Reconciling discordant myocardial perfusion imaging and coronary angiography

Area of Science:

• Cardiology
• Diagnostic Imaging
• Interventional Cardiology

Background:

• Discordance between non-invasive nuclear stress testing and invasive coronary angiography (ICA) is a frequent clinical challenge in patients with angina.
• Abnormal perfusion scans with normal ICA may lead to underdiagnosis of cardiac causes of chest pain.
• Normal perfusion scans in patients with significant coronary artery disease found on ICA can complicate risk stratification and treatment.

Purpose of the Study:

• To review current evidence explaining the paradoxical scenarios of discordant results between nuclear stress testing and ICA.
• To elucidate the underlying mechanisms and clinical implications of these discrepancies in angina patients.

Main Methods:

• Review of existing literature and clinical evidence.
• Analysis of studies investigating discrepancies between myocardial perfusion imaging and coronary angiography.
• Synthesis of data to explain paradoxical findings in the context of angina diagnosis.

Main Results:

• Identified common causes for abnormal perfusion scans despite normal coronary arteries, such as microvascular dysfunction.
• Highlighted scenarios where normal perfusion scans may underestimate the severity of obstructive coronary artery disease.
• Discussed the limitations of both diagnostic modalities in specific patient populations.

Conclusions:

• Understanding the discordance between nuclear stress testing and ICA is crucial for accurate diagnosis and management of angina.
• Further research is needed to refine diagnostic algorithms and improve risk stratification in cases of test result discrepancies.
• Integrating clinical presentation with both imaging and invasive findings is essential for optimal patient care.