title: Reconciling discordant myocardial perfusion imaging and coronary angiography.
abstract: A common clinical conundrum presents itself in the discordance between nuclear stress testing and invasive coronary angiography (ICA) in the patient presenting with angina. A patient with an abnormal perfusion scan and "normal coronary angiography" may result in the patient's symptoms being dismissed as "non-cardiac." Alternatively, a patient with a "normal perfusion study," who nonetheless undergoes ICA and is found to have significant coronary artery disease may confound efforts to risk stratify and potentially treat patients with angina. This paper will review the current evidence to explain these apparent paradoxical scenarios.
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Rollor
authors.affiliation: Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Feldmeier
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Jerome
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland Medical Center, Baltimore, MD, USA. agupta@medicine.umaryland.edu.
authors.forename: Anuj
authors.initials: A
authors.lastname: Gupta
mesh_terms: D060050:Angina, Stable / Q000000981:diagnostic imaging*; D000789:Angina, Unstable / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005080:Exercise Test; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality; D055414:Myocardial Perfusion Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment
keywords: Coronary artery disease; coronary flow reserve; fractional flow reserve; invasive coronary angiography; myocardial perfusion imaging: SPECT