With regard to equilibrium radionuclide ventriculography (RNV), which one of the following is true?
RNV provides very reproducible data. New techniques allow the RVEF to be assessed. RNV is independent of endocardial border detection as it images radiolabelled red cell passage through the LV. It is a nuclear-based technique. AF will limit the accuracy, as gating will be less regular.
With regard to positron emission tomography (PET), which one of the following is true?
This answer is correct, although rubidium-based isotopes may change this. PET remains a costly and specialist procedure. It uses glucose metabolism to detect abnormalities.
The following patients have sound evidence-based reasons to undergo an MPS study, based on the NICE 200 guidelines for the assessment of chest pain.
Choose the single best answer.
Scenario B needs emergency angiography. Scenario C is unsuitable for current vasodilator stress agents; however, new selective A2A agents which have much less bronchospasm (e.g. regadenoson) will soon be available. Scenario D should have echocardiography as the first line. Scenario E should be offered angiography in the first incidence.
A patient with severe LVSD and LBBB undergoes MPS. The following report is available to you in clinic. ‘Adenosine stress (40 micrograms/ kg/min) used over 6 minutes. 400 Mbq of 99mTc-sestamibi was injected after 4 minutes. Further dose of 800 MBq injected at rest. Line source attenuation corrected imaging also undertaken. Reduced septal counts noted on both studies. Probable anteroapical hypoperfusion noted on stress images. Normal counts elsewhere. Dilated LV cavity with global hypokinesia and LVEF 32%.’
Which one of the following statements is correct?
No information is given as to the size of the left ventricle. The report suggests ischaemia and therefore coronary angiography is required. The septal hypoperfusion is probably due to an LBBB artefact rather than a myocardial infarction. No inferior wall pathology is identified, which is sometimes masked by diaphragmatic attenuation.
What would you do based on your interpretation of the MPS study shown in Figure below?
This is a high-risk study confirming significant anterior and anteroseptal ischaemia. There is a large ischaemic burden with LV cavity dilatation with stress. Revascularization to the LAD should be attempted.