Myocardial perfusion SPECT with dipyridamole stress test in cardiac syndrome X

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

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