Myocardial perfusion scintigraphy fi ndings in patients with mild coronary atherosclerotic lesions on coronary angiography

Öz

Objectives : Myocardial perfusion scintigraphy (MPS) iswidely used in functional assessment of myocardial perfusion. But, some study results are in contradiction with severity of coronary artery disease detected by coronary angiography (CA). It is frequently encountered case that CA is completely normal whereas MPS describes ischemia. In this study, we aimed to investigate whether mild atherosclerotic lesions cause ischemia. Materials and methods: MPS with 99mTc-MIBI was performed in 52 patients who applied to cardiology clinics for history of chest pain and underwent diagnostic CA within 3 months. Results: In 22 of 52 patients with mild atherosclerotic lesions, ischemia in various degrees was detected on MPS.In statistical analysis, any signifi cant relationship was not found between ischemia and gender, hypertension, DM, dyslipidemia, smoking, mitral valve insuffi ciency, left ventricular hypertrophy, exercise testing result and affected coronary artery. Conclusion: Our study fi ndings have shown that mild atherosclerotic lesions even at very early stage may cause myocardial ischemia

Anahtar Kelimeler

• coronary artery disease, myocardial ischemia, myocardial perfusion imaging, coronary angiography

Koroner anjiografi sinde hafi f aterosklerotik koroner lezyonu olan hastalarda miyokard perfüzyon sintigrafi bulguları

Öz

Amaç: Miyokard perfuzyon sintigrafi si (MPS) miyokard perfuzyonunun fonksiyonel değerlendirmesinde yaygın olarak kullanılmaktadır. Fakat bazı calısma sonucları koroner anjiografi ile tespit edilen koroner arter hastalığının siddeti ile zıtlık gosterir. Koroner anjiografi tamamen normalken MPS\'nde iskemiden bahsedilmesi sık karsılasılan bir durumdur. Bu calısmada, hafi fterosklerotik lezyonların iskemiye sebep olup olmadıklarını arastırmayı amacladık. Yöntem ve Gereç: Kardiyoloji Polikliniğine goğus ağrısı sikayeti ile basvuran ve 3 ay icerisinde koroner anjiografi yapılmıs olan 52 hastaya 99mTc-MIBI ile miyokard perfuyon sintigrafi si yapıldı. Bulgular: Hafi f derecede aterosklerotik lezyonu olan 52 hastanın 22\'sinde MPS\'de değisik derecelerde iskemi bulguları gozlendi. Yapılan istatistik analizde iskemi ile cinsiyet, hipertansiyon, DM, dislipidemi, sigara icme,mitral kapak yetmezliği, sol ventrikul hipertrofi si, efor test sonucu ve aterosklerotik lezyonun bulunduğu damar arasında anlamlı bir iliski tespit edilmedi. Sonuç: Calısma bulgularımız koroner arterlerdeki hafi f aterosklerotik lezyonların, cok erken donemlerde bile olsa, miyokardda iskemiye sebep olabileceğini gostermektedir.

Anahtar Kelimeler

• koroner arter hastalığı, miyokard iskemisi, miyokard perfuzyon goruntuleme, koroner anjiografi

Kaynakça

1. Alqaisi F, Albadarin F, Jaffery Z, et al. Prognostic predictors and outcomes in patients with abnormal myocardial perfu- sion imaging and angiographically insignifi cant coronary artery disease. J Nucl Cardiol 2008;15:754-61.
2. Ammann P, Naegeli B, Rickli H, et al. Characteristics of pa- tients with abnormal stress technetium Tc 99m sestamibi SPECT studies without signifi cant coronary artery diameter stenoses. Clin Cardiol 2003;26:521-4.
3. Rodés-Cabau J, Candell-Riera J, Angel J, et al. Relation of myocardial perfusion defects and nonsignifi cant coronary lesions by angiography with insights from intravascular ul- trasound and coronary pressure measurements. Am J Car- diol 2005;96:1621-6.
4. Wiedermann JG, Schwartz A, Apfelbaum M. Anatomic and physiologic heterogeneity in patients with syndrome X: An intra-vascular ultrasound study. J Am Coll Cardiol 1995;25:1310-7.
5. Verna E, Ceriani L, Giovanella L, Binaghi G, Garancini S. “False-positive” myocardial perfusion scintigraphy fi nd- ings in patients with angiographically normal coronary arteries: Insights from intravascular sonography studies. J Nucl Med 2000;41:1935-40.
6. Erbel R, Ge J, Bockisch A, et al. Value of intracoronary ultra- sound and Doppler in the differentiation of angiographical- ly normal coronary arteries: A prospective study in patients with angina pectoris. Eur Heart J 1996;17:880-9.
7. Kemp HGJ. Left ventricular function in patients with the an- ginal syndrome and normal coronary arteriograms. Am J Cardiol 1973;32:375-6.
8. Beller GA, Zaret BL. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation 2000;101:1465-78.

9. Vrints CJ, Bult H, Hitter E, Herman AG, Snoeck JP. Impaired endothelium-dependent cholinergic coronary vasodilation in pa-tients with angina and normal coronary arteriograms. J Am Coll Cardiol 1992;19:21-31.
10. Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshita A. Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993;328:1659-64.
11. Quyyumi AA, Cannon RO, Panza JA, Diodati JG, Epstein SE. Endothelial dysfunction in patients with chest pain and normal coronary arteries. Circulation 1992;86:1864-71.
12. Reis SE, Holubkov R, Lee JS, et al. Coronary fl ow velocity response to adenosine characterizes coronary microvascu- lar func-tion in women with chest pain and no obstructive coronary disease. Results from the pilot phase of the Wom- en’s Ischemia Syndrome Evaluation (WISE) study. J Am Coll Cardiol 1999;33:1469-75.
13. Johnson BD, Shaw LJ, Buchthal SD, et al. Prognosis in women with myocardial ischemia in the absence of obstruc- tive coro-nary disease: Results from the National Institutes of Health-National Heart, Lung, and Blood Institute-Spon- sored Women’s Ischemia Syndrome Evaluation (WISE). Circulation 2004;109:2993-9.
14. Buchthal SD, den Hollander JA, Merz CN, Rogers WJ, Pep- ine CJ, Reichek N. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain bu normal coronary angiograms. N Engl J Med 2000;342:829-35.
15. Ammann P, Naegeli B, Rickli H, et al. Characteristics of patients with abnormal stress technetium Tc-99m sestamibi SPECT studies without signifi cant coronary artery diameter stenosis. Clin Cardiol 2003;26:521-4.
16. Widlansky ME, Gokce N, Keaney JF,Vita JA. The Clinical Implications of Endothelial Dysfunction. J Am Coll Cardiol 2003;42:1149–60.
17. Picano E, Palinkas A, Amyot R. Diagnosis of myo- cardial ischemia in hypertensive patients. J Hypertens 2001;19:1177-83.
18. Fragasso G, Chierchia SL, Arioli F, et al. Coronary slow- fl ow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: long-term clinical and functional prognosis. Int J Cardiol 2009;137:137-44.
19. Di Carli MF, Janisse J, Grunberger G, Ager J. Role of chronic hyperglycemia in the pathogenesis of coronary microvascular dysfunction in diabetes. Am Coll Cardiol 2003;16: 1387-93.
20. Camici PG. Coronary microvascular dysfunction in patients with cardiomyopathies. Circ Heart Fail 2008;1:150-2.
21. Husmann L, Wiegand M, Valenta I, et al. Diagnostic ac- curacy of myocardial perfusion imaging with single photon emission computed tomography and positron emission to- mography: a comparison with coronary angiography. Int J Cardiovasc Imaging 2008;24:511-8.