CTICasesSubendocardial Perfusion Defects with Normal Contractility and Discrepant Angiography (Possible Syndrome X)
Imaging findings
Cardiac MRI perfusion imaging demonstrated diffuse, multifocal subendocardial perfusion defects that surprisingly appeared worse during rest than during stress. Despite these findings, global and regional contractility was normal, and no delayed gadolinium enhancement was observed. Conventional angiography reported an 80% left main ostial narrowing, which was discordant with the MRI findings.
Key takeaways
Diffuse subendocardial perfusion defects, particularly if worsened at rest, can be indicative of microvascular dysfunction (Syndrome X), even in the absence of contractility abnormalities or delayed enhancement. Discrepancies between advanced cardiac imaging and conventional angiography, especially in patients with atypical symptoms and normal troponin, highlight the complexity of diagnosing ischemic heart disease and the potential role of microvascular disease.
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