ANGINA AND NORMAL EPICARDIAL CORONARY-ARTERIES - RADIONUCLIDE FEATURES AND PATHOPHYSIOLOGICAL IMPLICATIONS AT LONG-TERM FOLLOW-UP

Background: The aim of this study was to identify specific characteris tics associated with modifications of symptoms and to evaluate the pre sence of a pathophysiological link between radionuclide abnormalities and delayed run-off of coronary contrast dye in patients with angina a nd normal coronary arteries. Methods: We followed up 53 patients (21 m en and 32 women, mean age: 52+/-10 years) with angina and angiographic ally normal epicardial coronary arteries, 21 of whom (40%) displayed a pattern of slow contrast dye run-off from coronary vessels, on visual assessment using a semiquantitative empirical score. Exercise tests s howed ECG abnormalities in 29 patients (55%). Results: All patients we re alive 92+/-44 months after catheterization (140+/-79 months after b eginning of symptoms). However, 30 patients (57%), who reported worsen ing or no change of symptoms, presented with a non-significant higher prevalence of conduction abnormalities at rest ECG (27 versus 17%), pa thological exercise tests (57 versus 52%), and delayed run-off (47 ver sus 30%). Regional left ventricular function and perfusion were then s imultaneously assessed at rest and peak exercise with 99mTc-sestamibi. Exercise-induced radionuclide abnormalities were detected in 27 patie nts (51%), who also presented with a non-significant higher prevalence of pathological exercise tests (63 versus 43%) and no improvement of symptoms (63 versus 46%). However, exercise-induced functional and per fusional abnormalities were simultaneously present in 29 out of 42 (69 %) coronary territories supplied by vessels with delayed run-off, vers us 21 out of 117 (17%) normal territories (P=0.00032). Conclusions: De spite a good prognosis, some patients with angina and normal coronary arteries presented no improvement of symptoms at follow-up, and had fu nctional and perfusional abnormalities in coronary territories supplie d by vessels showing delayed contrast dye run-off.