We reviewed patients with normal or near-normal coronary angiograms enrolled in the SPAM contrast stress echocardiographic diagnostic study in which 400 patients with chest pain syndrome of suspected cardiac origin with a clinical indication to coronary angiography were enrolled. Patients underwent dipyridamole contrast stress echocardiography (cSE) with sequential analysis of wall motion, myocardial perfusion, and Doppler coronary flow reserve before elective coronary angiography. Ninety-six patients with normal or near-normal epicardial coronary arteries were screened for the presence of 2 prespecified findings: severely tortuous coronary arteries and myocardial bridging. Patients were divided in 2 groups based on the presence (false-positive results, n = 37) or absence (true-negative results, n = 59) of reversible myocardial perfusion defects during cSE and compared for history and clinical and angiographic characteristics. Prevalence of severely tortuous coronary arteries (35% vs 5%, p < 0.001) or myocardial bridging (13% vs 2%, p < 0.05) was 7 times higher in patients who demonstrated reversible perfusion defects at cSE compared to those without reversible perfusion defects. No significant differences were found between the 2 groups for the main demographic variables and risk factors. Patients in the false-positive group more frequently had a history of effort angina (p < 0.001) and ST-segment depression at treadmill electrocardiography (p < 0.001). In conclusion, we hypothesize that patients with a positive myocardial perfusion finding at cSE but without obstructive epicardial coronary artery disease have a decreased myocardial blood flow reserve, which may be caused by a spectrum of causes other than obstructive coronary artery disease, among which severely tortuous coronary arteries/myocardial bridging may play a significant role. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;108:973-978)
机构:
Orebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, SwedenOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
Nordenskjold, Anna M.
Lagerqvist, Bo
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Uppsala Univ, Dept Med Sci, Uppsala, Sweden
Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, SwedenOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
Lagerqvist, Bo
Baron, Tomasz
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Uppsala Univ, Dept Med Sci, Uppsala, Sweden
Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, SwedenOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
Baron, Tomasz
Jernberg, Tomas
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Karolinska Inst, Danderyds Hosp, Dept Clin Sci, Stockholm, SwedenOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
Jernberg, Tomas
Hadziosmanovic, Nermin
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Uppsala Univ, Dept Med Sci, Uppsala, Sweden
Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, SwedenOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
Hadziosmanovic, Nermin
Reynolds, Harmony R.
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NYU, Sch Med, Dept Med, Leon H Charney Div Cardiol, New York, NY USAOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
Reynolds, Harmony R.
Tornvall, Per
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Karolinska Inst, Dept Clin Sci & Educ Sodersjukhuset, Stockholm, SwedenOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
Tornvall, Per
Lindahl, Bertil
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Uppsala Univ, Dept Med Sci, Uppsala, Sweden
Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, SwedenOrebro Univ, Fac Med & Hlth, Dept Cardiol, S-70185 Orebro, Sweden
机构:
Univ Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, TurkeyUniv Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, Turkey
Simsek, Ersin Cagri
Sari, Cenk
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Univ Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, TurkeyUniv Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, Turkey
Sari, Cenk
Kucukokur, Murat
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Univ Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, TurkeyUniv Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, Turkey
Kucukokur, Murat
Ekmekci, Cenk
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Univ Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, TurkeyUniv Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, Turkey
Ekmekci, Cenk
Colak, Ayfer
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Univ Hlth Sci, Tepecik Training & Res Hosp, Dept Biochem, Izmir, TurkeyUniv Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, Turkey
Colak, Ayfer
Ozdogan, Oner
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Univ Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, TurkeyUniv Hlth Sci, Tepecik Training & Res Hosp, Dept Cardiol, Guney Mah 1140-1 Sk 1 Yenisehir, TR-35170 Izmir, Turkey