Case 2

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Case 2

  1. 1. <ul><li>74y/M, lung ca s/p OP </li></ul><ul><li>H/T(+), DM(-), Hyperlipidemia(-); Smoking(-); Family History(-) </li></ul><ul><li>No chest tightness </li></ul><ul><li>Undergoing 64-slice cardiac CT for CAD screening based on long-term H/T and old age </li></ul>
  2. 2. CAC:161
  3. 3. Calcifications at RCA with score 161, at LAD with score 466 and at LCX with score 195, and sum of them, with total score of 822. CAC:195 CAC:466
  4. 4. more than 70% stenosis more than 70% stenosis more than 50% stenosis less than 50% stenosis 50%~70% stenosis more than 70% stenosis
  5. 5. more than 70% stenosis 50%~70% stenosis 50%~70% stenosis less than 50% stenosis less than 30% stenosis
  6. 6. Questions ? <ul><li>Should the patient directly referred for invasive coronary angiography (ICA) ? </li></ul>
  7. 7. <ul><li>For risk stratification and evaluating the benefit from PCI, the patient was referred for stress/redist Tl-201 SPECT. </li></ul><ul><li>No significant discomfort are noted during persantine stress. </li></ul><ul><li>BP(basal->peak): 119/77 -> 93/68; HR: 59 -> 75 </li></ul>
  8. 8. Stress/Rest Perfusion Images No ischemia; Mild fixed defect in inferior wall; TID(-)
  9. 11. No ischemic stunning
  10. 12. Stress Perfusion
  11. 13. 3-D fusion of CTA/MPI
  12. 15. Discussion <ul><li>No ischemia, No TID, High post-stress EF, No stunning </li></ul><ul><li>Optimal medical therapy is considered first for this patient. </li></ul><ul><li>Why is the CTA and MPI discordant? </li></ul>
  13. 16. Predictive value of CTA for ischemia as defined by SPECT or PET Dorbala et al. JACC;2006:2515–7. (Editorial comment)

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