Reversible Myocardial Ischemia

Abstract

Reversible myocardial ischemia is a common disease that occurs in patients with atherosclerosis of coronary artery, myocardial microcirculation disturbance, and other infrequent etiologies. It is mainly due to the blood perfusion insufficiency of the myocardium. Ischemia is the single most important predictor of future hard cardiac events and ischemia correction remains the cornerstone of current revascularization strategies (Kennedy MW, Fabris E, Suryapranata H, Kedhi E, Cardiovasc Diabetol 16:51, 2017). Early accurate diagnosis of reversible myocardial ischemia is of great importance for reducing the incidence of myocardial infarction and improving the prognosis of patients. The electrocardiogram (ECG), functional testing, cardiac stress test (including exercise stress test and pharmacological stress test), and myocardial perfusion imaging were all the methods of choice for detecting myocardial ischemia. Among all these methods, the myocardial perfusion imaging approaches, which traditionally consist of radionuclide myocardial perfusion and magnetic resonance (MR) myocardial perfusion, have been considered as effective and accurate. Recently, with the rapid development of CT imaging techniques, CT myocardial perfusion imaging has been demonstrated as a promising noninvasive diagnostic strategy for myocardial ischemia. Up to now, the invasive fractional flow reserve (FFR) has been regarded as the “gold standard” for diagnosing hemodynamically significant coronary artery disease (CAD). In this chapter, based on a case of reversible myocardial ischemia, we will discuss the cardiac CT imaging manifestations of myocardial ischemia, and further possibly promising role of new cardiac CT technology, particularly the CT myocardial perfusion, in reversible myocardial ischemia.