Variant angina non-invasive assessment of coronary morphology

The predictability of coronary morphology was investigated in 28 patients with variant angina using clinical symptomatology, effectiveness of nifedipine an appropriate ECG changes. Using coronary angiography seven patients had shown normal or not significantly stenosed coronary arteries (group 1), 21 had significant coronary stenoses (greater than 70%) (group 2). Six patients of group 1 showed resting angina only, 11 out of group 2 had in addition exertional angina and 4 had to be assigned clinically to threatening infarct enlargement. Treatment with nifedipine was successful in 6 patients of group 1, however, only in 6 out of 17 patients in group 2. In no case did treatment with nifedipine lead to success in multiple vascular involvement. Normal control ECGs were present in 6 patients of group 1, a pathologic ECG with Q spikes or T inversions was seen in 20 patients of group 2. Results indicate good diagnostic accuracy for normal coronary vessels in the presence of angina at rest, effective treatment with nifedipine and normal control ECGs. Significant coronary stenoses may be assumed when angina at rest and during exertion, ineffective treatment with nifedipine and pathologic control ECGs are demonstrable. Using these parameters prediction of coronary morphology with non-invasive methods was possible in 14 of the 28 patients with variant angina.