[The differential diagnostic value and significance of combined heart stress tests in patients with atypical chest pain].
OBJECTIVE
To investigate the value of stress electrocardiography (S-ECG) and stress myocardial perfusion scintigraphy (S-MPS) in the differential diagnosis of patients with atypical chest pain.


METHODS
Patients with atypical chest pain were undergone S-ECG, S-MPS, coronary angiography and coronary artery spastic provocation with intracoronary acetylcholine test. The final diagnoses of those patients were coronary heart disease, coronary spasm, coronary artery muscular bridge, microvascular angina pectoris and chest pain with non-coronary heart disease. Those patients were grouped by final diagnoses to retrospectively compare the results of S-ECG and S-MPS between groups.


RESULTS
Totally 186 patients with integrated data were included. The final diagnoses were coronary artery stenosis (above 50% stenosis in diameter) in 20%, coronary artery spasm in 27%, coronary artery muscular bridge in 14%, microvascular angina pectoris in 5%, and chest pain with non-coronary artery disease in 34%. The sensitivity and specificity to diagnose ischemic coronary artery disease (including coronary stenosis, coronary artery muscular bridge and syndrome X but not coronary artery spasm) were 92% and 65% in S-ECG, 62% and 79% in S-MPS, respectively. Combination of atypical chest pain, negative S-ECG and reversal redistribution of S-MPS was an accurate non-invasive method to diagnose coronary artery spasm with sensitivity of 94% and specificity of 96%.


CONCLUSIONS
Most of patients with atypical chest pain have organic or functional ischemic coronary artery disease. Combination of heart stress tests are helpful to differentiate the etiology of atypical chest pain.
Xiang
Ding-cheng
DC
Department of Cardiology, Guangzhou General Hospital of Guangzhou Command, Guangzhou 510010, China. dcxiang@yahoo.com.cn
Yin
Ji-lin
JL
Teng
Ai-ping
AP
He
Jian-xin
JX
Gong
Zhi-hua
ZH
Hong
Chang-jiang
CJ
D002637:Chest Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000175:diagnosis / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D015635:Radionuclide Ventriculography; D012189:Retrospective Studies