Muscular tenderness in the anterior chest wall in patients with stable angina pectoris is associated with normal myocardial perfusion.
OBJECTIVE
This study examines the relationship between the existence of chest wall tenderness evoked by palpation and the absence of ischemic heart disease defined by myocardial perfusion imaging in patients with known or suspected stable angina pectoris.


METHODS
Two hundred seventy-five patients were recruited. Myocardial perfusion imaging was performed on 273 of the subjects. Chest pain was classified according to type by criteria given by the Danish Society of Cardiology and severity by the Canadian Cardiovascular Society. Pectoralis major and pectoralis minor were palpated for tenderness using a standardized procedure.


RESULTS
The association between tenderness and myocardial perfusion imaging (normal vs abnormal) produced an odds ratio (OR) of 2.24 (confidence interval, 1.26-3.99; P = .009). The OR was the same magnitude and significance when stratified by sex, age, type of pain, or class. When adjusting simultaneously for sex, age, type of pain, and class, the association between tenderness and myocardial perfusion imaging (normal vs abnormal) was still present (OR = 2.57; confidence interval, 1.342-4.902; P = .004).


CONCLUSIONS
Presence of tenderness in the anterior chest wall is associated with a higher prevalence of normal myocardial perfusion imaging in patients with known or suspected angina pectoris, and this association cannot be explained by a common association to age, sex, or pain.
Registrar, University of Southern Denmark, Denmark.
Preman
P
Kumarathurai
Mohammed Kashaf
MK
Farooq
Henrik Wulff
HW
Christensen
Werner
W
Vach
Poul F
PF
Høilund-Carlsen
D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003718:Denmark; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D016017:Odds Ratio; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement; D010173:Palpation / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D035441:Thoracic Wall; D015899:Tomography, Emission-Computed, Single-Photon