Related Experiment Videos
Angina and normal epicardial coronary arteries: radionuclide features and pathophysiological implications at
M Ciavolella1, A Avella, S Bellagamba
1II Department of Cardiology, La Sapienza University of Rome, Italy.
Insights
Patients with angina and normal coronary arteries may experience persistent symptoms due to delayed contrast dye run-off, linked to functional and perfusion abnormalities in coronary territories. This suggests a pathophysiological basis beyond epicardial coronary artery disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Angina with normal epicardial coronary arteries affects a significant patient population.
- The underlying pathophysiology and symptom modification characteristics remain incompletely understood.
- Delayed contrast dye run-off is a potential indicator of microvascular dysfunction.
Purpose of the Study:
- To identify characteristics associated with symptom modification in patients with angina and normal coronary arteries.
- To evaluate the pathophysiological link between radionuclide abnormalities and delayed coronary contrast dye run-off.
- To explore the relationship between microvascular function and clinical outcomes.
Main Methods:
- Follow-up of 53 patients with angina and normal epicardial coronary arteries.
- Assessment of coronary contrast dye run-off using a semiquantitative score.
- Evaluation of resting ECG, exercise tests, and regional left ventricular function/perfusion using 99mTc-sestamibi at rest and peak exercise.
Main Results:
- 40% of patients exhibited delayed contrast dye run-off.
- Patients with worsening or no symptom improvement showed a trend towards more conduction abnormalities, pathological exercise tests, and delayed run-off.
- Exercise-induced radionuclide abnormalities were more prevalent in territories with delayed run-off (69%) compared to normal territories (17%), P = 0.00032.
Conclusions:
- Despite a generally good prognosis, some patients with angina and normal coronary arteries experience persistent symptoms.
- Delayed contrast dye run-off is associated with exercise-induced functional and perfusional abnormalities in coronary territories.
- These findings suggest a pathophysiological link between microvascular dysfunction and symptom persistence in this patient group.
Background:
The aim of this study was to identify specific characteristics associated with modifications of symptoms and to evaluate the presence of a pathophysiological link between radionuclide abnormalities and delayed run-off of coronary contrast dye in patients with angina and normal coronary arteries.
Methods:
We followed up 53 patients (21 men and 32 women, mean age: 52 +/- 10 years) with angina and angiographically normal epicardial coronary arteries, 21 of whom (40%) displayed a pattern of slow contrast dye run-off from coronary vessels, on visual assessment using a semiquantitative empirical score. Exercise tests showed ECG abnormalities in 29 patients (55%).
Results:
All patients were alive 92 +/- 44 months after catheterization (140 +/- 79 months after beginning of symptoms). However, 30 patients (57%), who reported worsening or no change of symptoms, presented with a non-significant higher prevalence of conduction abnormalities at rest ECG (27 versus 17%), pathological exercise tests (57 versus 52%), and delayed run-off (47 versus 30%). Regional left ventricular function and perfusion were then simultaneously assessed at rest and peak exercise with 99mTc-sestamibi. Exercise-induced radionuclide abnormalities were detected in 27 patients (51%), who also presented with a non-significant higher prevalence of pathological exercise tests (63 versus 43%) and no improvement of symptoms (63 versus 46%). However, exercise-induced functional and perfusional abnormalities were simultaneously present in 29 out of 42 (69%) coronary territories supplied by vessels with delayed run-off, versus 21 out of 117 (17%) normal territories (P = 0.00032).
Conclusions:
Despite a good prognosis, some patients with angina and normal coronary arteries presented no improvement of symptoms at follow-up, and had functional and perfusional abnormalities in coronary territories supplied by vessels showing delayed contrast dye run-off.