Left main coronary artery (LMCA) obstruction is the most potentially dangerous coronary disease. There is limited data on use of nuclear stress test to identify patients with Isolated And Significant Left Main Coronary Artery Disease (ILMCAD).
We compared nuclear stress test results for patients with ILMCAD (n=25; Group I) with stress results of patients with isolated LAD disease (n=25; Group II). Group I was selected over a period of 10 years. We compared electrocardiographic portion and perfusion deficits in the study groups.
Electrocardiography portion of stress tests was non-revealing. In group I, perfusion deficits were absent in 4 (16%) patients. The different patterns are compared in figure 1. Inferolateral and inferior wall ischemia were commonly seen in group I as compared to significantly higher proportion (p=0.02) of anterior wall ischemia in Group II. The perfusion deficits in group I were independent of site of LMCA stenosis, coronary artery dominance, electrocardiogram changes, and severity of symptoms.
This is the largest series of nuclear stress test results analysis involving ILMCAD. There is no unique pattern of ischemia associated with ILMCAD. Nuclear stress test may vary from being normal to diffuse ischemia in 3 vessel distribution. Its role may be limited to being an adjunct to clinical parameters including electrocardiography for diagnosing ILMCAD.
Nuclear stress tests in diagnosing ILMCAD may be limited to being an adjunct to clinical parameters including electrocardiography.
Vijay Shetty, None.