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    Stress Test Results
    An_193170 posted:
    A report from a pharmacologic stress nuclear imaging test revealved "calculated left ventricular ejection fraction was 80%" and that it "revealed a small apical fixed defect with mildly decreased tracer uptake, most likely consistent with the artifact of apical thinning."

    What does that mean?
    CardiostarUSA1 responded:

    YOUR DOCTOR is obligated to fully explain the results of any diagnostic imaging test.

    In general-only here, normal resting range left ventricular ejection fraction (LVEF, the amount of blood pumped out of the left ventricle with each beat) is 50%/55%-75%. Average is in the low/mid 60s. An LVEF over 75% is considered too high, or medically-termed hyperdynamic or hypercontractile left ventricle (LV), the heart is pumping forcefully/forcibly, an excessive amount of blood is being pumped out.

    LVEF varies throughout the day, and from one diagnostic imaging modality to another. According to medical literature, there a few specific clinically-recognized causes of a hyperdynamic/hypercontractile LV which includes aortic valve regurgitation (leakage), sometimes the mitral valve, hypermetabolic states (thyrotoxicosis, anemia), some congenital heart defects (e.g., large patent ductus arteriosus, and ventricular septal defect), and hypertrophic cardiomyopathy (HCM). The condition may/can also be deemed as idiopathic (no known cause).

    Actual heart wall thinning is typically not good, however, with the exceptions that sometimes it can be deemed a normal physiological variant (that is, a variation of the norm but still within clinically acceptable parameters) such as in apical (apex, bottom tip of the heart) thinning OR an artifact (false nuclear image which yields a false-positive result/finding).

    An artifact can appear to affect the SPECT scanner's ability to properly read the amounts of IV administered radiotracer that is taken up (uptake) into the heart muscle.

    The two main concerns regarding a nuclear stress test involves an actual narrowing or scarring, i.e., the findings of reversible (ischemia) or non-reversible (fixed, permanent, scar tissue) perfusion (blood flow) defects.

    After stress myocardial perfusion imaging (stress MPI), the patient's cardiologist may take some time to study the results of the scan before discussing the findings.

    One can typically expect one of the following four results -


    No perfusion defect after exercise or at rest

    The heart muscle and blood flow to the heart muscle appear to be normal.


    Perfusion defect after exercise, BUT NOT at rest (reversible defect)

    There is some degree of blockage in a coronary artery that interferes with the blood flow to the heart muscle. In someone with significant heart disease, when the heart works hard, it does not get the blood supply and oxygen that it needs (a supply 'n demand mismatch).

    At rest, however, the blood adequately reaches these areas or regions, e.g., ANTERIOR/ANTERO (front wall), POSTERIOR/POSTERO (back wall), INFERIOR/INFERO (lower area/lower wall area), Septal/Septum (dividing wall) APICAL/APEX (bottom tip of the heart) and LATERAL (side wall).

    The heart muscle has living cells/tissue in these areas. This indicates that clearing the blockage in the affected artery will be of benefit.


    Perfusion defect AFTER exercise AND at rest (fixed defect)

    There is one or more totally blocked coronary arteries and one has had damage done to the heart muscle because of a heart attack.

    There is an area/areas of the heart muscle that has become scar tissue (scarring, scarred) because of the heart attack.

    This area would not be able to make functional use of any oxygen even if blood flow to that area of the heart were completely restored.


    Combined reversible and fixed defects

    It is common for individuals with coronary artery disease to have different degrees of blockages in different arteries.

    A heart attack has left a fixed defect in one area of the heart, but there is a reversible defect in another area of the heart due to a less severe blockage.

    Communicate/interact well with your doctor(s).

    Take care,


    WebMD member (since 8/99)

    James Beckerman, MD, FACC responded:
    Seems to be good news!

    The heart is squeezing vigorously. The blood flow to the heart muscle appears to be within normal limits overall.

    I definitely recommend you discuss the findings with your doctor too!

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