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[Abnormal myocardial blood flow distribution with a normal coronarogram in angina pectoris and after myocardial
Insights
Selective coronary perfusion scintigraphy reveals perfusion defects in patients with normal coronary angiograms, indicating issues in small vessels. This technique aids in diagnosing angina pectoris and myocardial infarction when angiography is inconclusive.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary angiography is standard for diagnosing coronary artery disease.
- Subtle or microvascular changes may not be detected by coronary angiography alone.
Purpose of the Study:
- To evaluate the utility of selective coronary perfusion scintigraphy in patients with suspected or post-myocardial infarction conditions.
- To identify cases where coronary angiography shows normal vessels but scintigraphy reveals perfusion abnormalities.
Main Methods:
- Selective coronary perfusion scintigraphy performed simultaneously with coronary angiography.
- Analysis of 47 patients: 25 post-myocardial infarction and 22 with angina pectoris.
- Correlation of scintigraphic findings with electrocardiographic data and coronary angiogram results.
Main Results:
- In post-myocardial infarction patients with normal coronaries, scintigraphy showed perfusion disturbances correlating with infarct location.
- In angina pectoris patients with normal coronaries, scintigraphy revealed regional changes in the terminal vascular system.
- Two cases showed rhythm and conduction disturbances correlated with septal perfusion lesions.
Conclusions:
- Coronary angiography alone is insufficient to rule out angina pectoris or myocardial infarction.
- Selective coronary perfusion scintigraphy effectively detects regional perfusion disturbances, even with normal coronary angiograms.
- Scintigraphy offers a non-invasive method to assess myocardial blood supply distribution but doesn't reveal the cause of microvascular issues.
Abstract:
It is reported on the selective coronary perfusion scintigraphy in 47 patients with angina pectoris and condition after myocardial infarction, which was performed simultaneously with the coronary angiography. For the paper were interesting the cases with normal coronarogram, but pathological perfusion scintigram. 3 of 25 patients with condition of infarction showed coronarographically inconspicuous vessels. In all cases the perfusion scintigram shows disturbances of regional perfusion, which corresponded with the electrocardiographic localisation of the infarction. In 3 of 22 patients with angina pectoris with normal coronarogram in the scintigram regional changes of the terminal vascular system were established. In 2 cases simultaneously a disturbance of rhythm and stimulus conduction was present, which showed a conspicuous correlation to the perfusion lesions in the septum. In the small intramural vessels haemodynamically effective changes take place which are below the coronarogram. Therefore, the only coronarography is not enough to confirm or to refuse a genuine angina pectoris or an infarction. The selecitve coronary perfusion scintigraphy gives the possibility to prove disturbances of the distribution of regional blood supply without a greater additional load of the patient as to coronary angiography. However, it cannot give evidence on the genesis of disturbances in the terminal vascular system in the normal coronarogram