Detecting occult coronary disease in a high-risk asymptomatic population
Roger S Blumenthal1, Diane M Becker, Lisa R Yanek
1Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rblument@jhmi.edu
Insights
Abnormal exercise stress tests in asymptomatic individuals with a family history of coronary artery disease (CAD) often indicate mild atherosclerosis, not severe blockages. Perfusion defects may stem from vasomotor dysfunction or plaque.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Exercise stress testing and perfusion imaging are standard for diagnosing obstructive coronary artery disease (CAD) in symptomatic patients.
- The significance of abnormal functional exercise tests in asymptomatic individuals with a family history of premature CAD remains unclear.
Purpose of the Study:
- To investigate the correlation between abnormal exercise test results and the severity of coronary atherosclerosis in asymptomatic individuals with a family history of CAD.
Main Methods:
- Evaluated 734 asymptomatic siblings of patients with documented CAD.
- 153 individuals had abnormal exercise tests, thallium scans, or both.
- 105 underwent coronary angiography for quantitative stenosis analysis.
Main Results:
- 95% of participants had coronary atherosclerosis; only 39% had stenoses >=50%.
- Among those with both abnormal tests, 70% had stenoses >=50%.
- Arteries feeding perfusion defects showed a mean stenosis of 43+/-31%, with 68% <50%.
Conclusions:
- Abnormal exercise scintigraphy in asymptomatic individuals with a family history of CAD primarily identifies mild coronary atherosclerosis.
- Perfusion defects may result from coronary vasomotor dysfunction in addition to atherosclerotic plaque.
Background:
Exercise stress testing alone or with perfusion imaging is the standard screening method to determine the presence of obstructive coronary artery disease (CAD) in people with chest pain. In asymptomatic individuals with a family history of premature CAD, it is unclear whether abnormalities on these functional exercise tests represent significant coronary disease.
Methods And Results:
An abnormal exercise test, thallium scan, or both occurred in 153 (21%) of 734 asymptomatic siblings of persons with documented CAD, of whom 105 underwent coronary angiography with quantitative analysis of stenosis severity. Overall, 95% had coronary atherosclerosis, but only 39% had 1 or more stenoses with >or=50% narrowing. Of 30 siblings in whom the exercise test and perfusion scan were both abnormal, 70% had >or=50% stenoses. The mean stenosis in arteries that fed perfusion defects was only 43+/-31%, and 68% of such stenoses were <50%. However, in 71% of all defects, the location matched arteries with the most severe stenoses.
Conclusions:
In asymptomatic persons with a family history of CAD, abnormal exercise scintigraphy identifies predominantly mild coronary atherosclerosis. Perfusion defects may be caused by coronary vasomotor dysfunction in addition to atherosclerotic plaque.
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