66 year old male patient who is admitted with refractory heart failure.
Symptom onset was 9 months earlier.
Creatinine of 2.4 mg/dl
LV dysfunction by echo with EF of 24 % and stage 3 diastolic dysfunction.
A cardiac cath was considered but given renal function…..
You would recommend
A. Medical management with referral for to advanced heart failure therapies.
B. Consideration for revascularization given large amount of myocardium at risk.
C. Referral for STEM cell therapy.
D. ICD prophylaxis.
Severe LM stenosis on angiogram
Correct Answer : B)
• Absence of ischemia and the presence of fixed, severe and larger perfusion defect in the LAD distribution.
• However, The metabolic images with FDG show a large area of mismatch with FDG uptake in all the segments where there is a perfusion defect.
• This finding indicated myocardial viability and no scar nd patient was referred for surgical revascularization.
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