Normal myocardial perfusion despite a very high coronary calcium score
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, Guanajuato, Mexico Cardiac Electrophysiology Department, Hospital Aranda de la Parra, Leo ´ n, Guanajuato, Mexico School of Medicine, Universidad de Guanajuato, Leo ´ dica Campestre, Leo ´ n, Guanajuato, Mexico Imaging Department, Hospital Me ´ n sanitaria 2, Lagos de Moreno, Jalisco, Mexico Cardiovascular Risk Department, Jurisdiccio Department of Nuclear Cardiology and Cardiac CT, Cardimax Research Center, Hospital Siena ´ n, Guanajuato, Me ´ xico del Moral, Leo
Received Aug 21, 2020; accepted Aug 21, 2020 doi:10.1007/s12350-020-02357-0
An exceptionally high coronary calcium score, greater than 10,000 UA, superior to any other found in the literature reviewed, was reported in an asymptomatic, adult man with hypertension, obesity and dyslipidemia, without myocardial ischemia and no significative coronary stenosis, associated to Glagov’s phenomenon in the left coronary artery and an abdominal aortic aneurysm. Key Words: Physiology of myocardial/coronary perfusion Æ CAD Æ atherosclerosis Æ CT Æ gated SPECT Æ cost-effectiveness During a pre-operative cardiovascular evaluation of elective orthopedic knee surgery in an asymptomatic, 71 years old, Hispanic man, 50 7 tall, 200 pounds of weight, a coronary artery calcium scan (CAC) showed a very high Agatston score (AS) of 10,461.42 (CAC-DRS A3/ N4). The patient had obesity, mild hypertension and untreated dyslipidemia, with total cholesterol of 337, triglycerides of 582, HDL of 46, LDL of 174.6 and VLDL of 116.4 mgdL-1 with no other comorbidities. Due to the high absolute maximum AS reported we decided to measure a second CAC in a different CT scanner; the second value obtained was 10,775 (Table 1); the scanners used to perform the test were a
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02357-0) contains supplementary material, which is available to authorized users. Reprint requests: Andre´s Preciado-Anaya, PhD, Department of Nuclear Cardiology and Cardiac CT, Cardimax Research Center, Hospital Siena del Moral, Compuerta 204, Col. Jardines del Moral, 37160 Leo´n, Guanajuato, Me´xico; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
GE Lightspeed VCT and a Brilliance Phillips CT, both of 64 detectors; the AS were acquired by two experienced technicians using prospective ECG gating at 75% of the R-R Interval; scan range carina to cardiac apex, a 2.5-mm slice thickness, 120 kV peak tube voltage, 200 mA, tube current per rotation, and a field-of-view of 250 9 250 mm. The AS were processed using the original software and workstation in each CT scanner, by a radiologist and a cardiologist experts in cardiovascular computed tomography. Additionally, an OsirixTM DICOM viewer was used to obtain the video 1, where severely calcified coronaries are shown. Figure 1 shows the left anterior descending (LAD), left circumflex (LCx) and the right coronary (RCA) arteries in curved views in which the extense calcification of the epicardial coronary vessels can be se
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