Figure 1

Discordance between left ventricular wall motion abnormalities and perfusion defects indicative of inducible myocardial ischemia. Cine white blood imaging end-diastolic (left panel) and end-systolic (middle panel) frames from slice position acquired in the middle of the left ventricle at peak dobutamine and atropine infusion administered to achieve >80% of the maximum predicted heart rate response for age. The white arrows indicate normal wall motion of the posterior and lateral wall segments. However, in the right panel, a first pass gadolinium enhanced perfusion image also acquired at peak stress is displayed. The yellow arrows indicate a hypoperfused region of the LV myocardium consistent with inducible ischemia. This participant underwent contrast coronary angiography which demonstrated a >70% stenosis of the saphenous vein graft to the right coronary artery.