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 48 – Case 12 - Electrocardiogram showing prolonged ischemic alterations during the late recovery phase. flow reserve (CFR), associated with non-obstructive CAD, the risk of cardiovascular events is significantly higher, and it is similar to that of individuals who have obstructive CAD, but who are not indicated for revascularization. 259 Thus, as the prevalence of obstructive CAD is lower in women, angio- CT has been growing as a preferential diagnostic method for ruling out obstructive CAD in patients with intermediate probability, especially when there are limits to the physical exercise test. 260 In the case in question, the combination of functional (ischemia) and anatomical (non-obstructive CAD) data was essential to the diagnosis of endothelial dysfunction and to guiding therapeutic management. 12. Abnormal ET characterized as intermediate-risk and abnormal MPS with high-risk indicators Clinical history: male, age 69, with precordial pain during greater efforts for 4 months. Hypertensive, ex-smoker, referred for MPS due to altered ET, with intermediate Duke score. Findings: patient exercised for 9.5 minutes in the Bruce protocol, reporting non-limiting anginal pain during peak exercise, with descending ST-segment depression of 1.0 mm, measured at the J point, in multiple leads, with prolonged duration, during the recovery phase (Duke score = +0.5) (Figure 48). Perfusion imaging showed transient reduced 388