To the Editor: We agree with the observations of Stark et al. (June 20 issue)1 that chest pain can occur with myocardial ischemia in some cardiac-transplant recipients. The case we report emphasizes that in transplant recipients myocardial ischemia may develop in a myocardial region even when recent coronary arteriography has shown only minimal luminal disease. A 54-year-old man who had undergone transplantation five years earlier for idiopathic cardiomyopathy had severe chest pain three weeks after a cardiac catheterization that showed total occlusion of the circumflex vessel with only diffuse minimal luminal irregularities of the left anterior descending and right coronary. . .