Elsevier

Journal of Nuclear Cardiology

Volume 5, Issue 6, November–December 1998, Pages 591-597
Journal of Nuclear Cardiology

Original article
123I-MIBG myocardial scintigraphy as a noninvasive screen for the diagnosis of coronary artery spasm

https://doi.org/10.1016/S1071-3581(98)90113-1Get rights and content

Abstract

Background. It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. However, no cardiac imaging modality has been able to demonstrate abnormal sympathetic innervation in patients with coronary artery spasm. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation using iodine 123-metaiodobenzylguanidine (123I-MIBG) single photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of 123I-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm.

Methods and Results. Coronary arteriography and a provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (20 men, 6 women, mean age 48.2 ± 12.0 years, range 20 to 67 years) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups: group 1 (n = 18) comprised subjects with a positive provocative test result, and group 2 (n = 8) comprised subjects with negative provocative test results. Ten healthy subjects served as controls. No abnormal MIBG uptake was observed in the control subjects. Abnormal sympathetic nervous innervation using 123I-MIBG SPECT was observed either as a reduced uptake or a defective pattern in the perfused areas in 13 of the 18 regions supplied by vessels of ergonovine-induced vasospasm. Normal sympathetic innervation, as evidenced by normal 123I-MIBG uptake, was noted in all of the 60 segments of normal vessel territories. Reduced uptake of 123I-MIBG was not detected in the perfused areas of 5 vasospasm-induced vessels (perfusion territory of left anterior descending coronary artery [LAD] and the right coronary artery [RCA] in 2 and 3 patients, respectively). The sensitivity and specificity of 123I-MIBG for detection of coronary artery spasm were 72.2% (95% confidence interval [CI] 55 % to 89 %) and 100 %, respectively. The positive predictive and negative predictive values were 100% and 92.3% (95% CI 91% to 93%), respectively.

Conclusion. 123I-MIBG SPECT is a feasible method to evaluate noninvasively and localize the territories of coronary arteries with spasm. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan results, but showing abnormalities in 123I-MIBG SPECT.

References (45)

  • A Buxton et al.

    Refractory ergonovine induced coronary vasospasm: importance of intracoronary nitroglycerine

    Am J Cardiol

    (1980)
  • S Widlansky et al.

    Coronary angiography, echocardiographic, and electrocardiographic studies on a patient with variant angina due to coronary artery spasm

    Am Heart J

    (1975)
  • H Egeblad et al.

    Ischemic and postischemic ventricular wall motion abnormalities in Prinzmetal's angina provoked by hyperventilation

    Am Heart J

    (1982)
  • A Distante et al.

    Echocardiographic versus hemodynamic monitoring during attacks of variant angina pectoris

    Am J Cardiol

    (1985)
  • JK Song et al.

    Ergonovine echocardiography as a screening test for diagnosis of vasospastic angina before coronary angiography

    J Am Coll Cardiol

    (1996)
  • CJ Pepine

    Ergonovine echocardiography for coronary spasm: facts and wishful thinking

    J Am Coll Cardiol

    (1996)
  • H Yasue et al.

    Prinzmetal's variant form of angina as a manifestation of alpha-adrenergic receptor-mediated coronary artery spasm: documentation by coronary arteriography

    Am Heart J

    (1976)
  • J Meller et al.

    Coronary arterial spasm in Prinzmetat's angina: a proved hypothesis

    Am J Cardiol

    (1976)
  • H Tsutsui et al.

    Detection of angina-provoking coronary stenosis by resting iodine 123 metaiodobenzylguanidine scintigraphy in patients with unstable angina pectoris

    Am Heart J

    (1995)
  • T Nakata et al.

    Regional cardiac sympathetic nerve dysfunction and the diagnostic efficacy of metaiodobenzylguanidine tomography in stable coronary artery disease

    Am J Cardiol

    (1996)
  • H Takano et al.

    Regional myocardial sympathetic dysinnervation in patients with coronary vasospasm

    Am J Cardiol

    (1995)
  • K Sakata et al.

    Sympathetic nerve activity in the spasm-induced coronary artery region is associated with disease activity of vasospastic angina

    J Am Coll Cardiol

    (1996)
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