Onlineartikel 02.11.2015

Stenosis of the mid-LAD

deutsche Version


60 year old female patient, with the following relevant medical history:

  • Hypertension
  • Hyperlipidemia


Anamnesis


The patient complains of exercise-triggered chest pain since approximately a year. Her physical examination and ECG at rest are normal. She is referred for adenosine stress CMR.


Cine imaging at rest


Video 1 shows cine imaging at rest. The left ventricle has a normal size (diameter 47 mm at end-diastole), normal thickness (basal septum 9 mm), and a normal function (EF 65%). No wall motion abnormalities are identified.






Perfusion imaging during adenosine infusion


Adenosine is administered at 0.14 mg/kg/min. During adenosine administration the patient refers an oppressive pain in the neck.

In the perfusion imaging during adenosine infusion (Video 5), a perfusion defect can be observed in the medial and apical anterior segment (segment 7 and 13) and apical septal segment (segment 14). Figure 1 shows the exact location of the perfusion defects. 


Stenose in medialer LAD Bild 1

Abbildung 1/ Figure 1

Credit:
DGK 2015


Perfusion at rest


Video 6 shows the rest perfusion, which shows no perfusion abnormalities.



Adenosine vs. rest perfusion


Figure 2 shows the comparison between stress and rest perfusion.


Stenose in medialer LAD Bild 2

Abbildung 2/ Figure 2

Credit:
DGK 2015


Late-Gadolinium Enhancement


Stenose in medialer LAD Bild 3

Abbildung 3/ Figure 3

Credit:
DGK 2015

Figure 3 shows the delayed enhancement images of the patient. No areas of late gadolinium enhancement were observed.

In conclusion, the patient has inducible perfusion deficits in the apical anterior and septal segments and in the medial anterior segment. The left ventricle function at rest is normal, and no myocardial scar can be observed. These findings are highly suggestive of coronary artery disease.


Stenose in medialer LAD Bild 4

Abbildung 4/ Figure 4

Credit:
DGK 2015

An invasive coronary angiography was performed, and showed a 90% lesion of the medial left anterior descending artery. A drug-eluting stent was implanted.