Radionuclide esophageal transit test to detect esophageal disorders in patients with mitra valve prolapse

Chia-Hung Kao; Shih-Chuan Tsai; Jih-Fang Hsieh; Yung-Jen Ho; Hueisch-Jy Ding

doi:10.1055/s-0038-1632252

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2000; 39(04): 92-96
DOI: 10.1055/s-0038-1632252

Original Article

Schattauer GmbH

Radionuclide esophageal transit test to detect esophageal disorders in patients with mitra valve prolapse

Nachweis ösophagealer Störungen bei Patienten mit Mitralklappenprolaps mittels der Ösophagus-Funktionsszintigraphie

Authors

Chia-Hung Kao

¹Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung; Taiwan
Shih-Chuan Tsai

²Department of Nuclear Medicine, Show-Chwan Memorial Hospital, Changhua; Taiwan
Jih-Fang Hsieh

³Department of Nuclear Medicine, Chi-Mei Foundation Hospital, Tainan; Taiwan
Yung-Jen Ho

⁴Department of Radiology, Jen-Ai Hospital, Taichung; Taiwan
Hueisch-Jy Ding

⁵Department of Nuclear Medicine, Kaohsiung Medicine College, Kaohsiung; Taiwan

Abstract

Summary

Aim: The origin of chest discomfort in patients with mitral valve prolapse (MVP) is controversial. Our aim was to prospectively determine the incidence of esophageal disorders in MVP patients with or without chest pain. Methods: Twenty-five MVP patients with chest pain (group A) and 25 MVP patients without chest pain (group B) underwent evaluation of esophageal motility. None of the total of 50 MVP patients had significant coronary artery disease on cardiac catheterization. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (Rl) was analyzed by the radionuclide esophageal transit test (RETT). Results: In comparison with 25 age and sex-matched healthy volunteers, the results showed that: (1) 19 patients in group A (76%) had abnormal RETT findings (48% of cases with prolonged MTT, 44% of cases with higher RF, and 60% of cases with higher Rl); (2) 3 patients in group B (12%) had abnormal RETT findings (8% of cases with prolonged MTT, 4% of cases with higher RF, and 8% of cases with higher Rl). In addition, mean values of MTT, RF, and Rl in group A patients were significantly higher than in group B patients and healthy volunteers. Conclusion: We found that the chest pain in some MVP patients may be related to abnormal esophageal motility, based on the evidence from a simple and noninvasive RETT.

Zusammenfassung

Ziel: Die Ursache thorakaler Beschwerden bei Patienten mit Mitralklappenprolaps (MVP) wird kontrovers diskutiert. Wir bestimmten prospektiv die Häufigkeit ösophagealer Störungen in MVP-Patienten mit oder ohne thorakale Beschwerden. Methode: Bei jeweils 25 MVP-Patienten mit thorakalen Beschwerden (Gruppe A) und 25 MVP-Patienten ohne thorakale Beschwerden (Gruppe B) wurde die ösophageale Motilität untersucht. Keiner der 50 MVP-Patienten hatte eine koronarangiographisch nachweisbare koronare Herzkrankheit. Mittels der Ösophagus-Funktionsszintigraphie (ÖFZ) wurden ösophageale Motilität inklusive der mittleren Transitzeit (MTT), der residualen Fraktion (RF) und des Refluxindex (Rl) analysiert. Ergebnisse: Im Vergleich zu 25 alters- und geschlechtsgematchten, gesunden Freiwilligen zeigte sich, daß zum einen die 0FZ bei 19 Patienten der Gruppe A (76%) pathologische Befunde zeigte (48% mit prolongierter MTT, 44% mit erhöhter RF und 60% mit erhöhtem Rl), daß zum anderen drei Patienten aus Gruppe B (12%) abnormale ÖFZ-Befunde aufwiesen (8% prolongierte MTT, 4% erhöhte RF und 4% erhöhter Rl). Hinzu kam, daß die Mittelwerte für MTT, RF und Rl signifikant höher lagen als bei Gruppe-B-Patienten und bei Gesunden. Schlußfolgerung: Thorakale Beschwerden bei MVP-Patienten können durch eine gestörte Funktion des Ösophagus bedingt sein, nachweisbar durch eine einfache und nichtinvasive Ösophagus-Funktionsszintigraphie.

Keywords

Radionuclide esophageal transit test - mitral valve prolapse - chest pain

Schlüsselwörter

Ösophagus-Funktionsszintigraphie - Mitralklappenprolaps - Thoraxschmerz

Full Text

References

References
1 Devereux RB, Perloff JK, Reichek N, Josephson ME. Mitral valve prolapse. Circulation 1976; 54: 3-514.
2 Naggar CZ. The mitral valve prolapse syndrome. Spectrum and therapy. Med Clin North Am 1979; 63: 337-53.
3 Jeraaty RM. Mitral valve prolapse – click syndrome. Prog Cardiovasc Dis 1973; 15: 623-52.
4 Beton DC, Brear SG, Edwards JD, Leonard JC. Mitral valve prolapse: an assessment of clinical features, associated conditions and prognosis. Q J Med 1983; 206: 150-64.
5 Hancock EW, Cohn K. The syndrome associated with midsystolic click and late systolic murmur. Medicine 1966; 41: 183-95.
6 Le Winter MM, Hoffman JR, Shell WE, Karliner JS, O’Rourke RA. Phenylephrine – induced atypical chest pain in patients with prolapsing mitral valve leaflets. Am J Cardiol 1974; 34: 12-8.
7 Hewson EG, Dalton CB, Hackshaw BT, Wu WC, Richter JE. The prevalence of abnormal esophageal test results in patients with cardiovascular disease and unexplained chest pain. Arch Intern Med 1990; 150: 965-9.
8 Koch KL, Davidson Jr WR, Day FP, Spears PF, Voss SR. Esophageal dysfunction and chest pain in patients with mitral valve prolapse: a prospective study utilizing provocative testing during esophageal manometry. Am J Med 1989; 86: 32-8.
9 Spears PF, Koch KL. Esophageal disorders in patients with chest pain and mitral valve prolapse. Am J Gastroenterol 1986; 81: 951-4.
10 Kao CH, Wang SJ. Radionuclide esophageal transit test to detect esophageal dysmotility and gastro-esophageal reflux in noncardiac chest pain. Abdom Imaging 1993; 18: 220-2.
11 Kao CH, Wang KY, Wang SJ, Chen YT, Yeh SH. Detection of abnormal esophageal motility and gastresophageal reflux in the patients with angina-like chest pain by radionuclide esophageal transit test. J Nucl Biol Med 1993; 37: 53-6.
12 Alpert MA, Carney RJ, Flaker GC, Santelippo JF, Webel RR, Kelly DL. Sensitivity and specificity of two dimensional echocardiographic signs of mitral valve prolapse. Am J Cardiol 1984; 54: 792-6.
13 DeMaria AN, King JF, Bogren HG, Lies JE, Mason DT. The variable spectrum of echocardiographic manifestations of the mitral valve prolapse syndrome. Circulation 1974; 50: 33-41.
14 Levine RA, Triulzi MO, Harrigan P, Weyman AE. The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. Circulation 1987; 75: 756-67.
15 Klein HA, Wald A. Computer analysis of radionuclide esophageal transit studies. J Nucl Med 1984; 25: 957-64.
16 Svedberg JB. The bolus transport diagram: a functional display method applied to esophageal studies. Clin Phys Physiol Meas 1982; 310: 267-72.
17 Lassen NA, Perl W. Tracer Kinetic Methods in Medical Physiology. New York: Raven Press; 1979: 76-101.
18 Savage DD, Devereux RB, Garrison RJ, Castelli WP, Anderson SJ, Levy D, Thomas HE, Kannel WB, Feinleib M. Mitral valve prolapse in the general population. 2. Clinical features: the Framingham study. Am J Heart 1983; 106: 577-81.
19 Spears PF, Koch KL, Day FP. Chest pain associated with mitral valve prolapse. Evidence for esophageal origin. Arch Intern Med 1986; 146: 796-7.
20 Rosenberg CA, Derman GH, Grabb WB, Buda AJ. Hypomastia and mitral valve prolapse: evidence of a linked embryologie and mesenchymal dysplasia. N Engl J Med 1983; 309: 1230-2.
21 Spears PF, Koch KL, Day FP. Chest pain associated with mitral valve prolapse: evidence for esophageal origin. Arch Intern Med 1986; 146: 796-7.
22 Russel CO, Hill LD, Holmes ER, Null DA, Gannon R, Pope CE. Radionuclide transit: a sensitive screening test for esophageal dysfunction. Gastroenterology 1981; 80: 887-92.
23 Blackwell JN, Hannan WJ, Adam RD, Heading RC. Radionuclide transit studies in the detection of esophageal dysmotility. Gut 1983; 24: 421-6.
24 Babic Z, Ugarkovic B, Ivancevic D, Babic D. Dynamic scintigraphy of the oesophagus in the evaluation of reflux oesophagitis. Nuklearmedizin 1990; 29: 204-9.
25 Bartlett RJ, Parkin A, Ware FW, Riley A, Robinson PJ. Reproducibility of oesophageal transit studies: several ‘single swallows’ must be performed. Nucl Med Commun 1987; 8: 317-26.
26 Tatsch K, Voderholzer WA, Weiss MJ, Schroettle W, Klauser AG, Mueller-Lissner SA, Kirsch CM. Simultaneous assessment of bolus transport and contraction parameters in multiple-swallow investigations. J Nucl Med 1992; 33: 1291-300.
27 Tatsch K, Schroettle W, Kirsch CM. Multiple swallow test for the quantitative and qualitative evaluation of esophageal motility disorders. J Nucl Med 1991; 32: 1365-70.
28 Tatsch K, Schrottie W, Kirsch CM. Parametric esophageal scintigrams of transit studies using the multiple swallow technique: a comparison of a new method with a standard esophageal transit test. Nuklearmedizin 1990; 29: 195-203.
29 Tatsch K, Voderholzer WA, Weiss MJ, Schröttle W, Hahn K. Reappraisal of quantitative esophageal scintigraphy by optimizing results with ROC analyses. J Nucl Med 1996; 37: 1799-805.