Additional parameters of myocardial perfusion imaging in the detection of multivessel coronary artery lesions (case report)

Myocardial perfusion imaging is included in the diagnostic algorithm in management of chronic coronary syndromes. However, in patients with multivessel coronary artery disease (CAD) this method can demonstrate false-negative result, which, in case of low pretest probability of CAD and mild symptomatology, can lead to errors in diagnostic tactics. The presented clinical case demonstrates the significance of analysis of additional parameters of myocardial perfusion imaging on the example of a patient with multivessel coronary artery disease and the phenomenon of balanced ischemia, in which the left ventricular perfusion has an almost normal perfusion. A 58-year-old patient has main complaints of dyspnea and blood pressure elevations up to 170/100 mmHg. The calculated pre-test probability of coronary heart disease was 20%. Rest ECG, echocardiography showed no significant abnormalities. According to the guidelines for diagnostics and treatment of patients with stable ischemic heart disease, the patient was referred for noninvasive stress testing myocardial perfusion scintigraphy. According to the study results, the size of reversed perfusion defect was 3% of the left ventricle, which is defined as a moderate risk of adverse cardiovascular events. However, extended analysis of myocardial perfusion data, such as transient ischemic dilatation index, stress-induced dynamics of left ventricular ejection fraction, wall motion and mechanical dyssynchrony of the left ventricle, as well as the presence of coronary calcium allowed to suspect multivessel coronary artery disease in the patient, which was the reason for coronarography and subsequent revascularization.