Role of CT Angiography in Detection Left Main disease in Asymptomatic Patients

• Male patient, 50 years old, Mediterranean background, not diabetic, not hypertensive, nor hyperlipidemic, no significant medical history and takes no medications. He does not use tobacco, alcohol, or illicit drugs. No family history of medical disease.
• The patient has very mild occasional chest discomfort that’s not related to activities and has no precipitating factors. No dyspnea, no orthopnea.
• On physical examination: Temperature is 37c (99.5F) Blood pressure 120/80 mm, pulse is 90/m and respiration are 16/min. On Auscultation no heart sounds, no murmurs, The Lungs are clear. There is no peripheral edema.
• Electrocardiogram shows no significant changes. Echo shows Ejection fraction 56%, No resting wall motion abnormalities.

C.T Coronary angiography Findings

Left main coronary artery (L.M): is an average caliber atherosclerotic vessel showing an ostial non calcified plaque causing critical lumen narrowing; the LM is seen originating normally from the left coronary cusp, it ends by bifurcating into LAD and LCX. Left anterior descending coronary artery (LAD): is an average caliber atherosclerotic long vessel showing several noncalcified plaques throughout its course with no significant stenoses. It gives origin to three average caliber normal diagonals; the LAD ends by wrapping around the apex. Left circumflex coronary artery (LCX): is an average caliber non-dominant atherosclerotic vessel, giving origin to an average caliber long OM branch then the LCX continues as a small caliber vessel, the LCX and its OM branch are free of significant lesions. Right coronary artery (RCA): is a dominant average caliber atherosclerotic vessel, it gives origin to a small conal and RV branches and ends by bifurcating into average caliber PDA and PLB; the RCA and its branches show several nonocclusive plaques. Coronary Impression: Atherosclerotic CAD. Critical ostial LM stenosis with no other significant lesions.

C.T coronary calcium score report

(Table 1) This is the total amalgamation of a calcium score of 37 in the left main coronary artery, 8 in the right coronary artery, 0 in the left anterior descending coronary artery, 0 in the circumflex artery and 0 in the posterior descending artery.

Table 1: Calcium Plaque Burden.

Total calcium score of 53 is between the 50th and 75th percentile for men between the ages of 55 and 59

This means that 50 percent of people this age and gender had less calcium than was detected in this study. The following graph shows the distribution of total calcium scores for each age group by percentiles. Your calcium score, relative to other age groups, is indicated by the highlighted square in the graph (Figure 1). [1] Callister TQ et. al., Coronary Artery Calcium Scores on Electron Beam Computed Tomography: JACC 1999. 33 (Supl.): 415A [1,2].

(Table 2) [2] Mayo Clinic Proceedings, March 1999, Vol. 74. Findings based on EBCT data. [3] Carr JJ, et. al., Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Electron Beam CT.; AJR 2000; 174: 915- 921

Table 2:

CT Cardiac Functional Analysis Report

Table 3:

(Table 3) Normal left ventricular systolic function with no resting SWMA. There are no calcifications within mitral and aortic annuli, including valves. There is no pericardial or pleural effusion. There is no aneurysm or dissection of the thoracic aorta [3,4]. Impression: Atherosclerotic CAD. Critical ostial LM stenosis with no other significant lesions.

• Calcium Score is calculated to be 53 by Agatston Score. Normal LV EF (56%) with no resting SWMA’s (Figures 2-8).

C.T angiography is having a good diagnostic value in detection of the left Main coronary artery disease.

None.

No Conflict of Interest.

1. Callister TQ (1999) Coronary Artery Calcium Scores on Electron Beam Computed Tomography. JACC 33 (Supl): 415A.
2. Mayo Clinic Proceedings (1999) Findings based on EBCT data. 74
3. Carr JJ, JR Crouse, DC Goff, RBD Agostino, NP Peterson, et al. (2000) Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Electron Beam CT. AJR 174(4): 915-921.
4. Jagt Narula, Y Chandrashekhar, Amir Ahmadi, Suhny Abbara, Daniel S Berman, et al. (2021) SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A report of the Scoiety of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr15(3): 192-217.