Elsevier

Journal of Nuclear Cardiology

Volume 10, Issue 5, September–October 2003, Pages 490-497
Journal of Nuclear Cardiology

Original article
Esophageal dysfunction in patients with atypical chest pain investigated with esophageal scintigraphy and myocardial perfusion imaging: An outcome study

https://doi.org/10.1016/S1071-3581(03)00551-8Get rights and content

Abstract

Background

The objectives of this study were to determine the role of esophageal scintigraphy (ES) and myocardial perfusion imaging (MPI) in patients with atypical chest pain investigated for ischemic heart disease (IHD).

Methods and results

One hundred five consecutive patients with atypical chest pain were investigated by dual-isotope MPI (1-day rest-stress protocol). Within a 10-day period, each patient also had liquid and semisolid ES performed with dynamic imaging over a 2-minute period for each phase. All patients were risk-stratified, and 28 patients were also investigated by coronary angiography. Patient outcome was assessed with the use of endpoints including cardiac death, myocardial infarction, and coronary revascularization procedures. Of the patients, 53 (50%) had esophageal dysfunction (ED) but no IHD, 41 (39%) had both ED and IHD, 5 (5%) had normal ES and IHD, and 6 (6%) had neither ED nor IHD. On the basis of outcome findings (n = 105) and coronary angiogram results (n = 28), MPI showed sensitivity for the detection of IHD of 92% in this patient population. Of the 94 patients (89%) with ED, 48 (51%) showed esophageal dysmotility, 9 (10%) showed gastroesophageal reflux, 17 (18%) showed esophageal spasm and dysmotility, 17 (18%) showed both reflux and dysmotility, and 3 showed other abnormalities. The median follow-up period after MPI was 20 months (range, 9-30 months). Twenty-one patients had cardiac events. These included 2 cardiac deaths, 2 myocardial infarctions, 6 coronary artery bypass graft surgeries, and 11 angioplasty/stent procedures. All but 2 of these patients had abnormal ES studies, and 7 had no prior history of IHD. MPI detected IHD in all but 2 of these patients.

Conclusions

There is a high incidence of ED in patients with atypical chest pain referred for cardiologic assessment. The low proportion of patients with IHD alone and of those with neither IHD nor ED presenting with atypical chest pain (5%), as well as the high proportion with ED alone (50%), indicates the high likelihood of chest pain derived from ED. However, of the 21 patients with cardiac events, 7 had no prior history of IHD, indicating the importance of the use of MPI in the investigation of patients with atypical chest pain syndromes.

Section snippets

Study design and follow-up

This outcome study used a prospective descriptive design. All patients gave informed consent, and ethics committee approval was granted. The measured endpoints were cardiac events that included cardiac death, myocardial infarction, and revascularization procedures. The revascularization procedures included coronary artery bypass graft surgery, coronary angioplasty, and/or coronary artery stenting. Outcome was determined by patient telephone contact and by clinical details of regular follow-up

Results

Of the patients, 53 (50%) had ED but no IHD, 41 (39%) had both ED and IHD, 5 (5%) had normal ES and IHD, and 6 (6%) had neither ED nor IHD (Figure 1). The patients were stratified for risk of coronary artery disease (Table 1). Of the patients, 75% had a low or intermediate likelihood of significant CAD and 64% had a low or intermediate relative risk ratio. Of the 45 patients who were tested by Bruce protocol treadmill exercise stress testing, 19 were positive for ischemia and 19 had their

Discussion

The causes of chest discomfort are many. Most adults, particularly those over age 40 years, will have chest discomfort in one form or another at some time. Commonly, this is the result of ED, but such an assumption can prove fatal.8, 9 Our results indicate that in a group of 105 patients with atypical chest pain, only 11% did not have ED. Those with ED comprised 50% of patients who had underlying ED without coexisting IHD and 39% who had both ED and IHD. This demonstrates not only a high

Acknowledgements

The authors have indicated they have no financial conflicts of interest.

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