Figure 1

Ischemia by treadmill stress CMR in a 59-year-old male with known history of CAD with new onset chest pain. At peak exercise, no ST changes diagnostic of ischemia were present (panel A). No wall motion abnormalities were present on peak stress cines (panel B, end diastolic frame; panel C, end systolic frames in three slice positions). Delayed enhancement imaging did not show myocardial scar (panel D). There was LV septal wall perfusion abnormality extending from the base to the apex on CMR stress short axis slices (panel E) that was minimally present at rest (panel F). SPECT images also illustrated ischemia in the same region (panel G, stress; panel H, rest). Cardiac catheterization showed total occlusion of the septal branch of the LAD with collaterals from the RCA to the septal branch (panels I and J).