Thallium201 perfusion imaging in mitral valve prolapse

ABSTRACT

The clinical significance of chest pain in patients [pts.] with mitral valve prolaspe [MVP] has been difficult to assess. The characteristic pain is usually atypical of angina pectoris, however, some patients may have typical anginal pain in the absence of coronary artery disease [CAD]. The aim of this study was to assess stress thallium201 myocardial perfusion imaging in pts. With MVP without CAD. The study included 24 pts. With MVP with a mean age of 23 years; 12 males and 12 females were submitted for resting 12-lead ECG, Echo-cardiography and Doppler study as well as an exercise thallum201 SPECT study. Patients with positive perfusion studies were submitted for coronary angiography. Nineteen pts. [79.16%] had chest pain; 7/24 [29.16%] typical of angina and 12/24 [50%] atypical. Resting ECG was abnormal in five pts. [20.8%] and exercise stress ECG was abnormal in 3/24 [12.5%] and inconclusive in 1/24 [4.16%]. The echocardiographic examination revealed prolapse of both leaflets in 12/24 [50%], posterior in eight [33.3%] and anterior leaflet in 4/24 [16.6%]. Trivial mitral regurgitation in 18/24 [75%]. Thallium SPECT revealed reversible perfusion defects in 6/24 [25%]. Their coronary angiography was found to be normal. All of them had chest pain 6/19 [31.6%]; four with typical angina. The perfusion defects were inferior in four and combined anterior and inferior in on study and anterior only in another one regardless the site of leaflet prolapse. We conclude that despite potential myocardial ischemia in pts. With MVP, objective evidence with exercise-T1201 SPECT studies is present in only about one third of pts. presented with chest pain in absence of CAD and the majority of such pts. have normal scan