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변형 협심증에서 운동부하검사 , Thallium - 201 심근관류검사 및 Holter 심전도 검사의 다양성
최석주(Seok Joo Choi),서홍석(Hong Seok Suh),오동주(Dong Joo Oh),박정의(Jeong Euy Park),노영무(Young Moo Ro) 대한내과학회 1989 대한내과학회지 Vol.36 No.3
N/A Variant angina is defined as angina occurring at rest with reversible ST-segment elevation of the ECG. However, the underlying coronary pathology of variant angina can be either a spasm of the coronary artery with fixed stenosis or a spasm of the normal coronary artery. Therefore, the clinical or laboratory features of variant angina may vary according to the underlying coronary pathology. In an attempt to investigate the features of the exercise stress test, Thallium-201 myocardial perfusion scintigraphy (MPS) and Holter ECG monitoring in 14 patients with variant angina were studied. The exercise stress test was positive in 57.1% of patients and negative in 42.9%. There was no relationship between the degree of ST-segment depression and the frequency and severity of attacks of chest pain at rest. Thallium-201 MPS showed reversible perfusion defects in 71.4%. The locations of the perfusion defects were anteroseptal (20%), anterolateral (20%), septal (10%), apical (10%), posterolateral (20%) and inferior walls (20%). Both the exercise stress test and Thallium-201 MPS were positive in 57.1% of patients, which favors the presence of exercise-induced myocardial ischemia due to fixed coronary artery disease. The exercise stress test and Thallium-201 MPS were both negative in 28.6%, and only the Thallium-201 MPS was positive in 14.3%. The Holter ECG during attacks of chest pain at rest showed ventricular tachycardia in 14.3%. The concordance rate of the Holter ECG lead of ST-segment elevation during the attacks of chest pain at rest with the location of the Thallium-201 MPS perfusion defect was 70%, and the discordance rate was 30%. In conclusion, the findings we observed in a limited patient series showed that there was diversity in the features of the exercise stress test and Thallium-201 MPS in patients with variant angina. These results seem to favor the coexistence of fixed coronary artery disease and spasm in a considerable proportion of patients with variant angina.