{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T14:41:40Z","timestamp":1761748900773,"version":"build-2065373602"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100030938","name":"ACGME","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100030938","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Myocardial perfusion imaging (MPI) stress testing using technetium sestamibi is a non-invasive tool for diagnosing and risk-stratifying patients with coronary artery disease. Despite its utility, MPI stress testing exhibits various limitations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 80-year-old male presented with severe non-radiating exertional epigastric pain. Four months earlier, an MPI test was low risk with no significant perfusion defect. High-sensitivity cardiac troponins peaked at 97\u2005ng\/L with a delta value of 25. Left cardiac catheterization revealed a 99% calcified stenosis in the left main coronary artery. The patient underwent emergent coronary artery bypass grafting for refractory angina.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A critical left main coronary artery stenosis occurred despite a recent negative stress MPI. False-negative MPI can occur with balanced ischaemia in multi-vessel and left main coronary artery disease. This case underscores the importance of cautiously interpreting MPI results in intermediate\/high-risk patients to identify balanced ischaemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf519","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T12:08:57Z","timestamp":1759925337000},"source":"Crossref","is-referenced-by-count":0,"title":["Left main coronary artery stenosis presenting with negative myocardial perfusion imaging: a case report of balanced ischaemia"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2723-3456","authenticated-orcid":false,"given":"Walter Y","family":"Agyeman","sequence":"first","affiliation":[{"name":"Internal Medicine Program, Piedmont Athens Regional , 1270 Prince Avenue #102, Athens, GA 30606 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saint-Martin","family":"Allihien","sequence":"additional","affiliation":[{"name":"Internal Medicine Program, Piedmont Athens Regional , 1270 Prince Avenue #102, Athens, GA 30606 , USA"},{"name":"Texas A&M University Naresh K. Vashisht College of Medicine, Bryan, Tx 77807 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick O","family":"Berchie","sequence":"additional","affiliation":[{"name":"Internal Medicine Program, Piedmont Athens Regional , 1270 Prince Avenue #102, Athens, GA 30606 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Kumi","sequence":"additional","affiliation":[{"name":"Internal Medicine Program, Piedmont Athens Regional , 1270 Prince Avenue #102, Athens, GA 30606 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Chinnatambi","sequence":"additional","affiliation":[{"name":"Internal Medicine Program, Piedmont Athens Regional , 1270 Prince Avenue #102, Athens, GA 30606 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"2025102910063616500_ytaf519-B1","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s12350-013-9837-5","article-title":"Prevalence, location, and extent of significant coronary artery disease in patients with normal myocardial perfusion imaging","volume":"21","author":"Yokota","year":"2014","journal-title":"J Nucl Cardiol"},{"key":"2025102910063616500_ytaf519-B2","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.nuclcard.2007.05.008","article-title":"Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease","volume":"14","author":"Berman","year":"2007","journal-title":"J Nucl Cardiol"},{"key":"2025102910063616500_ytaf519-B3","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur Heart J"},{"key":"2025102910063616500_ytaf519-B4","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1161\/CIR.0000000000001168","article-title":"2023 AHA\/ACC\/ACCP\/ASPC\/NLA\/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association\/American College of Cardiology joint committee on clinical practice guidelines","volume":"148","author":"Virani","year":"2023","journal-title":"Circulation"},{"key":"2025102910063616500_ytaf519-B5","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1161\/CIRCOUTCOMES.114.001384","article-title":"The HEART pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge","volume":"8","author":"Mahler","year":"2015","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2025102910063616500_ytaf519-B6","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1136\/bmj.38985.646481.55","article-title":"Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)","volume":"333","author":"Fox","year":"2006","journal-title":"BMJ"},{"key":"2025102910063616500_ytaf519-B7","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1111\/echo.14127","article-title":"Coronary \u201cbalanced ischemia\u201d with false negative regadenoson technetium Tc99\u2005m sestamibi stress test subsequently diagnosed by FFRCT","volume":"35","author":"Turner","year":"2018","journal-title":"Echocardiography"},{"key":"2025102910063616500_ytaf519-B8","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1001\/jama.284.7.835","article-title":"The TIMI risk score for unstable angina\/non-ST elevation MI: a method for prognostication and therapeutic decision making","volume":"284","author":"Antman","year":"2000","journal-title":"JAMA"},{"key":"2025102910063616500_ytaf519-B9","first-page":"193","article-title":"Artifacts and pitfalls in myocardial perfusion imaging","volume":"34","author":"Burrell","year":"2006","journal-title":"J Nucl Med Technol"},{"key":"2025102910063616500_ytaf519-B10","first-page":"e53789","article-title":"Multivessel coronary artery disease presenting as a false-negative nuclear stress test: a case of balanced ischemia","volume":"16","author":"Santos Argueta","year":"2024","journal-title":"Cureus"},{"key":"2025102910063616500_ytaf519-B11","first-page":"e11321","article-title":"Multi vessel coronary artery disease presenting as a false negative myocardial perfusion imaging and true positive exercise tolerance test: a case of balanced ischemia","volume":"12","author":"Baqi","year":"2020","journal-title":"Cureus"},{"key":"2025102910063616500_ytaf519-B12","doi-asserted-by":"crossref","first-page":"101836","DOI":"10.1016\/j.nuclcard.2024.101836","article-title":"Prevalence of balanced ischemia on positron emission tomography relative perfusion imaging among patients with high-risk coronary artery disease","volume":"34","author":"Patel","year":"2024","journal-title":"J Nucl Cardiol"},{"key":"2025102910063616500_ytaf519-B13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijcard.2021.06.012","article-title":"Extensive and balanced reduction of myocardial blood flow in patients with suspected obstructive coronary artery disease: 15O-water PET study","volume":"338","author":"Maaniitty","year":"2021","journal-title":"Int J Cardiol"},{"key":"2025102910063616500_ytaf519-B14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jacc.2018.10.056","article-title":"Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis","volume":"73","author":"Driessen","year":"2019","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytaf519\/64582689\/ytaf519.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/10\/ytaf519\/64582689\/ytaf519.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/10\/ytaf519\/64582689\/ytaf519.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T14:06:44Z","timestamp":1761746804000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf519\/8280096"}},"subtitle":[],"editor":[{"given":"Nidhi","family":"Madan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Dmitry","family":"Duplyakov","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":14,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf519","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,10,1]]},"article-number":"ytaf519"}}