ArticleEuropean heart journal. Case reports2025
Left main coronary artery stenosis presenting with negative myocardial perfusion imaging: a case report of balanced ischaemia.
Article in European heart journal. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Myocardial perfusion imaging (MPI) stress testing using technetium sestamibi is a non-invasive tool for diagnosing and risk-stratifying patients with coronary artery disease. Despite its utility, MPI stress testing exhibits various limitations. Case summary: An 80-year-old male presented with severe non-radiating exertional epigastric pain. Four months earlier, an MPI test was low risk with no significant perfusion defect. High-sensitivity cardiac troponins peaked at 97 ng/L with a delta value of 25. Left cardiac catheterization revealed a 99% calcified stenosis in the left main coronary artery. The patient underwent emergent coronary artery bypass grafting for refractory angina. Discussion: A critical left main coronary artery stenosis occurred despite a recent negative stress MPI. False-negative MPI can occur with balanced ischaemia in multi-vessel and left main coronary artery disease. This case underscores the importance of cautiously interpreting MPI results in intermediate/high-risk patients to identify balanced ischaemia.
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