Published on 02/03/2015 by admin
Filed under Internal Medicine
Last modified 03/03/2015
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Case 15
A 66-year-old man with known severe three-vessel coronary artery disease (CAD) and ischemic cardiomyopathy was referred for myocardial viability assessment.
Heart catheterization demonstrated severe left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] = 15% to 20%) and severe three-vessel CAD (75% proximal left anterior descending [LAD], 80% proximal circumflex, 80% mid–first obtuse marginal [OM1], 100% proximal right coronary artery [RCA]).
The baseline ECG demonstrates normal sinus rhythm, first-degree AV block, and Q waves suggestive of extensive anterior (and possibly inferior) infarction.
Rubidium-82 (82Rb) PET MPI demonstrates moderately severe and extensive perfusion defects in the anterior, anteroapical, and anterolateral regions. [18F]Fluorodeoxyglucose (18FDG) PET images demonstrate a mild localized area of reduced glucose metabolism in the anteroapical region. The “perfusion-metabolism mismatch” is consistent with preserved myocardial viability and predicts improvement of left ventricular systolic function with revascularization.
The polar plots and 17-segment scoring results confirm that the regional reduction in myocardial perfusion (82Rb) is more severe and extensive than the reduction in glucose metabolism (18FDG).
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