Open Access e-Journal Cardiometry No.16 May 2020

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used 3 times more than stress echocardiography and 2times more than exercise stress tests since 1996. Consideringrapid development and application of thismodality some insufficiencies have been also reportedfor this modality. In several clinical conditions MPI isthe most common used modality for evaluating myocardialperfusion status(10, 11).Although different diagnostic modalities such asexercise stress test, MPI, angiography ae really valuablein diagnosis of coronary artery disease (CAD),but the chance to use them is not prepare and equalfor all people. In some regions and societies it seemsthat it is necessary to know importance and capabilitiesof other non-invasive, cheap, rapid and accessiblemodalities too(12).For the first time Dr. Rose innovated a questionnaireto diagnose CAD and later was applied by otherresearchers in different regions as a very cheap modalityfor diagnosis of CAD. This questionnaire possessa sensitivity of 78 to 81 % and specificity of 94 to 97%compared to clinical judgement(13-15).Nowadays DM is known as a comorbidity whichis associated with an elevated risk of cardiovascularevent and can lead to early death or disability followedby myocardial ischemia. Risk of cardiovascular eventsincrease 2 to 4 folds in diabetic patients compared tonon-diabetics. Diabetic patients have a more complicatedcardiovascular disease at the time of primary diagnosis.MPI is a good screening method for coronaryartery disease in diabetic patients(16, 17).Considering important role of MPI in diagnosis ofCAD and also high expenses and low accessibility fora great percentage of patients along with accessibilityand simplicity of Rose angina questionnaire, in thisstudy we decided to investigate possible associationbetween Rose angina score (RAS) and MPI results indiabetic and non-diabetic patients. We think that thisstudy can help to clarify diagnostic importance of RASin comparison to MPI.Materials and methodsThis study is a descriptive-analytic study performedon 585 diabetic and non-diabetic patients with anginapectoris referred to department of nuclear medicineof Shahid Sadoughi hospital, Yazd, Iran for myocardialperfusion scan during 2019. All patients signedan informed consent to let us use their medical informationfor research purpose. This study was designedand performed based on Helsinki declaration and isregistered in committee of research ethics of ShahidSadoughi university of medical sciences, Yazd, Iranwith IR.SSU.MEDICINE.REC.1398.260 approval ID.We included 300 diabetic and 300 non diabetic patientswith angina pectoris that were referred to nuclearmedicine department for MPI. 15 patients that werenot available or their medical folder was corruptedwere excluded and finally 585 complete folders wereelected for further analysis.MPI were done via Gamma camera device with128 by 128 matrix in both rest and stress conditionfor all patients. All patients underwent physical stressand 20 to 25 milli curry Tc99m-MIBI was used for allimages. MPI results were reported and categorized ina 5-point scale as normal, mild ischemia, moderateischemia, severe ischemia and no perfusion.A Rose angina score questionnaire was also usedfor all patients in which patients are categorized in 3categories based on assessed risk as: score below 6 aslow risk, score between 6 and 11 as moderate risk andscore above 11 as severe risk. Patients angina pectorisis also categorized in 3 degrees as: 1) grade 2 definiteangina (severe) in which patients feel pain while walkingon even land rather than inclined ground. 2) grade1 definite angina (moderate) in which patients answerall questions positive. 3) possible angina (mild) inwhich not all answers are positive but angina pain occurswhile walking with hurry or on inclined ground.All patient’s demographic information including gender,age, comorbidities, Rose angina score and ischemiadetected in MPI were recorded in a questionnaire andfinally all data were analyzed using SPSS ver.21 softwareusing appropriate statistical tests such as Chi-square,independent T test or paired T test. In all tests a P-value<0.05was considered to be statistically significant.ResultsThis is a descriptive-analytic study performed in2019 to assess the relationship between Rose anginascore and MPI results in diabetic and non-diabeticpatients. Among 585 enrolled patients, 294 (50.3%)of them were diabetic and 291 of them (49.7%) werenot diabetic. 399 (68.2%) of them were diagnosed withHTN and 75 (12.8%) patients remarked a history ofprior myocardial infarction.In our study population mean patients age was58.33±10.8 and ranged between 24 and 87. Based onRAS, 201 (34.4%) of them had probable angina, 135patients (23.1%) had grade 1 definite angina and 249112 | Cardiometry | Issue 16. May 2020
Table 1Descriptive statistics of patients based on age and genderWomen Men Mean age Total P-valueDiabetic 198 (67.3%) 96 (32.7%) 58.89 294 (100%)Non-diabetic 177 (60.8%) 114 (39.2%) 57.76 291 (100%) Gender = 0.1 Age = 0.2Total 375 (64.1%) 210 (35.9%) 58.33±10.8 585 (100%)Table 2Association between DM and HTN. HTN is significantly more in diabetic patients (P-value=0.001)History of HTN No HTN Total P-valueDiabetic 237 (80.6%) 57 (19.4%) 294 (100%)Non-diabetic 162 (55.7%) 129 (44.3%) 291 (100%)0.001Total 399 (68.2%) 186 (31.8%) 585 (100%)Table 3Association between DM and history of ischemia. there is a statistically significant association between DM and history ofischemia (P-value=0.04)History of HTN No HTN Total P-valueDiabetic 45 (15.3%) 249 (84.7%) 294 (100%)Non-diabetic 30 (10.3%) 261 (89.7%) 291 (100%)0.04Total 75 (12.8) 510 (87.2%) 585 (100%)Table 4Descriptive results associated with frequency of different MPI abnormalities in both diabetic and non-diabetic patientsNormal Mild ischemiaModerate Severeischemia ischemiaNo perfusionDiabetic 114 (38.8%) 99 (33.7%) 30 (10.2%) 36 (12.2%) 15 (5.1%)Non-diabetic 183 (62.9%) 45 (15.5%) 24 (8.2%) 24 (8.2%) 15 (5.2%)Total 297 (50.8%) 144 (24.6%) 54 (9.2%) 60 (10.3%) 30 (5.1%)P-value0.001Table 5There is no statistically significant association between RAS and DM (P-value=0.93).Mild (probable Moderate (grade 1 Sever (grade 2angina) definite angina) definite angina)TotalDiabetic 102 (34.7%) 69 (23.5%) 123 (41.8%) 294 (100%)Non-diabetic 99 (34%) 66 (22.7%) 126 (43.3%) 291 (100%)Total 201 (34.4%) 135(23.1%) 249 (42.6%) 585 (100%)P-value0.93Table 6Association between RAS and MPI results in diabetic patients. There is a significant association between RAS and MPIabnormalities in diabetic patients (P-value=0.001)Mild Moderate Severe Total P-valueNormal 66 (57.9%) 24 (21.1%) 24 (21.1%) 114 (100%)Mild ischemia 36 (36.4%) 33 (33.3%) 30 (30.3%) 99 (100%)Moderate ischemia 0 (0%) 12 (40%) 18 (60%) 30 (100%)Severe ischemia 0 (0%) 0 (0%) 36 (100%) 36 (100%)0.001No perfusion 0 (0%) 0 (0%) 15 (100%) 15 (100%)Total 102 (34.7%) 69 (23.5%) 123 (41.8%) 294 (100%)Table 7Statistically significant association between RAS and abnormal MPI findings in non-diabetic patients (P-value=0.001)Mild Moderate Severe Total P-valueNormal 90 (49.2%) 54 (29.5%) 39 (21.3%) 183 (100%)Mild ischemia 9 (20%) 12 (26.7%) 24 (53.3%) 45 (100%)Moderate ischemia 0 (0%) 0 (0%) 24 (100%) 24 (100%)Severe ischemia 0 (0%) 0 (0%) 24 (100%) 24 (100%)0.001No perfusion 0 (0%) 0 (0%) 15 (100%) 15 (100%)Total 99 (34%) 66 (22.7%) 126 (43.3%) 291 (100%)Issue 16. May 2020 | Cardiometry | 113
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Dear Reader!Our life dictates what
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Prof. Mohammad AleemCairo Universit
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74808597The study of hemodynamics i
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