Multimodality imaging of a patient with single coronary artery: CTA, FFRCT, SPECT, and beyond
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Houston Methodist Debakey Heart & Vascular Center, Houston, TX Weill Cornell Medical College, New York
Received Sep 1, 2020; accepted Sep 2, 2020 doi:10.1007/s12350-020-02370-3
INTRODUCTION There are multiple investigations the clinician’s toolbox to assess for myocardial ischemia. In some cases, multiple modalities are needed to delineate the exact cause of chest pain. CT-based fractional flow reserve (CT-FFR)1 is a new tool that has not been evaluated in patients with anomalous coronaries such as single coronary artery (SCA), a rare finding with incidence of 0.024%-0.066%2,3. We present a case single coronary artery presenting with myocardial infarction documented with both CT-FFR and nuclear imaging. CASE HISTORY The patient is a 78-year-old male with past medical history significant for poorly controlled type II diabetes with diabetic retinopathy, chronic kidney disease and essential hypertension. He presented with chest pain of
Reprint requests: Mouaz H. Al-Mallah, MD, MSc, Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
2-days duration. Labs were significant for elevated troponin and ECG showed sinus rhythm with nonspecific T wave findings. Gated myocardial perfusion imaging with technetium-99m(Tc-99m) showed ischemia in the inferior and lateral wall as well as apex, with normal ejection fraction (Figure 1). Coronary angiography revealed single coronary artery arising from the right coronary cusp with significant atherosclerotic plaque and stenosis in the RCA (Figure 2). To better delineate the course of the LAD, Coronary CT Angiography was performed and confirmed an anterior course to the pulmonary artery (Figure 3). FFRCT confirmed ischemia in the RCA (Figure 4). The patient had rotational atherectomy and placement of a drug-eluting stent with near resolution of symptoms. He is currently on aggressive secondary prevention therapy. This case illustrates the complementary role of the different imaging modalities in the patient management.
Ahmed et al Multimodality imaging of a patient with single coronary artery: CTA, FFRCT, SPECT, and beyond
Journal of Nuclear CardiologyÒ
Figure 1. Gated myocardial perfusion imaging with technetium-99m(Tc-99m) showed severe ischemia of left ventricle and lateral wall as well as apex, with normal ejection fraction.
Figure 2. Coronary angiography showed a single origin of coronary artery from right coronary cusp with aneurysm (white arrowhead) at ostium and a significant stenosis (yellow arrowhead) in RCA.
Journal of Nuclear CardiologyÒ
Ahmed et al Multimodality imaging of a patient with single coronary artery: CTA, FFRCT, SPECT, and beyond
Figure 3. A Coronary CT Angiogram showed a single coronary artery originating from right coronary cusp. The left main coronary artery and left coronary ostium were not present. B RCA branch was heavily calcified with multiple significant sten
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