Outcomes in Patients with Abnormal Myocardial Perfusion Imaging and Normal Coronary Angiogram

Abstract

A subset of subjects undergoing myocardial perfusion imaging has perfusion abnormalities that are subsequently labeled false positive based on coronary angiography. We evaluated the long-term prevalence of cardiovascular events in these patients. We retrospectively identified 48 patients who had reversible perfusion abnormalities with myocardial perfusion imaging and normal coronary angiography. Patients with known coronary artery disease, left ventricular dysfunction, valvular disease, and cardiomyopathy were excluded. Patient follow-up, conducted for at least 3 (mean interval, 7.4) years from the index myocardial perfusion imaging, was accomplished by a review of medical records and telephone interviews. Study endpoints were cardiovascular events defined as sudden cardiac death, myocardial infarction, percutaneous coronary revascularization, coronary artery bypass grafting, and cerebrovascular or peripheral revascularization. Thirty-one percent (15 of 48) of the patients had cardiovascular events. Six of the 48 patients had coronary events. These patients had abnormal myocardial perfusion imaging and normal coronary angiogram. The time between myocardial perfusion imaging and coronary event was 0.5 to 8.67 years. There was a strong correlation between the regions of original perfusion abnormality and the ultimate coronary ischemia or revascularization. Abnormal findings on myocardial perfusion imaging may predict a higher prevalence of coronary and peripheral vascular events than suggested by a normal coronary angiogram.

Determinação do Tecido Cicatricial do Miocárdio no Fenômeno de Fluxo Coronário Lento e a Relação entre a Quantidade de Tecido Cicatricial e o Nt-ProBNP

“…Embora o FCL possa ser uma consequência de alterações microvasculares, o aumento da resistência microvascular e a aterosclerose generalizada em estágio inicial também demonstraram desempenhar um papel na etiologia. 22,23 Além disso, tentou-se lançar mão das alterações histológicas e patológicas nas artérias coronárias para elucidar a etiologia. Em um estudo conduzido em pacientes com FCL, Mangieri et al, 17 encontraram mudanças, tais como edema celular, hiperplasia fibromuscular, hipertrofia medial, proliferação miointimal, fibrose irregular, lesão capilar e redução do lúmen capilar, resultantes da biópsia do miocárdio, tendo alegado que essas alterações patológicas tornavam o fluxo sanguíneo mais lento através do aumento da resistência vascular.…”

Cardiovascular outcomes of a positive nuclear stress test but negative coronary angiography in a multiethnic male predominant cohort

“…In fact, recent reviews suggest that over 43% of individuals proposed to meet criteria for syndrome x are male sex 3. The Veterans Association (VA) study demonstrated an increase in adverse events among their all-male, predominantly, white cohort 23. In our selection of patients, we found that over 50% of individuals meeting criteria for syndrome x-like disease were male.…”

Overestimation of Aerobic Capacity With the Bruce Treadmill Protocol in Patients Being Assessed for Suspected Myocardial Ischemia

“…However, previous, research has demonstrated that a positive MPS is a significant predictor of adverse events regardless of catheterization findings. 19 Moreover, all diagnostic analyses regarding the DTS in the current investigation must be interpreted with a level of caution given the relatively low positive MPS number, particularly in females. In addition, it would have been advantageous to have included a randomly matched cohort that did not use the handrails during the exercise test to quantify the influence of handrail use on the peak VO 2 discrepancy, which is likely substantial.…”