Case 16

A 76-year-old male with known coronary artery disease (CAD) and multiple myocardial infarctions (MIs) and congestive heart failure (CHF) in the past was admitted to the hospital because of chest pain and worsening heart failure. He underwent cardiac catheterization, which showed 100% occlusion of the right coronary artery (RCA) and left circumflex (LCX) and 80% narrowing of the left anterior descending (LAD). Left ventriculogram showed severely impaired left ventricular ejection fraction (LVEF) of 15%.

(Video 1)

(Video 2)

He was referred for a viability study to decide the further course of management and possible revascularization. A dose of 3.2 mCi of thallium-201 was injected at rest, followed by gated SPECT imaging 15 minutes and 4 hours later (Videos 4 and 5 and Figures 1 and 2). What is your interpretation of this study?

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