Patient with previously undiagnosed anterior MI who comes for the first time to medical attention because of heart failure symptoms. Angiography shows 70% LAD stenosis, in the absence of ischaemic symptoms, and revascularisation will be performed only if tissue in the LAD territory is viable.
Rest perfusion, assessed as late replenishment (10 seconds after flash) is significantly reduced (but not completely absent) in the true apex and distal part of apical segments in 4-chamber, whereas in 2 and 3-chamber hypoperfusion does not extend beyond true apex; anterior mid and basal segments show normal perfusion while basal lateral is not interpretable. Revascularization will be indicated, since viability is substantially absent only in the true apex ( 1 segment).
Quantitative Analysis of MCE Replenishment velocity is blunted in the apical segments(red lower curves)-for comparison see the green normal curve sampled in the basal-mid septum.
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