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Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities

  • Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.

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Abbreviations

LM:

Left main

LMS:

Left main stenosis

LV:

Left ventricular

LAD:

Left anterior descending

EKG:

Electrocardiogram

SPECT:

Cardiac single photon emission computed tomography

CAD:

Coronary artery disease

MPI:

Myocardial perfusion imaging

RV:

Right ventricular

CT:

Computed tomography

PET:

Positron emission tomography

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Acknowledgments

Karthik Ananthasubramaniam acknowledges the research Grant support as part of trials involving Astellas Pharma US Inc, GE Healthcare, Alnylam pharmaceuticals, and Speakers Bureau Lantheus Medical Imaging.

Conflicts of interest

Nishtha Sareen declares no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA

    Nishtha Sareen MD

  2. Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI, 48202, USA

    Karthik Ananthasubramaniam MD FACC FASE FASNC FRCP(Glas)

Authors
  1. Nishtha Sareen MD
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  2. Karthik Ananthasubramaniam MD FACC FASE FASNC FRCP(Glas)
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Corresponding author

Correspondence to Karthik Ananthasubramaniam MD FACC FASE FASNC FRCP(Glas).

Additional information

See related editorial, doi:10.1007/s12350-015-0306-1.

Funding: None.

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Sareen, N., Ananthasubramaniam, K. Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities. J. Nucl. Cardiol. 23, 1411–1429 (2016). https://doi.org/10.1007/s12350-015-0152-1

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  • DOI: https://doi.org/10.1007/s12350-015-0152-1

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