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CHRONIC CAD PROGNOSTICATION
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Case History Answers
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CHRONIC CAD PROGNOSTICATION
figure 1
figure 2
Case History Answers
1. Describe the scintigraphic findings in detail. Include in your description, both the visual interpretation of the slice report and the quantitative polar map findings.
The study shows extensive reversible ischemia involving all 3 vascular territories. The most important prognostic indicator which can be extracted from a stress myocardial perfusion study is the extent of the ischemic defect. This is usually expressed as a percent of the total myocardium. Recall that cardiogenic shock occurs when 40% or more of the total left ventricular myocardium is destroyed. This patient had stress myocardial defects totaling 60% of the total myocardium (see polar map).
2 .Categorize the scintigraphic findings into low, intermediate or high-risk for future coronary events.
Reversible defects correlate best with the risk of myocardial infarctions whereas fixed defects correlate best with the risk of cardiac mortality. The combined total stress defect size is a marker of both MI risk and cardiac mortality. This patient falls into a high risk subject for MI/mortality.