Myocardial perfusion SPECT with dipyridamole stress test in cardiac syndrome X

R. Czepczyński; I. Smolarek; D. Rogacka; M. Kazmiercźak; H. Wysocki; J. Sowiński

doi:10.1055/s-0038-1625328

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2006; 45(03): 111-114
DOI: 10.1055/s-0038-1625328

Originalarbeiten – Original Articles

Schattauer GmbH

Myocardial perfusion SPECT with dipyridamole stress test in cardiac syndrome X

Myokardperfusionsszintigraphie mit dem Dipyridamol-Belastungstest im kardialen Syndrom X

R. Czepczyński

¹Nuclear Medicine Unit (Leiter: Prof. Dr. med. Jerzy Sowiński), Dept. of Endocrinology and Metabolism

,

I. Smolarek

¹Nuclear Medicine Unit (Leiter: Prof. Dr. med. Jerzy Sowiński), Dept. of Endocrinology and Metabolism

,

D. Rogacka

²Dept. of Intensive Care and Cardiology (Leiter: Prof. Dr. med. Henryk Wysocki), Poznan University of Medical Sciences, Poznań, Poland

,

M. Kazmiercźak

²Dept. of Intensive Care and Cardiology (Leiter: Prof. Dr. med. Henryk Wysocki), Poznan University of Medical Sciences, Poznań, Poland

,

H. Wysocki

²Dept. of Intensive Care and Cardiology (Leiter: Prof. Dr. med. Henryk Wysocki), Poznan University of Medical Sciences, Poznań, Poland

,

J. Sowiński

¹Nuclear Medicine Unit (Leiter: Prof. Dr. med. Jerzy Sowiński), Dept. of Endocrinology and Metabolism

› Author Affiliations

Abstract

Summary

Cardiac syndrome X defines patients with typical anginal chest pain, a positive exercise ECG stress test and angiographically normal coronary arteries. Aim of this study was to evaluate the role of myocardial perfusion SPECT with dipyridamole stress in the diagnosis of cardiac syndrome X. Patients, methods: 68 patients with syndrome X aged 32 to 60 years were subjected to myocardial imaging using ^99mTc-MIBI according to the two-days protocol: at rest and after dipyridamole infusion. Semiquantitative evaluation of the images was based on the assessment of ^99mTc-MIBI uptake in 17 myocardial segments using a 5-points scale (0 point – normal uptake, 4 points – no uptake). Scores obtained in each segment were summed up, constituting the summed rest score (SRS) and summed stress score (SSS). Results: Mean SRS was 7.9 ± 4.8 and mean SSS was 7.2 ± 4.4 (non-significant difference). Individual comparison of SRS and SSS values revealed three patterns of scintigraphic images: 1) in 25 patients (36.8%), a paradoxical improvement of perfusion at stress images was found, 2) in 23 patients (33.8%), the myocardial perfusion deteriorated after dipyridamole, 3) in 20 patients (29.4%), no significant change of the myocardial perfusion between rest and stress images occurred. Conclusions: In cardiac syndrome X, myocardial SPECT with dipyridamole stress shows different patterns of myocardial perfusion that reflects heterogeneity of this pathology.

Zusammenfassung

Die Diagnose kardiales Syndrom X umfasst eine Gruppe der Patienten mit typischen pektanginösen Beschwerden, mit positivem Belastungs-EKG und mit normalem Gefäßbefund in der Koronarangiographie. Ziel: Beurteilung der Rolle der Myokardperfusions-SPECT mit Dipyridamol in der Diagnostik des kardialen Syndroms X. Patienten, Methoden: 68 Patienten mit Syndrom X (Lebensalter: 32-60 Jahre) wurden mit Myokardperfusions-SPECT mit ^99mTc-MIBI nach 2-Tages-Protokoll untersucht. Die Belastung erfolgte mit Dipyridamol-Infusion. Zur semiquantitativen Beurteilung der SPECT-Bilder wurde die Aktivität in 17 Myokardsegmenten mit einer 5-Stufenskala (0 – normale Speicherung, 4 – keine Speicherung) geschätzt. Die Summe der Quantifizierung in allen Segmenten bildete den SRS (summed rest score) und den SSS (summed stress score). Ergebnisse: Der mittlere SRS betrug 7.9 ± 4.8 und der mittlere SSS 7.2 ± 4.4 (Unterschied nicht signifikant). Bei individueller Analyse der Befunde stellten sich drei szintigraphische Muster dar: 1) Bei 25 Patienten (36,8%) wurde eine paradoxe Besserung der Perfusion unter Belastung festgestellt, 2) bei 23 Patienten (33,8%) verschlechterte sich die Perfusion nach Dipyridamol, 3) bei 20 Patienten (29,4%) wurde kein Unterschied zwischen Ruhe- und Belastungsszintigrammen gefunden. Schlussfolgerung: Bei kardialem Syndrom X zeigt die Myokard-SPECT in Ruhe und nach Belastung mit Dipyridamol unterschiedliche Muster der Myokardperfusion. Dies spiegelt die Heterogenität dieser pathologischen Entität wider.

Keywords

Cardiac syndrome X - ^99mTc-Sestamibi - SPECT - dipyridamole - coronary angiography

Schlüsselwörter

Kardiales Syndrom X - ^99mTc-MIBI - SPECT - Dipyridamol - Koronarangiographie

Full Text

References

References
1 Albertsson PA, Emanuelsson H, Milsom I. Beneficial effect of treatment with transdermal estradiol-17-beta on exercise-induced angina and ST segment depression in syndrome X. Int J Cardiol 1996; 54: 13-20.
2 Araujo W, DePuey EG, Kamran M. et al. Artifactual reverse distribution pattern in myocardial perfusion SPECT with technetium-99m sestamibi. J Nucl Cardiol 2000; 7: 633-8.
3 Bellamy MF, Goodfellow J, Tweddel AC. et al. Syndrome X and endothelial dysfunction. Cardiovasc Res 1998; 40: 410-7.
4 Cannon RO. The sensitive heart. A syndrome of abnormal cardiac pain perception. JAMA 1995; 273: 11883-7.
5 Cannon RO, Camici PG, Epstein S. Pathophysiological dilemma of syndrome X. Circulation 1992; 85: 883-92.
6 Cavusoglu Y, Entok E, Timuralp B. et al. Regional distribution and extent of perfusion abnormalities, and the lung to heart uptake ratios during exercise thallium-201 SPECT imaging in patients with cardiac syndrome X. Can J Cardiol 2005; 21: 57-62.
7 Cerqueira MD, Weissman NJ, Dilsizian V. et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105: 539-42.
8 Crea F, Lanza GA. Angina pectoris and normal coronary arteries: cardiac syndrome X. Heart 2004; 90: 457-63.
9 Egashira K, Inou T, Hirooka Y. et al. Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Eng J Med 1993; 328: 192-6.
10 Frober O, Nielsen LA, Bak P. et al. Pain perception and brain evoked potentials in patients with angina despite normal coronary angiograms. Heart 1996; 75: 436-41.
11 Fujita H, Yamabe H, Yokoyama M. Effect of L-arginine administration on myocardial 201Tl perfusion during exercise in patients with angina pectoris and normal coronary angiograms. J Nucl Cardiol 2000; 7: 97-102.
12 Inobe Y, Kugiyama K, Morita E. et al. Role of adenosine in pathogenesis of syndrome X: assessment with coronary hemodynamic measurments and thallium-201 myocardial single-photon emission computer tomography. J Am Coll Cardiol 1996; 28: 890-6.
13 Kaski JC, Elliott PM, Salomone O. et al. Concentration of circulation plasma endothelin in patients with angina and normal coronary angiograms. Br Heart J 1995; 74: 620-4.
14 Kemp H. Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol 1973; 32: 375-6.
15 Kemp HG, Kronmal RA, Vliestra RE. et al. Seven years survival of patients with normal or near normal coronary angiograms: a CASS Registry study. J Am Coll Cardiol 1986; 7: 479-83.
16 Lanza GA, Giordano A, Pristipino C. et al. Abnormal cardiac adrenergic nerve function in patients with syndrome X detected by ¹²³I-metaiodobenzylguanidine myocardial scintigraphy. Circulation 1997; 96: 821-6.
17 Legrand V, Hodgson JM, Bates ER. et al. Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms. J Am Coll Cardiol 1985; 6: 1245-53.
18 Masci PG, Laclaustra M, Lara JG. et al. Brachial artery flow-mediated dilation and myocardial perfusion in patients with cardiac syndrome X. Am J Cardiol 2005; 95: 1478-80.
19 Mazeika P, Nihoyannopoulos P, Joshi J. et al. Uses and limitations of high-dose dipyridamole stress echocardiography for evaluation of coronary artery disease. Br Heart J 1992; 67: 144-9.
20 Nihoyannopoulos R, Kaski JC, Crake T. et al. Absence of myocardial dysfunction during stress in patients with syndrome X. J Am Coll Cardiol 1991; 18: 1463-70.
21 Panting JR, Gatehouse PD, Guang-Zhong Y. et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med 2002; 346: 1948-53.
22 Pozzolini MMA, Fioretti PM, Salustri A. et al. Exercise echocardiography and ^99mTc-MIBI single photon emission computed tomography in the detection of coronary artery disease. Am J Cardiol 1991; 67: 350-5.
23 Rogacka D, Guzik P, Kazmierczak M. et al. Cardiac syndrome X. The role of ECG Holter monitoring, dipyridamole stress echocardiography and technetium SPECT imaging. Kardiol Pol 1999; 51: 293-9.
24 Rosano GMC, Collins P, Kaski JC. et al. Syndrome X in women is associated with oestrogen deficiency. Eur Heart J 1995; 15: 610-4.
25 Rosano GM, Kaski JC, Arie S. et al. Failure to demonstrate myocardial ischemia in patients with angina and normal coronary arteries. Evaluation by continuous coronary sinus pH monitoring and lactate metabolism. Eur Heart J 1996; 17: 1175-80.
26 Rosano GM, Ponikowski P, Adamopoulos S. et al. Abnormal autonomic control of cardiovascular system in syndrome X. Am J Cardiol 1994; 73: 1174-9.
27 Turiel M, Galassi AR, Glazier JJ. et al. Pain treshold and tolerance in women with syndrome X and women with stable angina pectoris. Am J Cardiol 1987; 6: 503-7.
28 Tweddel AC, Martin W, Hutton I. Thallium scans in syndrome X. Br Heart J 1992; 68: 48-50.
29 Yoshio H, Shimizu M, Kita Y. et al. Effect of short term aminophylline administration on cardiac functional reserve in patients with syndrome X. J Am Coll Cardiol 1995; 25: 1547-51.