Welcome to Touch Briefings

Samuel Wann
American heart Hospital Journal Volume 7 No.1

A50-year-old asymptomatic physician referred himself for coronary computed tomography angiography (CTA) because of an elevated lowdensity lipoprotein (LDL) of 120. His high-density lipoprotein (HDL) was 42. Triglycerides, high-sensitivity C-reactive protein (hsCRP), glucose, and vitamin D levels were normal. He exercised regularly on an elliptical trainer without chest pain or unusual shortness of breath. He had never smoked. His body mass index (BMI) was normal. His father died of an acute myocardial infarction at 50 years of age. CT showed no coronary calcium. Coronary CTA was entirely normal except for the presence of an area of apparent non-calcified plaquein the mid-left anterior descending coronary (see Figure 1). The lesion was seen on images constructed at several different phases of the cardiac cycle. Curved re-formatted images (see Figure 2) confirmed the presence of a lesion primarily in the wall of the vessel, with only moderate impingement on the coronary lumen. Reconstructed 'virtual intravascular ultrasound (IVUS)' views (see Figure 3) showed mild to moderate reduction in cross-sectional area in the region of the lesion, again showing most of the abnormality to be confined to the vessel wall, with moderate but definite luminal narrowing. The patient was treated with a statin, niacin, and aspirin. He did not undergo further testing and remains asymptomatic 18 months later. His current LDL is 68, and his HDL is 48.

View Article here