Case 15
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]).
12-Lead ECG
The baseline ECG demonstrates normal sinus rhythm, first-degree AV block, and Q waves suggestive of extensive anterior (and possibly inferior) infarction.
Perfusion and Glucose Metabolism
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.
Semiquantitative Assessment of Myocardial Perfusion and Glucose Metabolism
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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