The Correlation of Reverse Redistribution Pattern with Coronary Angiography: A Conundrum Revisited

Objective  The reverse redistribution (RR) pattern is a phenomenon whose etiology, pathophysiology, and clinical implications are not well understood. The studies examining this pattern date back to days when timely coronary interventions and anti-ischemic therapies were not widely used, so we aimed to reinvestigate any relationship between RR and coronary angiography (CA) findings in today's contemporary clinical settings. Methods  All patients with an RR pattern on the Tc99m-MIBI (technetium-99m sestamibi) scan between 2021 and 2023 were screened. Information on demographics, history of acute coronary syndrome, revascularization, comorbidities, and risk factors was collected. The CA findings were compared to RR regions. The physician's decision in the case of the RR pattern was grouped. Results  In a total of 67 patients (men 83%, aged 63.6 ± 10.5), the RR pattern was most commonly seen in the inferior-posterior wall ( n  = 41, 31.3%), followed by the apex ( n  = 19, 14.5%) and anterior ( n  = 12, 9.2%). Most patients with RR pattern had normal/nonobstructive coronary angiograms (61.1%, n  = 22); significant stenoses in 1, 2, and 3 vessels were present in 19.4% ( n  = 7), 13.8% ( n  = 5), and 5.5% ( n  = 2) of patients, respectively. There was no correlation between the regions of the RR pattern and significant stenosis detected on CA ( p  = 0.6, p  = 0.5, p  = 0.6, respectively, for left anterior descending artery, circumflex artery, and right coronary artery). Conclusion  In this study, no evidence of a relationship between RR patterns and CA findings was found. The 60% of the patients with RR pattern had normal/nonobstructive coronaries, so the decision to proceed with CA should not be made based solely on this finding.