Do You Need Angiography and Stenting After Myocardial Perfusion Imaging?

Is there a blockage in the blood vessels after a myocardial perfusion scan? Is it necessary to actively perform a cardiac catheterization and place a stent? Thank you?

Hello Doctor, I recently underwent an exercise electrocardiogram and experienced issues with oxygen deficiency.
I also had a myocardial perfusion SPECT scan, which showed the following:
1.
Mild severity, reversible perfusion defects in the basal anterior wall, basal anterolateral wall, mid anterior wall, and mid anteroseptal wall of the left ventricle, suggesting stress-induced myocardial ischemia.
2.
Moderate severity, reversible perfusion defects in the basal inferior wall of the left ventricle, suggesting stress-induced myocardial ischemia.
3.
Fixed perfusion defects in the basal anteroseptal wall, basal inferoseptal wall, and basal inferolateral wall of the left ventricle, suggesting myocardial ischemia.
4.
Reverse redistribution of thallium activity in the apical anterior wall of the left ventricle, possibly due to damaged myocardium.
The total summed stress score is 9, and the summed rest score is 5.
The percentage of stress perfusion defects is 21% of the total myocardium of the left ventricle, while the percentage of rest perfusion defects is 8% of the total myocardium of the left ventricle.
Could you please advise if there is a blockage in the vessels? Should I actively pursue a coronary angiogram and stent placement? Thank you.

MIMI, 40~49 year old female. Ask Date: 2023/09/07

Dr. Wu Xueming reply Cardiology

The report indicates the presence of myocardial ischemia, which can initially be treated with medication.
If symptoms remain poorly controlled, catheter-based intervention may be considered.

Reply Date: 2023/09/07

More Info

Based on the myocardial perfusion imaging (MPI) results you provided, there are several key findings that suggest the presence of myocardial ischemia. The report indicates mild to moderate reversible perfusion defects in various regions of the left ventricle, particularly in the basal anterior, anterolateral, and inferior walls. Additionally, there are fixed perfusion defects in the basal anteroseptal, inferoseptal, and inferolateral walls, which may indicate areas of myocardial damage or scarring.

Understanding the Findings
1. Reversible Perfusion Defects: These suggest that during stress (induced by exercise or pharmacological agents), certain areas of the heart are not receiving adequate blood flow, which can lead to ischemia. The fact that these defects are reversible means that the heart muscle may recover its function if blood flow is restored.

2. Fixed Perfusion Defects: These are concerning because they indicate areas of the heart that have likely suffered damage, possibly due to previous ischemic events. These areas do not show improvement during stress, suggesting that they may not respond well to increased blood flow.

3. Summed Stress Score (SSS) and Summed Rest Score (SRS): Your SSS of 9 indicates a moderate level of ischemia during stress, while the SRS of 5 suggests that there is still some degree of perfusion defect at rest. The percentage of stress perfusion defects (21%) indicates that a significant portion of the myocardium is affected during stress.

Need for Further Investigation
Given these findings, it is reasonable to consider further evaluation through coronary angiography. This procedure is essential for assessing the coronary arteries directly and determining if there are blockages or significant stenosis that would warrant intervention, such as stenting.

1. Angiography: This is an invasive procedure that allows for direct visualization of the coronary arteries. It can help identify the location and severity of any blockages. If significant blockages are found, angioplasty and stenting may be necessary to restore adequate blood flow to the affected areas of the heart.

2. Stenting: If angiography reveals significant coronary artery disease (CAD), stenting may be indicated to keep the artery open and improve blood flow. This is particularly important if the ischemia is causing symptoms such as chest pain or if there is a risk of myocardial infarction (heart attack).

Risk Assessment
The presence of reversible ischemia, especially in multiple regions of the heart, raises concerns about the risk of future cardiac events. It is crucial to discuss these findings with your cardiologist, who can assess your overall risk factors, including age, family history, and other health conditions (such as hypertension, diabetes, and hyperlipidemia).

Conclusion
In summary, your MPI results indicate the presence of myocardial ischemia, which warrants further investigation through coronary angiography. This will provide a clearer picture of your coronary artery health and help determine if stenting or other interventions are necessary. It is essential to have a thorough discussion with your cardiologist about these findings and the best course of action tailored to your specific situation. Early intervention can significantly improve outcomes and reduce the risk of serious cardiac events in the future.

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