Ischemia in women with angina and normal coronary angiograms.
BACKGROUND
Coronary artery disease is frequent in postmenopausal women. Myocardial ischemia has been induced with stress testing, and a relationship between endothelial dysfunction and perfusion defects has been reported.


OBJECTIVE
To evaluate whether myocardial ischemia can be evidenced both by perfusion and function abnormalities using gated single-photon emission computed-tomography myocardial scintigraphy with technetium-labeled compounds in women with typical angina, normal coronary angiography, and endothelial dysfunction.


RESULTS
Fifty-nine postmenopausal patients were studied. Each underwent technetium-99m methoxy-isobutyl-isonitrile myocardial scintigraphy (protocol: exercise stress-rest), brachial artery endothelial function measured by ultrasonography, lipidogram, and 24-h ambulatory ECG recording (Holter). Twenty-one patients (group I) showed perfusion defects in myocardial scintigraphy, whereas the other 38 patients (group II) did not. Group I patients exhibited endothelial dysfunction more frequently (57 vs. 29%) than those of group II. Among group I patients, 12 showed a reversible perfusion defect that, in 75% of the cases, was associated with poststress left ventricular ejection fraction reduction greater than 5% and a regional hypokinesis. Nine patients had fixed defects, which in 56% of the cases were associated with poststress left ventricular ejection fraction reduction greater than 5%. Left ventricular ejection fraction poststress minus left ventricular ejection fraction at rest was -5.2% in group I patients versus -1.8% in group II (P<0.001). Three patients in group I showed evidence of ischemia by Holter compared with four in group II.


CONCLUSIONS
Stress-induced ischemia is associated with poststress left ventricular ejection fraction reduction in postmenopausal women with typical angina, normal coronary angiography, and a trend toward abnormal endothelial-mediated vasodilation.
Peix
Amalia
A
Institute of Cardiology, La Habana, Cuba. peix@infomed.sld.cu
García
Ernesto J
EJ
Valiente
Juan
J
Tornés
Francisco
F
Cabrera
Lázaro O
LO
Cabalé
Beatriz
B
Carrillo
Regla
R
García-Barreto
David
D
D017023:Coronary Angiography; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017566:Microvascular Angina / Q000000981:diagnostic imaging; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D017698:Postmenopause; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology*