Multivessel Coronary Disease on Stress MPI
CC BY-SA 4.0 · Wikimedia Commons · source file
Question
A patient has reversible perfusion defects in BOTH the anterior wall AND the inferior wall on stress MPI, with an LVEF drop from 60% to 45% with stress. Which of the following is the most appropriate interpretation?
- ATwo separate prior myocardial infarctions (fixed defects)
- BNormal variant — bilateral attenuation artifacts
- CBalanced triple-vessel ischemia — stress perfusion appears normal
- DMultivessel CAD — ischemia in both LAD and RCA territories with stress-induced LV dysfunction
Show the answer and explanation
D. Multivessel CAD — ischemia in both LAD and RCA territories with stress-induced LV dysfunction
Reversible perfusion defects in multiple coronary territories (anterior wall = LAD, inferior wall = RCA) combined with a significant LVEF drop at stress (>5%) indicates multivessel CAD with hemodynamically significant ischemia in two major territories. The stress-induced LV dysfunction (transient ischemic dilation) indicates that the ischemic burden is large enough to impair global left ventricular function. This high-risk scan pattern warrants urgent cardiology consultation and likely coronary angiography. Multivessel disease with LV dysfunction at stress carries a high annual cardiac event rate (>3%) and typically benefits from revascularization.
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