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

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

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