Fig. 2

Stress perfusion-CMR in a permanent pacemaker dependent (PPM) patient. A 74-year-old man was referred to stress perfusion CMR due to exertional dyspnea and angor. A double chamber PPM was implanted for a 2-degree atrioventricular block and the patient was PPM-dependent (Panel A). X-ray coronary angiography showed a severe stenosis of the proximal portion of the left anterior descending artery (Panel B, C, yellow arrowed) that was treated by drug-eluting stent implantation. Stress perfusion CMR, performed before x.ray coronary angiography showed an extensive hypoperfusion in the anterior and septal wall (Panel D–G, red arrowed) without the presence of myocardial scar in late gadolinium (LGE) images (Panel H, I, L, M) indicating a positive stress test, consistent with the lesion found in x-ray coronary angiography