[Totally asymptomatic coronary left main artery critical stenosis: when non-invasive tests are falsely reassuring]

Abstract

Left main coronary artery severe stenosis is frequently very symptomatic and is considered as a classical contraindication for non-invasive ischemia testing. When performed, those tests usually yield a large area of ischemia associated with a rich symptomatology. We report the case of a 69-year-old completely asymptomatic man in whom both treadmill effort testing and dobutamine stress echocardiography were falsely reassuring as they eliminated significant ischemia despite the presence of a critical stenosis of distal left main artery ultimately confirmed by angiography. Dobutamine 2D strain performed afterwards was pathological and could have corrected the initially reassuring diagnosis.

Keywords: Angiography; Coronarographie; Left main stenosis; Stress dobutamine ecography; Sténose du tronc commun; Écocardiographie de stress à la dobutamine.