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Journal of Nuclear Medicine Vol. 48 No. 2 175-181
© 2007 by Society of Nuclear Medicine

Clinical Investigations

Typical Chest Pain and Normal Coronary Angiogram: Cardiac Risk Factor Analysis Versus PET for Detection of Microvascular Disease

Senta Graf1, Aliasghar Khorsand1, Marianne Gwechenberger1, Clemens Novotny2, Kurt Kletter2, Heinz Sochor1, Christian Pirich3, Gerald Maurer1, Gerold Porenta4 and Manfred Zehetgruber1

1 Department of Cardiology, Medical University of Vienna, Vienna, Austria; 2 Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria; 3 Department of Nuclear Medicine, Private Medical University of Salzburg, Salzburg, Austria; and 4 Department of Nuclear Medicine, Rudolfinerhaus, Vienna, Austria

Correspondence: For correspondence or reprints contact: Senta Graf, MD, Division of Cardiology, Department of Internal Medicin II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: senta.graf{at}meduniwien.ac.at

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 20%. Coronary flow reserve (CFR) determination is an elaborate, but helpful, task, as only the evidence of microvascular disease enables appropriate therapy. We prospectively evaluated the incidence of a dysfunctional microcirculation and searched for predictive parameters of a reduced CFR. Methods: In 79 consecutive patients (52 females, 27 males) with typical angina and a normal angiogram and 10 control subjects (6 females, 4 males), CFR was measured by 13N-ammonia rest/dipyridamole PET and correlated with clinical parameters individually and summarized as the number of risk factors (NRF) using an elaborated cardiac risk factor score. Results: Sixty-five percent of patients had a reduced CFR (CFR < 2.5). CFR correlated with NRF (r = 0.55, P < 0.001), systolic blood pressure (r = 0.46, P < 0.001), interventricular septal thickness (r = 0.33, P < 0.01), and age (r = 0.25, P = 0.02). Eighty-five percent of patients with a high risk factor score (NRF ≥ 5) had a reduced CFR. In contrast, 100% of our patients with a low risk factor score (NRF < 2) presented a normal CFR. In total, 55% of our patients could be allocated to either one of these groups. Conclusion: In about two thirds of patients, anginal pain can be explained by a reduced CFR. Risk factors have a cumulative negative effect on CFR. A clinical cardiac risk factor analysis enables estimation of individual probability of microvascular dysfunction in a significant proportion of these patients. However, CFR measurements are recommended for those with an intermediate NRF.

Key Words: microvascular disease • PET • coronary flow reserve • cardiac risk factors

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.


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