Myocardial perfusion in patients with typical chest pain and normal angiogram

Background  Approximately 10–30% of patients with typical chest pain present normal epicardial coronaries. In a proportion of these patients, angina is attributed to microvascular dysfunction. Previous studies investigating whether angina is the result of abnormal resting or stress perfusion are con...

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Bibliographic Details
Published in:European journal of clinical investigation 2006-05, Vol.36 (5), p.326-332
Main Authors: Graf, S., Khorsand, A., Gwechenberger, M., Schütz, M., Kletter, K., Sochor, H., Dudczak, R., Maurer, G., Pirich, C., Porenta, G., Zehetgruber, M.
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Coronary Angiography
Coronary Circulation
Coronary flow reserve
Exercise Test
Female
General aspects
Humans
Hyperemia - physiopathology
Image Processing, Computer-Assisted - methods
Male
Medical sciences
Microvascular Angina - diagnostic imaging
Microvascular Angina - physiopathology
microvascular disease
Middle Aged
Positron-Emission Tomography
Vascular Resistance
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Summary:Background  Approximately 10–30% of patients with typical chest pain present normal epicardial coronaries. In a proportion of these patients, angina is attributed to microvascular dysfunction. Previous studies investigating whether angina is the result of abnormal resting or stress perfusion are controversial but limited by varying inclusion criteria. Therefore, we investigated whether microvascular dysfunction in these patients is associated with perfusion abnormalities at rest or at stress. Patients and methods  In 58 patients (39 female, 19 male, mean age 58 ± 10 years) with angina and normal angiogram as well as 10 control patients with atypical chest pain and normal coronaries (six female, four male, mean age 53 ± 11 years) myocardial blood flow (MBF) was measured at rest and under dipyridamole using 13N–ammonia PET. Resting MBF and coronary flow reserve (CFR) as the ratio of hyperaemic to resting MBF were corrected for rate – pressure – product (RPP): normalized resting MBF (MBFn) = MBF × 10 000/RPP and CFRn = CFR × RPP/10 000. Results  Sixteen/58 patients had a normal CFRn (= 2·5; group I; CFRn: 3·1 ± 0·88); the same as the controls (CFRn: 3·3 ± 0·74). Forty‐two/58 patients presented a reduced CFRn (group II; CFRn: 1·78 ± 0·57). Group II had both a higher MBFn (group II: 1·30 ± 0·33 vs. Group I: 1·03 ± 0·26; P 
ISSN:0014-2972
1365-2362
DOI:10.1111/j.1365-2362.2006.01635.x