ABC | Volume 114, Nº2, February 2020

Update Update of the Brazilian Guideline on Nuclear Cardiology – 2020 Arq Bras Cardiol. 2020; 114(2):325-429 Figure 44 – Case 10 - Myocardial perfusion scintigraphy with homogenous radiopharmaceutical distribution throughout the walls of the left ventricle, considered within the limits of normal. Images acquired with dedicated cardiac equipment (gamma camera), equipped with conventional sodium iodide crystals. Reproduced with the permission of Vitola JV. 234 quantifies degree of obstruction and determines the presence and extent of non-calcified atherosclerosis, adds incremental prognostic value. 256 In this specific case, the presence of non-obstructive atherosclerosis, even with normal perfusion, denotes worse prognosis than in patients with normal perfusion and the absence of atherosclerosis. 257 Moreover, the presence of atherosclerosis in multiple segments, as in the present case, confers a prognosis similar to that of uniarterial obstructive CAD. 250 In conclusion, clinical translation of such findings could be resumed in the following manner: there are no indications that the ET alterations are secondary to ischemia, and there are thus no accrued benefits to coronary intervention, whether percutaneous or surgical revascularization. Orientation should be toward aggressive treatment of atherosclerosis to reach lipid goals recommended in current guidelines, in addition to strict control of other modifiable risk factors. The patient’s current profile confers medium- and long-term prognosis similar to that of a patient with obstructive CAD in a single coronary artery. 385