study design: The study is designed as a cross-sectional study which examined the presence
of risk factors and analyzed the coronary anatomy in subjects with non-obstructive coronary
disease compared to subjects with obstructive coronary disease.
Participants and methods: The study included 160 subjects over the age of 18 with diagnosed
obstructive or non-obstructive coronary disease, a total of 89 men and 71 women, who
presented as ACS or CCS. All subjects underwent anamnesis, physical examination, analysis
of laboratory findings (cholesterol, triglycerides, HDL, LDL, homocysteine),
echocardiographic examination and psychological questionnaire testing. Each subject coronary
angiogram was analyzed, with assessment of the type of coronary artery supply and the
presence of coronary artery tortuosity. Two methods were used to measure the tortuosity of the
coronary arteries on the coronary angiogram - the method of calculating the tortuosity index
and the method of angle measurement. In the group of patients with CCS we analyzed the
findings of exercise testing or myocardial perfusion scintigraphy, which were performed prior
to recruitment to the study.
Results: Mean age of the subjects was 61.6 (SD, 10.2), of which 56.9 % were diagnosed with
ACS, and 43.1 % with CCS. According to the findings of coronary angiography, the subjects
were divided into a group with non-obstructive coronary disease and a group with obstructive
coronary disease. Tortuosity of coronary arteries measured by the method of angle
measurement as well as the method of calculating the tortuosity index showed significantly
more tortuosity of coronary arteries in the subgroup with non-obstructive coronary disease
compared to the control group for all three coronary arteries – LCX, LAD and RCA. The results
showed a significant correlation between LCX and LAD tortuosity and signs of ischemia in
specific regions of the myocardium that are irrigated by these vessels. The level of stress was
significantly higher in the subgroup with non-obstructive coronary disease, where 18.8 % of
patients with non-obstructive coronary disease had the highest level of stress.
Conclusion: Female sex, tortuosity of coronary arteries, left coronary dominance, extremely
high stress level and elevated cholesterol are independent predictors of non-obstructive
coronary disease. |
