PMC8084405_01
A. Shows the myocardium in the short axis; B. Bulls-eye myocardium perfusion images (MPI), depicting the entire myocardium. MPI scans were performed with a 1 day protocol using Technetium (99mTc) Tetrofosmin in years, 2013, 2014, 2016, and 2017. Black arrows point to the hypoperfused areas during stress and the white arrows indicate at rest. The differences between the stress and at rest MPI demonstrate the progressive nature of the myocardial ischemia which appears to be less severe and reversible at rest in 2013 and more severe and partially reversible in 2016 and 2017. The parts of the ischemic myocardium predominantly involve the inferior, inferolateral and a segment of the apical wall (seen in the center of the Bulls-eye image); C. Coronary angiography (a: left coronary artery; b: right coronary artery; c: circumflex artery; d: circumflex artery with myocardial blush). There is no stenosis in any of the coronary arteries and with low myocardial blush.
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In the upper bulls-eye images (Fig. 1) a normal MPI SPECT is depicted in another individual for comparison, and in the lower images, the MPI SPECT of the present case demonstrated perfusion defects. Coronary angiogram in 2017 showed no hemodynamically significant coronary abnormalities (Fig. 1), however myocardial blush was very low, indicating small vessels dysfunction.