Positive vasodilator stress electrocardiogram does not always indicate obstructive coronary artery disease, the role of non-invasive myocardial flow reserve

The presence of transient ischemic dilatation (TID) and positive vasodilator stress electrocardiographic (ECG) changes on SPECT is often associated with multi-vessel coronary artery disease. PET allows for evaluation of myocardial blood flow and myocardial flow reserve both of which have incremental diagnostic and prognostic perspective. We are reporting a case with significant vasodilator stress ECG abnormalities and TID with normal myocardial blood flow and flow reserve that had normal coronary arteries on invasive angiography. This case suggests that normal myocardial blood flow and flow reserve in conjunction with normal perfusion can rule out significant CAD regardless of vasodilator-induced ECG changes and TID.