Objectives: To investigate coronary artery lesions in patients with essential hypertension by Dual-source 256-slide MSCT compared to percutaneous coronary angiography. Subjects and methods: 186 patients were enrolled. All of them underwent 256-slide MSCT in Vietnam Heart Institute from 11 - 2014 to 10 - 2016.
Journal of military pharmaco-medicine no5-2017 INVESTIGATION OF CORONARY ARTERY DISEASE IN PATIENTS WITH ESSENTIAL HYPERTENSION BY DUAL-SOURCE 256-SLIDE MSCT To Thi Mai Hoa*; Pham Thi Hong Thi**; Pham Minh Thong** SUMMARY Objectives: To investigate coronary artery lesions in patients with essential hypertension by Dual-source 256-slide MSCT compared to percutaneous coronary angiography Subjects and methods: 186 patients were enrolled All of them underwent 256-slide MSCT in Vietnam Heart Institute from 11 - 2014 to 10 - 2016 Results: The percentage of significant coronary stenosis was 47.8% The number of 1, and branches with stenosis accounted for 19.9%, 16.1% and 11.8%, respectively Almost patients were suffered from diffuse coronary injury: LAD, RCA, LCx, LM stenosis at 41.4%, 24.7%, 18.8% and 4.3%, respectively The proportion of patients with severe stenosis was 49.6% The percentages of LAD and RCA were higher than others Patients with hypertension also suffered coronary calcification Conclusion: Dual-source 256slide MSCT is not only a non-invasive approach of coronary disease, but also should be used to assess patients with essential hypertension and coronary artery disease (CAD) * Key words: Hypertension; Coronary artery disease; 256-slide computed tomography INTRODUCTION Hypertension is one of the most common diseases and has a high mortality rate It is also a highly prevalent risk factor for cardiovascular diseases throughout the industrialized world According to World Health Organization (WHO), worldwide hypertension is estimated to cause 7.1 million premature deaths and 4.5% of the disease burden [5] Despite of the universal acknowledgment, hypertension should be diagnosed and aggressively treated, blood pressure control rates around the world are abysmally low and shameful [5] Coronary artery disease is one of the leading causes threating human health in developed countries and it increasingly becoming a significant public health problem in developing countries CAD has a variety of risk factors, including hypertension - one of the most dangerous independent ones Thanks to the development of the multislide CT (MSCT), a non-invasive approach of coronary CT angiography (CTA), it has been applied widely to avoid the complications of invasive coronary angiography (ICA), which is generally believed to be the gold standard in evaluating CAD [8] * Bac Ninh Health Department ** Bach Mai Hospital Corresponding author: To Thi Mai Hoa (tomaihoa71@gmail.com) 204 Journal of military pharmaco-medicine no5-2017 However, the number of studies about CAD in patients with essential hypertension by 256 slides MSCT has been not much currently Therefore, we carried out the study with objectives: To evaluate coronary artery lesion in patients with essential hypertension by Dual-source 256slide MSCT + Criteria for CAD: European Society of Cardiology (2013) [7] SUBJECTS AND METHODS Severe: stenosis with > 75% reduction in lumen diameter + The stenosis degree of coronary artery was evaluated according to Pujadas G [6]: Mild: stenosis < 50% reduction in lumen diameter Moderate: stenosis with 50 - 75% reduction in lumen diameter Subjects Lesions with a diameter reduction of 50% or more were considered to represent significant stenoses 186 primary hypertensive patients were enrolled In Vietnam National Heart Institute from 11 - 2014 to 10 - 2016 All of them agreed to participate in the research Assessment of coronary artery calcification: According to Agatston Methods * Statistical analysis: Using SPSS statistical package 22.0 (SPSS Inc., Chicago, IL, USA) All data were expressed as proportions or - Study design: Descriptive, cross-sectional in comparison with subgroup - Study contents: Patients were assessed by clinical and preclinical examinations All of the subjects underwent 256 slide MSCT mean ± SD ( X ± SD) Chi-square test was used to compare two proportions or more Student t-test, the non-parametric MannWhitney test were used to assess the differences between study groups The statistical significance was established at 2-tailed (p < 0.05) - Diagnostic and evaluation criteria: + Criteria for hypertension diagnosis: According to 2015 guideline of Vietnam National Heart Association [3] RESULTS AND DISCUSSION General characteristics of patients Table 1: Age and gender of subjects Age Total (N = 186) (1) Male (N = 116) (2) Female (N = 70) (3) n % n % n % < 50 years 10 5.4 6.9 2.9 50 - 60 years 54 29.0 33 28.4 21 30.0 60 - 70 years 73 39.2 39 33.6 34 48.5 ≥ 70 years 49 26.3 36 31.0 13 18.6 Mean (years) (X ± SD) 63.88 ± 9.39 63.90 ± 9.97 63.86 ± 8.41 p 2&3 > 0.05 > 0.05 205 Journal of military pharmaco-medicine no5-2017 The mean age of hypertensive patients was 63.88 ± 9.39 years Age of male hypertensive group had no differences compared to those of female group (p > 0.05) Similarly, the distribution of subjects by age groups of patients had no differences Patients aged 60 or more accounted for the largest percentage (65.5%) * Hypertensive duration (N = 186): < years: 103 patients (55.4%); - 10 years: 43 patients (23.1%); ≥ 10 years: 40 patients (21.5%) Patients with hypertensive duration from to years had the highest rate (55.4%) These results were similar to those of other authors’ studies such as Almasi A et al (mean age of patients was 59.75 years), Phung Bao Ngoc (mean age of patients was 63.19 years) [4] Characteristics of coronary artery disease in patients by Dual-source 256-slide MSCT than other authors such as Stuijfzand W.J (2014) (61%), Nguyen Thi Thanh Loan (2015) (69.5%) [1, 9], because the majority of patients in this study have just been detected, received better advices from doctors and risk factors are conditionally controlled Table 2: Characteristics of coronary artery disease in patients by Dual-source 256-slide MSCT Feature (N = 186) Number of branches Position of stenosis (> 50%) n % branch 37 19.9 branches 30 16.1 ≥ branches 22 11.8 LAD 77 41.4 RCA 46 24.7 LCx 35 18.8 LM 4.3 All of coronary position suffered from stenosis, the percentage of LAD stenosis accounted for highest rate of 41.4% Number of 1, and branches with stenosis were 19.9%, 16.1% and 11.8%, respectively Most of the patients were suffered diffuse coronary injury: LAD, RCA, LCx, LM at 41.4%, 24.7%, 18.8% and 4.3%, respectively * Coronary stenosis degree in patients by Dual-source 256-slide MSCT (N = 186): Figure 1: Significant coronary stenosis in patients by Dual-source 256-slide MSCT The percentage of significant coronary stenosis was 47.8% This result was lower 206 Non-stenosis: 63 patients (33.9%); < 50%: 34 patients (27.6%); 50 - 70%: 28 patients (22.8%); ≥ 70%: 61 patients (49.6%) Most patients had significant coronary stenosis with different degree The percentage for degree of 70% or more coronary stenosis reached the highest point at 49.6% Journal of military pharmaco-medicine no5-2017 Table 3: Degree of coronary artery stenosis in specific positions Branch LAD RCA LCx LM % Stenosis n % n % n % n % Non-stenosis 73 39.2 119 64.0 128 68.8 163 87.6 < 50% 36 19.4 21 11.3 23 12.4 15 8.1 50 - 70% 26 14.0 16 8.6 15 8.1 4.3 ≥ 70% 51 27.4 30 16.1 20 10.7 Sum 186 100 186 100 186 100 186 100 From perspective position, LAD severe lesion accounted for 27.4%, RCA severe lesion accounted for 10.8%, LCx severe lesion accounted for 16.1% and the figure for LM was 2.7% LAD artery is the most commonly occluded of the coronary arteries It provides the major blood to the interventricular septum and bundle branches of the conducting system Therefore, stenosis of this artery due to CAD can lead to impairment or death of the conducting system Severe stenosis with > 70% reduction in lumen diameter in LAD, RCA accounted for largest percentage These results were similar to those of other authors’ studies such as Phan Đong Bao Linh: LAD lesion 73.33%, RCA lesion 63.3%, LCx lesion 45% and LM lesion 4.4% [2] Table 4: Assessment of coronary artery calcification Feature N % Non-calcification 81 43.5 < 100 points 55 29.6 100 - 400 points 26 14.0 > 400 points 24 12.9 186 100 Calcification Sum Mean (X ± SD) 164.33 ± 386.47 Patients with hypertension also suffered coronary calcification The proportion of patient with calcification was higher than those of non-calcification CONCLUSION The percentage of significant coronary stenosis was 47.8% Most patients suffered diffuse coronary injury The proportion of patients with severe stenosis was quite high (49.6%) From perspective position, LAD severe lesion accounted for the largest percentage Patients with hypertension also suffered coronary calcification After all, we recommended that 256-slide MSCT was not only a non-invasive approach of coronary disease, but should also be used to assess patients with essential hypertension and CAD 207 Journal of military pharmaco-medicine no5-2017 REFERENCES worldwide data Lancet 2005, 365 (9455), pp.217-223 Nguyễn Thị Thanh Loan Nghiên cứu đặc điểm tổn thương động mạch vành chụp cắt lớp vi tính 256 dãy bệnh nhân tăng huyết áp có nguy tim mạch cao Luận văn Thạc sỹ Y học Học viện Quân y 2015 Matt D, Scheffel H, Leschka S et al Dual-source CT coronary angiography: image quality, mean heart rate, and heart rate variability AJR Am J Roentgenol 2007, 189 (3), pp.567-573 Phan Đồng Bảo Linh Nghiên cứu đặc điểm tổn thương mạch vành vận tốc sóng mạch bệnh nhân tăng huyết áp nguyên phát có bệnh động mạch vành Luận án Tiến sỹ Y học Trường Đại học Y Dược Huế 2013 Montalescot G, Sechtem U, Achenbach S et al 2013 ESC guidelines on the management of stable CAD: the task force on the management of stable CAD of the European Society of Cardiology Eur Heart J 2013, 34 (38), pp.2949-3003 Bộ Y Tế Hướng dẫn chẩn đoán điều trị tăng huyết áp Hướng dẫn chẩn đoán điều trị bệnh tim mạch Nhà xuất Y học 2015 Almasi A, Pouraliakbar H, Sedghian A et al The value of coronary artery calcium score assessed by dual-source computed tomography coronary angiography for predicting presence and severity of CAD Pol J Radiol 2014, 79, pp.169-74 Kearney P.M, Whelton M, Reynolds K et al Global burden of hypertension: analysis of 208 Mowatt G, Cummins E, Waugh N et al Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of CAD Health Technol Assess 2008, 12 (17), iii-iv, ix-143 Stuijfzand W.J, Raijmakers P.G, Driessen R.S et al Value of hybrid imaging with PET/CT to guide percutaneous revascularization of chronic total coronary occlusion Curr Cardiovasc Imaging Rep 2015, (7), pp.26 ... al (mean age of patients was 59.75 years), Phung Bao Ngoc (mean age of patients was 63.19 years) [4] Characteristics of coronary artery disease in patients by Dual-source 256-slide MSCT than other... carried out the study with objectives: To evaluate coronary artery lesion in patients with essential hypertension by Dual-source 256slide MSCT + Criteria for CAD: European Society of Cardiology (2013)... 256-slide MSCT was not only a non-invasive approach of coronary disease, but should also be used to assess patients with essential hypertension and CAD 207 Journal of military pharmaco-medicine