"These findings may in part be due to the fact that doctors are more likely to send patients with chest pain to bypass surgery or angioplasty than patients with shortness of breath," explained Berman.

Coronary artery disease, usually associated with the presence of plaque build-up in the arteries surrounding the heart, is one the main causes of death in both men and women. While it often is associated with chest pain, about half of the patients with this serious disease either die suddenly without prior symptoms or have a heart attack as the first manifestation of the disease.

The New England Journal paper authored by Aiden Abidov, M.D. and associates described the retrospective study of the medical records of 17,991 patients referred for stress testing by their physicians who knew or suspected they had coronary artery disease based on their symptoms or their cardiac risk factors. The stress testing was done with myocardial perfusion imaging, the most widely used noninvasive approach to detect blocked coronary arteries. During the test, patients exercise on a treadmill or, if they can't, are given medication that causes the heart's arteries to dilate. Once the patient reaches "peak" stress, a small amount of radioactive imaging agent is given that concentrates in the heart according to blood flow, emitting signals that are captured by a special type of camera. The cardiac images show the parts of the heart which do not get enough blood flow during stress and is very effective in predicting short-term risk of a cardiac event and determining whether it is necessary to consider angioplasty or surgery at that time. Approximately 8 million stress myocardial perfusion scans were performed in the United States in 2004.

The mechanism explaining why patients with shortness of breath without chest pain were more like
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Contact: Simi Singer
simi.singer@cshs.org
310-423-3674
Cedars-Sinai Medical Center
2-Nov-2005