Angina and normal epicardial coronary arteries: radionuclide features and pathophysiological implications at long-term follow-up.
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.
II Department of Cardiology, La Sapienza University of Rome, Italy.
M
M
Ciavolella
A
A
Avella
S
S
Bellagamba
E
E
Mangieri
A
A
Nigri
A
A
Reale
D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002306:Cardiac Volume / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004562:Electrocardiography; D004874:Ergonovine; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013318:Stroke Volume / Q000502:physiology; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left / Q000502:physiology
D017256:Technetium Tc 99m Sestamibi; D004874:Ergonovine