Patient History

Patient is a 45 year old male who presented with mild chest pain following low level exertion. The patient had no risk factors for cardiac disease (normal cholesterol, exercises, non-smoker, no family history of cardiac events). Height: 1.75 m; weight: 79 kg.

Imaging Procedure

A Two Day Sestamibi Protocol was used (Rest SPECT, Stress gated SPECT). Imaging was done on a GE Millennium MyoSIGHT Dual Head Camera with 36 stops/detector, 180 degrees.

Imaging Analysis

This data was reconstructed and reformatted using the ECToolbox. Slices were reviewed in the Planar/ Slice review (first row stress, second row rest). Slices were automatically aligned (since the data had already been processed with CEqual) and normalized to the maximum in the myocardium.

This data was processed with the CEqual option of the ECToolbox. The reversible nature of the defect is clearly seen in the CEqual plots and SSS scores, and is affirmed in the PerfEX results available on the Plot review.

Stress	Rest	Reversibility

The deep teal color in the standard deviation polar plots also emphasizes the severity of this defect (7-8 SD below normal); the extent scores show the size of the defect as well as the total per cent of the myocardium affected. The blackout 3D with superimposed arteries visually reaffirms the location and extent of the defect.

This data was further processed with QGS to give additional gated and 3D information. The reversible nature of the defect is seen on the 2D and 3D perfusion surfaces.

EKG Results

The EKG showed 2.2 mm of ST depression in AVF, and 1.8 mm of ST elevation in V2. Findings were consistent with inferior wall ischemia.

Findings

There was a large zone of stress-induced ischemia in the anterior wall and septum. Left ventricular function was normal. Cardiac catheterization revealed 95% stenosis of LAD (mid segment). A stent was placed at the site of narrowing, and the patient now has a 0% stenosis.

Courtesy of:

Oconomowoc Memorial Hospital, Oconomowoc, WI