Abstract
Background:
Coronary artery spasm usually attacks while at rest and the diagnosis depends on provoking tests which mostly are invasive, expensive and not practical. Previous investigations demonstrated that in most patients with coronary artery spasm, treadmill exercise electrocardiography (TEEC) did not induce any ischemic changes, and myocardial perfusion scintigraphy (MPS) showed reverse redistribution (RR).
Hypothesis:
Combination of resting chest pain, negative TEEC and RR might be a rational noninvasive set to predict coronary artery spasm.
Methods:
Patients with chest pain at rest, no significant coronary artery stenosis, and willing to undergo acetylcholine test were included. TEEC, dipyridamole and rest thallium‐201 MPS were performed before or after coronary angiography. The patients were divided into spasm and nonspasm groups by acetylcholine test. The clinical features and results of TEEC and MPS were compared between the spasm and nonspasm groups.
Results:
Acetylcholine test was performed in 92 patients and coronary artery spasm was successfully provoked in 68 patients. Positive TEEC was induced in only 4 patients in the spasm group. RR was present in totally 77 patients and 68 of them were from the spasm group. By a combination of resting chest pain, negative TEEC and RR to diagnose coronary artery spasm, the sensitivity and specificity were 94% and 96% respectively.
Conclusion:
Combination of resting chest pain, negative TEE and RR appears to be a rational noninvasive set to predict coronary artery spasm. Copyright © 2007 Wiley Periodicals, Inc.
Keywords: nuclear cardiology, imaging, exercise testing and exercise physiology, catheterization/diagnostic interventional, cardiac
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References
- 1. Kim MH, Park EH, Yang DK, Park TH, Kim SG, et al.: Role of vasospasm in acute coronary syndrome: insights from ergonovine stress echocardiography. Circ J 2005; 69: 39–43. [DOI] [PubMed] [Google Scholar]
- 2. Yasue H, Kugiyama K: Coronary spasm: clinical features and pathogenesis. Intern Med 1997; 36: 760–765. [DOI] [PubMed] [Google Scholar]
- 3. Nakano T, Osanai T, Tomita H, Sekimata M, Homma Y, et al.: Enhanced activity of variant phospholipase C‐delta 1 protein (R257H) detected in patients with coronary spasm. Circulation 2002; 105: 2024–2029. [DOI] [PubMed] [Google Scholar]
- 4. Mathey D, Montz R, Hanrath P, Kuck KH, Bleifeld W: Non‐invasive method for recognition of coronary artery spasm: 201thallium sequential scintigraphy of the myocardium after ergotamine provocation (author's transl). Dtsch Med Wochenschr 1980; 105: 509–515. [DOI] [PubMed] [Google Scholar]
- 5. Pfisterer M, Muller‐Brand J, Burkart F: Combined non‐invasive perfusion and function examinations in unclear chest pains: diagnosis without a heart catheter? Schweiz Med Wochenschr 1981; 111: 1000–1002. [PubMed] [Google Scholar]
- 6. Bultas J, Karetova D, Aschermann M, Krupicka P, Danzig V, et al.: Noninvasive diagnosis of coronary spasm. Vnitr Lek 1992; 38: 531–540. [PubMed] [Google Scholar]
- 7. Palinkas A, Picano E, Rodriguez O, Diordjevic‐Dikic A, Landi P, et al.: Safety of ergot stress echocardiography for non‐invasive detection of coronary vasospasm. Coron Artery Dis 2001; 12: 649–654. [DOI] [PubMed] [Google Scholar]
- 8. Sueda S, Hashimoto H, Ochi N, Hayashi Y, Kawada H, et al.: New protocol to detect coronary spastic angina without fixed stenosis. Jpn Heart J 2002; 43: 307–317. [DOI] [PubMed] [Google Scholar]
- 9. Xiang DC, Kleber FX: Smoking and hyperlipidemia are important risk factors for coronary artery spasm. Chin Med J 2003; 116: 510–513. [PubMed] [Google Scholar]
- 10. Xiang DC, Yin JL, He JX, Teng AP, Gong ZH, et al.: Characteristics of treadmill exercise electrocardiography and dipyridamole 201Tl myocardial perfusion image in patients with coronary artery spasm. Zhonghua Heyixue Zazhi 2005; 25: 10–13. [Google Scholar]
- 11. Xiang DC, Gong ZH, He JX, Hong CJ, Qiu J, et al.: The study on dose protocol and diagnostic criteria of acetylcoline test in Chinese. Chin Med J 2004; 117: 1564–1566. [PubMed] [Google Scholar]
- 12. Xiang DC: Treadmill exercise electrocardiography In Practice Manual of Heart Stress Tests (Ed. Xiang DC.), pp. 12–16 Beijing: People's Military Medical Press, 2001. [Google Scholar]
- 13. Feola M, Biggi A, Ribichini F, Rovere A, Vado A, et al.: Predicting cardiac events with Tl201 dipyridamole myocardial scintigraphy in renal transplant recipients. J Nephrol 2002; 15: 48–53. [PubMed] [Google Scholar]
- 14. Tanasescu D, Berman D, Staniloff H: Apparent worsening of 201Tl myocardial defects during redistribution. What does it mean? J Nucl Med 1979; 20: 688–691. [Google Scholar]
- 15. Tian YY, Liu XJ, Shi RF, Liu YZ, Zhang XL, et al.: Clinical significance of reverse redistribution in {99m}Tc‐MIBI myocardial perfusion scintigraphy. Zhonghua Heyixue Zazhi 1995; 15: 249–250. [Google Scholar]
- 16. Xiang DC, He JX, Hong CJ, Qiu J, Ma J, et al.: Clinical features of patients with atypical coronary artery spasm. Zhonghua Xinxueguanbing Zazhi 2006; 34: 227–230. [PubMed] [Google Scholar]
- 17. Kawasaki T, Ito K, Okano A, Nagata K, Yoneyama S, et al.: The usefulness of 123I‐BMIPP myocardial SPECT in diagnosis for silent myocardial ischemia induced by vasospasm. Kaku Igaku 1999; 39: 45–50. [PubMed] [Google Scholar]
- 18. Miwa K, Igawa A, Miyagi Y, Nakagawa K, Inoue H: Alterations of autonomic nervous activity preceding nocturnal variant angina: sympathetic augmentation with parasympathetic impairment. Am Heart J 1998; 135: 762–771. [DOI] [PubMed] [Google Scholar]
- 19. Ruan YJ, Xiang DC, Qiu J, Zhang JX, Zhang P, et al.: Changes of serous NO in patients with coronary artery spasm. Xin Fei Xueguanbing Zazhi 2005; 24: 11–13. [Google Scholar]