Stenosis of the mid-LAD
60 year old female patient, with the following relevant medical history:
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.
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.
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.
An invasive coronary angiography was performed, and showed a 90% lesion of the medial left anterior descending artery. A drug-eluting stent was implanted.