ACUTE CHEST PAIN PERFUSION IMAGING: UNDERUTILIZED BUT ALIVE AND WELL
Recommended Citation
Vishwanath R, Clark N, Ananthasubramaniam K. ACUTE CHEST PAIN PERFUSION IMAGING: UNDERUTILIZED BUT ALIVE AND WELL. J Am Coll Cardiol 2025; 85(12):3335.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
methoxy isobutyl isonitrile technetium tc 99m, troponin, adult, cardiac imaging, case report, clinical article, conference abstract, diagnosis, drug therapy, electrocardiography, exercise, female, heart muscle ischemia, human, hyperlipidemia, intravenous drug administration, male, morbid obesity, predictive value, scintigraphy, single photon emission computed tomography, thorax pain
Abstract
Background: In patients with chest pain, differentiating ischemic versus non ischemic etiologies can be challenging. Acute chest pain imaging with perfusion tracers which help identify critical ischemia leading to timely intervention. Case A 36-year-old female patient with history of hyperlipidemia, and morbid obesity BMI 46 presented with chest pressure, constant and present for 5 days without relief. Worse with exertion and inspiration. Hs-cTn I 30 ng/L. ECG did not show any evidence of ischemia. Decision-making We proceeded with acute chest pain perfusion nuclear imaging. Patient was injected with 25.2 millicurie of Tc 99m sestamibi and rest imaging obtained during symptoms. This showed a distal septal perfusion defect raising concern for acute ischemia in the LAD distribution. Coronary angiogram revealed 99% occlusion of the mid-LAD, and 71% mid-RCA disease. She then went PCI with a DES to the mid-LAD and staged PCI to the RCA. Conclusion Prolonged chest pain without definitive evidence of ischemia can be tricky to evaluate. SPECT chest pain imaging is done to evaluate if symptoms are to ischemia. Normal scan has a negative predictive value of 99.3% to exclude ischemic etiology of chest pain. The only class 1A recommendation for SPECT cardiac imaging is rest only imaging in patients with chest pain and non-ischemic ECG and equivocal troponin elevations as illustrated by this case. The use of rest only SPECT chest pain perfusion imaging serves as a valuable adjunct to assess for acute myocardial ischemia. [Formula presented]
Volume
85
Issue
12
First Page
3335
