CTICasesSevere Three-Vessel Coronary Artery Disease with Myocardial Hibernation
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Imaging findings
Cardiac MRI demonstrates a dilated left ventricle with severe global hypokinesis and diffuse thinning of the myocardial walls, particularly affecting the free wall. On rest myocardial perfusion imaging, there are no perfusion defects, and late gadolinium enhancement (LGE) imaging shows no significant myocardial enhancement, confirming preserved myocardial viability across all coronary territories.
Key takeaways
In patients with severe three-vessel coronary artery disease, the absence of late gadolinium enhancement combined with normal resting perfusion indicates viable, hibernating myocardium that is highly likely to recover functional performance following surgical revascularization. Resting perfusion scans can appear entirely normal despite severe underlying vascular disease, highlighting the importance of stress imaging or angiographic correlation to differentiate ischemic cardiomyopathy from non-ischemic etiologies.
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