Help with Cardiac PET Scan

[Ajax806]

I'm 43 years old, went in for a heart screen that included coronary calcium score, LAD 187, LCX 152, RCA 885, total 1224 (YIKES).  I am asymptomatic, excellent lipid panels and BP.  I do have a family history heart disease and am overweight.  I ended up doing a CPET with the following results:

STRESS EKG PORTION: Patient underwent Persantine PET protocol for 4 minutes and heart rate rose to 55% of the maximal age predicted heart rate. Stress EKG portion was non-diagnostic for ischemia.

FINDINGS: Stress perfusion images show a mild reduction in uptake in the distal anterior wall and apex with normalization on resting images. This is suggestive of mild ischemia in the distal left anterior descending artery territory. Gated perfusion images show normal wall thickening of all myocardial segments. Resting ejection fraction is 73%. Resting end diastolic volume 92 mL. Resting end systolic volume 25 mL. Stress ejection fraction 77%. Stress end diastolic volume 98 mL. Stress end systolic volume 23 mL. TID 0.98 is within normal limits. CT attenuation map reveals coronary calcification most prominently noted within the RCA and left circumflex and to a lesser degree within the left anterior descending coronary artery. Absolute flow quantifications shows global myocardial flow at rest of 0.61 mL/gram/minute which is normal. Global myocardial flow at stress is 1.88 mL/gram/minute which is mildly reduced. Global myocardial flow reserve is 3.05 which is normal.

IMPRESSION:
1. Abnormal study. Low risk study.
2. Perfusion images are suggestive of mild ischemia in the distal left anterior descending coronary artery territory.
2. Normal left ventricular ejection fraction, cavity size, and wall motion.
3. Coronary calcification noted within the right,  left circumflex, and to a lesser degree in the left anterior descending coronary artery.
4. Normal myocardial flow reserve.

Please help me understand this study.

[Ajax806]

I canceled my angiogram in favor of going to Mayo for a second opinion.  While at Mayo they looked at all my previous images and tests and ordered a Stress Echo.  I was able to get to 100% max heart rate and the results of my echo was completely normal, negative for ischemia, normal echo, no symptoms, ejection fraction at rest 65% at stress 75%. I was sent home and recommend I continue the 81mg asprin and 10mg of Simvistatin I currently take.  Does anyone know what % of false negative for Stress Echo?  I just want to understand how the CPET shows mild ischemia and the the Stress Echo shows nothing.  Mayo seems to believe in the Stress Echo.

[Ajax806]

I have scheduled an angiogram for Sept.14th.  I don't know if I'm doing the right thing.  I am completely asymptomatic and my doctor feels that we should head into this angio with the idea that a stent will be placed in any arteries that are candidates.  Based on my PET, that would most likely be the Distal Left Anterior Descending.  What are your opinions?

[Ajax806]

I have an Echo scheduled in a couple of weeks.  My dad died of an Aortic Aneurysm, so they want to make sure there are no other surprises for me.  Should I be concerned about Peripheral Artery Disease?  I'm wondering if anyone can explain global myocardial flow at stress and what a normal number is?  Also what does global myocardial flow reserve mean?  BTW, the only med's they have me on is 10mg Simvistatin and aspirin.  My stats before med's are HDL 47, LDL 78, Total 140, trig 74, BP 118/76.

[Occupant]

From what I understand, a Persantine Pet Scan is a stress test not on a treadmill, but with medication to speed up your heart. Similar to that, I had a Thallium Stress  test done four  years ago after the CT-Scan with medication since they could not get an ECG on the treadmill - so far it looks like, we are even test wise (EF 74%). The cardiologist at the time said, don't worry you're going to live another 35 years. Since I was 75 at the time that would bring me up to 110 years. So, even if your Agatston score appears pretty  high, it doesn't mean very much in my book - if you are really worried about this, do an Angigram, like you said.

[Ajax806]

I had Coronary calcium CT and a cardiac CPET scan.  My doc told me that if I had a MI in the left anterior distal region (apex) that I would probably even feel it and probably wouldn't even register on an EKG.  He felt that this blockage is not life threatening and a stent would be worth it.  He left it up to me to do an angiogram, which I am going to request.

[ed34]

Threw me at first until I read it again and saw "persantine"

[Occupant]

I'd agree with you if it weren't for the numbers the OP threw in. They look darn close to an Agatston score and that's why I assumed that he had a CT- and not a PET-Scan. And those numbers don't really tell you anything about your arteries other than there is lots of Calcium Phosphate build up.

[ed34]

What the study basically reveals is that your left anterior descending artery is moderately blocked. This is because while your heart is resting, sufficient blood is being received, but while it is stressed (working harder), there is not enough. The more your heart works, the more blood it requires. I don't think they will worry about the right side. Your left circumflex artery is basically ok and requires no work. You need some lifestyle changes for the better and possibly intervention on your left anterior descending in the form of a stent or 2.

[Occupant]

I had a similar study done 3.5 years ago with similar results. My total Agatston score was slightly higher than yours at 1243, but in my case it was not the RCA but rather the LAD with a score of 786. However, I still don't know what all this means and if you really want to know, you should have an Angiogram done. I probably should add, though, that I am 35 years older  than you and that, at least I think so, puts you into a different frame of mind.