Published Online
on January 13, 2003

A more recent version of this article appeared on February 11, 2003

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Submitted on August 1, 2002
Revised on October 24, 2002
Accepted on October 28, 2002

Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population

Roger S. Blumenthal MD^*, Diane M. Becker MPH, ScD, Lisa R. Yanek MPH, Thomas R. Aversano MD, Taryn F. Moy MS, RD, Brian G. Kral MD, MPH, and Lewis C. Becker MD

From the Divisions of Cardiology (R.S.B., T.R.A., L.C.B.) and Internal Medicine, the Center for Health Promotion (D.M.B., L.R.Y., T.F.M., B.G.K.), Johns Hopkins University School of Medicine, Baltimore, Md.

^* To whom correspondence should be addressed. E-mail: rblument{at}jhmi.edu.

Background--Exercise stress testing alone or with perfusion imaging is the standard screening method to determine the presence of obstructive coronary artery disease (CAD) in people with chest pain. In asymptomatic individuals with a family history of premature CAD, it is unclear whether abnormalities on these functional exercise tests represent significant coronary disease.

Methods and Results--An abnormal exercise test, thallium scan, or both occurred in 153 (21%) of 734 asymptomatic siblings of persons with documented CAD, of whom 105 underwent coronary angiography with quantitative analysis of stenosis severity. Overall, 95% had coronary atherosclerosis, but only 39% had 1 or more stenoses with 50% narrowing. Of 30 siblings in whom the exercise test and perfusion scan were both abnormal, 70% had 50% stenoses. The mean stenosis in arteries that fed perfusion defects was only 43±31%, and 68% of such stenoses were <50%. However, in 71% of all defects, the location matched arteries with the most severe stenoses.

Conclusions--In asymptomatic persons with a family history of CAD, abnormal exercise scintigraphy identifies predominantly mild coronary atherosclerosis. Perfusion defects may be caused by coronary vasomotor dysfunction in addition to atherosclerotic plaque.

Key words: coronary disease • exercise tests • scintigraphy

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