[en] Coronary flow reserve, exercise thallium-201 scintigraphy and exercise radionuclide ventriculography were compared in 18 patients with chest pain and angiographically normal coronary arteries. Regional exercise thallium-201 perfusion was abnormal in three patients, regional exercise wall motion was abnormal in three other patients and results of both tests were abnormal in one additional patient. Left ventricular ejection fraction responses were abnormal in five of these seven patients. The coronary flow reserve of arterial distributions with abnormal perfusion or regional dysfunction was significantly lower than that of distributions associated with normal radionuclide results (1.42 +/- 0.23 versus 2.58 +/- 0.83, p less than 0.001). All patients with abnormal scintigraphic results had low coronary flow reserve (less than 1.95) in at least one distribution. Perfusion abnormalities appeared to be more localized in the arterial distributions with the lowest flow reserve. Only two patients had low flow reserve (less than 1.95) with normal scintigraphic results; both were hypertensive. These data suggest that abnormal exercise scintigraphic findings in patients with angiographically normal coronary arteries and chest pain are indicative of true blood flow or perfusion abnormalities.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Legrand, Victor ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie
Hodgson, J. M.
Bates, E. R.
Aueron, F. M.
Mancini, G. B.
Smith, J. S.
Gross, M. D.
Vogel, R. A.
Language :
English
Title :
Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms.
Meller J, Goldsmith SJ, Rudin A (1979) Spectrum of exercise thallium201 myocardial perfusion imaging in patients with chest pain and normal coronary angiograms. Am J Cardiol 43:717-723.
Berger BC, Abramowitz R, Park CH (1983) Abnormal thallium 201 scans in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol 52:365-670.
Berger HJ, Sands MJ, Davies RA (1981) Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries. Ann Intern Med 94:186-191.
Rozanski A, Diamond GA, Berman D, Forrester JS, Morris D, Swan HJC (1983) The declining specificity of exercise radionuclide ventriculography. N Engl J Med 309:518-522.
Fuller CM, Raizner AE, Chahine RA (1980) Exercise-induced coronary arterial spasm: angiographic demonstration, documentation of ischemia by myocardial scintigraphy and results of pharmacologic intervention. Am J Cardiol 46:500-506.
Bulkley BH, Hutchins GM, Bailey I, Strauss HW, Pitt B (1977) Thallium201 imaging and gated cardiac blood pool scans in patients with ischemic and idiopathic cardiomyopathy: a clinical and pathologic study. Circulation 55:753-760.
Dunn RF, Wolff L, Wagner S, Botvinick EH (1981) The inconsistent pattern of thallium defects: a clue to the false positive perfusion scintigram. Am J Cardiol 48:224-232.
Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastham CL (1982) Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med 307:1362-1366.
Pichard AD, Smith H, Holt J, Meller J, Gorlin R (1983) Coronary vascular reserve in left ventricular hypertrophy secondary to chronic aortic regurgitation. Am J Cardiol 51:315-320.
Pichard AD, Gorlin R, Smith H, Ambrose J, Meller J (1981) Coronary flow studies in patients with left ventricular hypertrophy of the hypertensioe type: evidence for an impaired coronary vascular reserve. Am J Cardiol 47:547-554.
Nichols AB, Sciacca RR, Weiss MB, Blood DK, Brennan DL, Cannon PJ (1980) Effect of left ventricular hypertrophy on myocardial blood flow and ventricular performance in systemic hypertension. Circulation 52:329-349.
Strauer BE (1979) Ventricular function and coronary hemodynamics in hypertensive heart disease. Am J Cardiol 44:999-1006.
Opherk D, Mall G, Zebe H (1984) Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation 69:1-7.
Opherk D, Zebe H, Weihe E (1981) Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 63:817-825.
Cannon RO, Watson RM, Rosing DR, Epstein SE (1983) Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol 1:1359-1373.
White CW, Wright CB, Doty DB (1984) Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis?. N Engl J Med 310:819-824.
Vogel R, LeFree M, Bates E (1984) Application of digital techniques to selective coronary arteriography: use of myocardial contrast appearance time to measure coronary flow reserve. Am Heart J 107:153-164.
Garcia E, Maddahi J, Berman D, Waxman A (1981) Space/time quantitation of thallium-201 myocardial scintigraphy. J Nucl Med 22:309-317.
Hodgson, Legrand V, Bates E (1985) Validation in dogs of a rapid angiographic technique to measure relative coronary blood flow during routine catheterization. Am J Cardiol 55:188-194.
Margolis JR, Kannel WB, Feinleib M, Dawber TR, McNamara PM (1973) Clinical features of unrecognized myocardial infarction-silent and symptomatic. ghteen year follow up: the Framingham study. Am J Cardiol 32:1-7.
Rosenblatt A, Selzer A (1977) The nature and clinical features of myocardial infarction with normal coronary arteriogram. Circulation 55:578-580.
Cheitlin MD, McAllister HA, de Castro CM (1975) Myocardial infarction without atherosclerosis. JAMA 231:951-959.
Braunwald E (1978) Coronary spasm and acute myocardial infarction-new possibility for treatment and prevention. New Engl J Med 299:1301-1303.
Legrand V, Deliege M, Henrard L, Boland J, Kulbertus H (1982) Patients with myocardial infarction and normal coronary arteriogram. Chest 82:678-685.
Nicklas JM, Sanford G, Van Heyningen CA (1984) Decreased flow reserve following transient myocardial ischemia (abstr). J Am Coll Cardiol 3:546.
Mueller TM, Marcus ML, Kerber RE, Young JA, Barnes RW, Abboud FM (1978) Effect of renal hypertension and left ventricular hypertrophy on the coronary circulation in dogs. Circ Res 42:543-549.
Holtz J, Restorff WV, Bard P, Bassenge E (1977) Transmural distribution of myocardial blood flow and of coronary reserve in canine left ventricular hypertrophy. Basic Res Cardiol 72:286-292.
Kobayashi K, Tarazi RC (1984) Lovenberg, Rakusan K. Coronary blood flow in genetic cardiac hypertrophy. Am J Cardiol 53:1360-1364.
Bache RJ, Vrobel TR, Ring WS, Emery RW, Andersen RW (1981) Regional myocardial blood flow during exercise in dogs with chronic left ventricular hypertrophy. Circ Res 48:76-87.
Cook DJ, Bailey I, Strauss HW, Rouleau J, Wagner HN, Pitt B (1976) Thallium-201 for myocardial imaging: appearance of the normal heart. J Nucl Med 17:583-589.
Berger BC, Watson DD, Taylor GJ (1981) Quantitative thallium-201 exercise scintigraphy for detection of coronary artery disease. J Nucl Med 22:585-593.
Marcus ML (1983) Pharmacologic agents. The Coronary Circulation in Health and Disease , McGraw-Hill, New York; 416-452.
Barner HB, Kaiser GC, Willman VL (1974) Effect of nitroglycerine and papaverine on coronary flow in man. Am Heart J 88:13-17.
Hodgson, Mancini GBJ, Vogel RA (1984) Characterization of changes in coronary blood flow during the first six seconds after contrast injection (abstr). J Am Coll Cardiol 3:589.