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A review of patients with a 'normal' coronary angiogram over a 3-year period
Insights
Patients with normal coronary arteries undergoing stress tests may show false positives. This study identifies potential indicators like higher left ventricular end-diastolic pressure and specific artery characteristics.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Coronary angiography is crucial for diagnosing coronary artery disease.
- Identifying characteristics of patients with normal or non-critical coronary arteries is important for accurate diagnosis.
- False positive stress tests can lead to unnecessary interventions.
Purpose of the Study:
- To investigate the clinical, electrocardiographic, stress testing, and angiocardiographic features of patients with normal or non-critical coronary artery stenosis.
- To identify potential indicators associated with false positive treadmill tests in this patient group.
Main Methods:
- Retrospective analysis of 54 patients over 36 months.
- Review of clinical data, electrocardiograms (ECG), stress test results, and coronary angiograms.
- Correlation of findings with left ventricular end-diastolic pressure (LVEDP) and coronary artery anatomy.
Main Results:
- A preponderance of female patients and ethnic Indians were observed.
- Most patients had at least one coronary risk factor; 52% had normal resting ECG.
- Positive stress tests showed a near-equal distribution of horizontal and J-type ST depression.
- Patients with positive treadmill tests tended to have higher LVEDP and a higher proportion of small distal left anterior descending arteries.
Conclusions:
- Raised LVEDP and a "small distal left anterior descending artery" may be associated with false positive treadmill tests in patients with normal coronary arteries.
- These findings suggest potential markers for differentiating true ischemia from false positives.
- Further research is warranted to validate these associations and improve diagnostic accuracy.
Abstract:
Over a period of 36 months, we detected 54 patients with normal coronary arteries or non-critical coronary artery stenosis within our study series of coronary angiography. We studied these patients to determine their clinical, electrocardiographic, stress testing and angiocardiographic characteristics. We detected among them a preponderance of female sex and a higher incidence of ethnic Indians. The majority of the patients studied had one or more coronary risk factors. 52% had a normal resting ECG. In those with a positive stress test and reports available for review, there is a near equal distribution of horizontal and J-type ST depression. Those patients with a positive treadmill tend to have a higher left ventricular end diastolic pressure (LVEDP) at cardiac catheterization. We also noted in this group of patients a higher proportion with a small distal left anterior descending artery. These patients also tend to have higher LVEDP even in the presence of normal left ventriculogram. Our current series suggests the possibility of raised left ventricular end-diastolic pressure and the presence of a "small distal left anterior descending artery" syndrome in association with patients with a 'false positive' treadmill test.