Author + information
- Received December 6, 1989
- Revision received February 13, 1990
- Accepted March 14, 1990
- Published online September 1, 1990.
- Edward M. Geltman, MD, FACC∗,
- C.Gregory Henes, MD,
- Martha J. Senneff, MD,
- Burton E. Sobel, MD, FACC and
- Steven R. Bergmann, MD, PhD, FACC
- ↵∗Address for reprints: Edward M. Geltman, MD, Box 8086, Cardiology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110.
Angiographically normal coronary arteries are found in a substantial number of patients evaluated for angina pectoris. One third to one half of such patients demonstrate abnormalities of myocardial perfusion or metabolism when evaluated with invasive techniques. This study was designed to determine whether angina in such patients is attributable to abnormalities of perfusion at rest, maximal perfusion or vasodilator reserve and whether any identified abnormalities were global or regional in nature.
Positron emission tomography was performed with oxygen-15-labeled water (H215O) and oxygen-15-labeled carbon monoxide (C15O) before and after intravenous dipyridamole to assess regional myocardial perfusion and perfusion reserve in absolute terms in 16 normal subjects and 17 patients with chest pain and angiographicaliy normal coronary arteries. Eight of the 17 patients had a myocardial perfusion reserve < 2.5 (the lower limit of normal in studies with positron emission tomography, as well as with other techniques) and 9 of 17 patients had a normal response. In the patients with an impaired perfusion reserve, perfusion at rest was significantly higher than that measured in normal subjects (1.61 ± 0.38 versus 1.25 ± 0.28 ml/g per min, p < 0.02) and maximal flow and perfusion reserve were significantly reduced (2.26 ± 0.92 versus 4.62 ± 1.58 ml/g per min and 1.4 ± 0.5 versus 3.8 ± 1.1, respectively; p < 0.001 for both comparisons). Abnormalities of perfusion and perfusion reserve were spatially homogeneous without detectable regional disparities.
Thus, nearly half of patients with chest pain and normal coronary arteries have abnormalities of myocardial perfusion that are detectable noninvasively with positron emission tomography and H215O.
☆ This study was supported in part by Specialized Center of Research Grant HL17646 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
- Received December 6, 1989.
- Revision received February 13, 1990.
- Accepted March 14, 1990.