title: Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms.
abstract: BACKGROUND
  After hospitalization for chest pain, women are more likely than men to have normal coronary-artery angiograms. In such women, myocardial ischemia in the absence of clinically significant coronary-artery obstruction has long been suspected. Most methods for the detection of the metabolic effects of myocardial ischemia are highly invasive. Phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy is a noninvasive technique that can directly measure high-energy phosphates in the myocardium and identify metabolic evidence of ischemia.
  
  
  METHODS
  We enrolled 35 women who were hospitalized for chest pain but who had no angiographically significant coronary-artery obstructions and 12 age- and weight-matched control women with no evidence of heart disease. Myocardial high-energy phosphates were measured with 31P-NMR spectroscopy at 1.5 tesla before, during, and after isometric handgrip exercise at a level that was 30 percent of the maximal voluntary grip strength. We measured the change in the ratio of phosphocreatine to ATP during exercise.
  
  
  RESULTS
  Seven (20 percent) of the 35 women with chest pain and no angiographically significant stenosis had decreases in the phosphocreatine:ATP ratio during exercise that were more than 2 SD below the mean value in the control subjects without chest pain. There were no significant differences between the two groups with respect to hemodynamic variables at rest and during exercise, risk factors for ischemic heart disease, findings on magnetic resonance imaging and radionuclide perfusion studies of the heart, or changes in brachial flow during the infusion of acetylcholine.
  
  
  CONCLUSIONS
  Our results provide direct evidence of an abnormal metabolic response to handgrip exercise in at least some women with chest pain consistent with the occurrence of myocardial ischemia but no angiographically significant coronary stenoses. The most likely cause is microvascular coronary artery disease.
authors.affiliation: Center for Nuclear Magnetic Resonance Research and Development, University of Alabama at Birmingham, 35294, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Buchthal
authors.forename: J A
authors.initials: JA
authors.lastname: den Hollander
authors.forename: C N
authors.initials: CN
authors.lastname: Merz
authors.forename: W J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: C J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: N
authors.initials: N
authors.lastname: Reichek
authors.forename: B L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: S
authors.initials: S
authors.lastname: Reis
authors.forename: S F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: G M
authors.initials: GM
authors.lastname: Pohost
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002637:Chest Pain / Q000209:etiology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000378:metabolism; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D010725:Phosphocreatine / Q000378:metabolism; D010758:Phosphorus
chemical_list: D010725:Phosphocreatine; D010758:Phosphorus; D000255:Adenosine Triphosphate