Abstract
Objective The reverse redistribution (RR) pattern is a phenomenon whose etiology, pathophysiology,
and clinical implications are not well understood. The studies examining this pattern
date back to days when timely coronary interventions and anti-ischemic therapies were
not widely used, so we aimed to reinvestigate any relationship between RR and coronary
angiography (CA) findings in today's contemporary clinical settings.
Methods All patients with an RR pattern on the Tc99m-MIBI (technetium-99m sestamibi) scan
between 2021 and 2023 were screened. Information on demographics, history of acute
coronary syndrome, revascularization, comorbidities, and risk factors was collected.
The CA findings were compared to RR regions. The physician's decision in the case
of the RR pattern was grouped.
Results In a total of 67 patients (men 83%, aged 63.6 ± 10.5), the RR pattern was most commonly
seen in the inferior-posterior wall (n = 41, 31.3%), followed by the apex (n = 19, 14.5%) and anterior (n = 12, 9.2%). Most patients with RR pattern had normal/nonobstructive coronary angiograms
(61.1%, n = 22); significant stenoses in 1, 2, and 3 vessels were present in 19.4% (n = 7), 13.8% (n = 5), and 5.5% (n = 2) of patients, respectively. There was no correlation between the regions of the
RR pattern and significant stenosis detected on CA (p = 0.6, p = 0.5, p = 0.6, respectively, for left anterior descending artery, circumflex artery, and
right coronary artery).
Conclusion In this study, no evidence of a relationship between RR patterns and CA findings
was found. The 60% of the patients with RR pattern had normal/nonobstructive coronaries,
so the decision to proceed with CA should not be made based solely on this finding.
Keywords
coronary angiography - myocardial perfusion imaging - myocardial scintigraphy - reverse
redistribution - technetium Tc 99m sestamibi
