Multiple Choice Question of the Week : Nuclear-03 : [Answer]

             
      

60year Male
PMx:
-CAD s/p CABG x 4 in 2007 (LIMA-LAD, RIMA-diag, S-OM, S-PDA)
-Recent decline in EF (40-> 20%), heart failure symptoms
-Severe PAD
-Osteoarthritic
-GFR 27

You know patient has CAD.What test would you choose? We choose Cardiac PET

Which is the best interpretation of the following images?
A) Mixture of LAD territory Ischemia and Hibernation
B) MultivesselIschemia
C) LAD territory Scar
D) LAD territory Hibernation but no Ischemia

Right answer is C)
1 – Large scar in apical territory of the LAD c/w a prior transmural infarction.
2 – No evidence of Ischemia or peri-infarct ischemia.
3 – No evidence of hibernation by FDG imaging.
4 – LV is dilated with large area of apical dyskinesis
5 – Rest LVEF is 16 %, Stress LVEF is 17 %.

Echo showing Large LAD apiacal aneurysm.
Futility of revascularization, CRT, LV remodelling surgery, when you identify large areas of scar.

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