Fig. 4

CMR imaging in a primary prevention ICD patient with biventricular stimulation (male, 82 years) presenting with progressive dyspnea and chest pain 46 months after device implantation. A, adenosine stress CMR dynamic perfusion imaging (three slices in short-axis geometry) demonstrated inducible ischemia(white arrows) in the anterior/anteroseptal segments (apical and medial slice). B, wideband LGE (identical scan geometries) proved the absence of ischemic scar or myocardial fibrosis. C, corresponding invasive coronary angiography revealed eccentric high-grade stenosis of medial left anterior descending artery (black arrow). Approximate generator position is indicated by the asterisk