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Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary
Insights
Chest pain with normal coronary arteries may indicate true blood flow issues. Abnormal exercise scintigraphy findings correlate with reduced coronary flow reserve, suggesting underlying perfusion abnormalities.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Chest pain in patients with angiographically normal coronary arteries presents a diagnostic challenge.
- Exercise scintigraphy and radionuclide ventriculography are commonly used to assess cardiac function and perfusion.
- Coronary flow reserve (CFR) is a measure of blood flow capacity in the coronary arteries.
Purpose of the Study:
- To compare coronary flow reserve (CFR), exercise thallium-201 scintigraphy, and exercise radionuclide ventriculography.
- To determine if abnormal scintigraphic findings in patients with normal coronary arteries indicate true perfusion abnormalities.
Main Methods:
- Eighteen patients with chest pain and normal coronary arteries underwent CFR measurement, exercise thallium-201 scintigraphy, and exercise radionuclide ventriculography.
- Regional perfusion and wall motion abnormalities were assessed using scintigraphy and ventriculography.
- CFR was measured in arterial distributions corresponding to normal and abnormal scintigraphic findings.
Main Results:
- Abnormal regional perfusion or wall motion was observed in 7 out of 18 patients.
- Coronary flow reserve was significantly lower in distributions with abnormal perfusion or dysfunction (1.42 ± 0.23) compared to normal distributions (2.58 ± 0.83).
- All patients with abnormal scintigraphic results had low CFR (<1.95) in at least one distribution; perfusion abnormalities were more localized with lower CFR.
Conclusions:
- Abnormal exercise scintigraphic findings in patients with chest pain and normal coronary arteries are indicative of true blood flow or perfusion abnormalities.
- Reduced coronary flow reserve is associated with abnormal scintigraphic results in this patient group.
- These findings support the use of advanced imaging techniques to identify underlying causes of chest pain even with normal coronary angiograms.
Abstract:
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.