[Positive exercise test and normal exercise myocardial perfusion SPECT. Clinical significance].
OBJECTIVE
To establish, in our area, the clinical significance of a normal exercise myocardial perfusion study, in patients with an ischemic response of the exercise test.


METHODS
A retrospective study was carried out in our Service for the last four years. We studied 45 patients (41 women and 4 men) with an ischemic response of the exercise test and normal myocardial perfusion SPECT, during a mean follow-up of 13,2 months. We considered the final clinical diagnosis according to clinical evolution, therapy outcome and coronary angiography results.


RESULTS
The presence of positive exercise test and normal SPECT was predominant in women (93.3%). In 35 patients (77.8%), the final diagnosis was chest pain of probable non-coronary origin (not secondary to coronary artery disease): 18 patients were diagnosed of hypertensive cardiomyopathy, 3 of valvulopathy, 2 of vasospastic angina, 1 of hypertrophic obstructive cardiomyopathy, 1 of microvascular angina, 1 of angina due to arrhythmia, and 9 patients diagnosed of atypical chest pain due to functional or non-cardiac origin. In 10 patients (22.2%), the final diagnosis was chest pain of probable coronary origin. We did not observe any major cardiac events (cardiac death and nonfatal myocardial infarction) during the follow-up period.


CONCLUSIONS
Patients with chest pain, positive exercise test and normal SPECT have an excellent prognosis within an intermediate follow-up period. 77.8% of patients were diagnosed of chest pain of non-coronary origin. The most common cause of non-coronary chest pain was hypertensive cardiomyopathy (51.4%), followed by functional or non-cardiac chest pain (28.6%).
Ruiz Solís
S
S
Servicios de Medicina Nuclear, Hospital Alarcos, Complejo Hospitalario de Ciudad Real, 13002 Ciudad Real. sruiz@sescam.jccm.es
Montero Gaspar
M
M
García Vicente
A M
AM
Rodado Marina
S
S
Poblete García
V M
VM
Cortés Romero
M
M
Talavera Rubio
P
P
Soriano Castrejón
A
A
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology; D002637:Chest Pain / Q000209:etiology*; D003326:Coronary Circulation; D003329:Coronary Vasospasm / Q000150:complications / Q000175:diagnosis; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011379:Prognosis; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014463:Ultrasonography