Question: I had CPET scan completed the results are as follows: 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 quantificationaj 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.
The calcium score for the left main coronary is 0.0 .
The calcium score for the LAD is 186.7.
The calcium score for the LCX is 152.
The calcium score for the RCA is 884.9 .
The total calcium score is 1223.6.
My Cardiologist has left it up to me if I wanted an angiogram. I am now on 10mg Simvistatin, and 81mg Asprin. Prior to these meds, my BP was 122/75, LDL 78, HDL 47, Total Chol. 140, TriG 74. I am obese, and have a family history of heart disease. I have made major lifestyle changes since 2 months agos and have dropped 20#'s so far. I will continue with these changes, but am looking for direction on what this all means and if I should proceed with an Angiogram?

Thank you Dr. Sharka.

My Doctor felt that since the mild ischemia (what does mild even mean? <70% blocked) is in the distal left anterior descending artery, that it was not life threatening and further said that if a blockage there did result in an MI, that I would most likely not feel it or register on an EKG. He felt that my risk of death because of the ischemia is extremely low.

I am most concerned with my CAC of over 800 in the RCA. How is it possible I can have 0 in Left Main, not that I'm complaining. I worry about plaque rupture. What is the main benefit to the angiogram? My doc felt that is was not necessary based on the CAC alone, but now that I have the mild ischemia, he didn't have strong feeling not to do it.

I do annual lipid panels and monitor my BP constantly because of my obesity and family history. I recently went to do a Heart Screening because it was cheap and did an EKG which I never had before. The screen showed a normal EGK and a Framingham score of 0. My screener thought is was a good idea to get a calcium score because of my parent heart disease. We were all surprised by the number and that was the reason I even saw a Cardiologist. I am completely asymptomatic.

Since then I have been on a strict Mediterranean diet, and considered the Ornish diet. My doctor feels the Mediterranean is the way to go because of the research. I know I can maintain the Mediterranean diet, but the Ornish might be difficult, but not as difficult as dying. He also plans to increase my simvastatin to 40mg eventually.

So...bottom line is what is the benefit of the angiogram, and what would they discover that would change my current treatment plan (lifestyle change\medications)? I also have not gotten a real straight answer on a my risk factors, CAC score >1000 indicated a 30% chance of MI in one year, now that I'm on a statin\aspirin therapy and lifestyle changes, where am I at?

Thanks,
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