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By Schoenhagen, MD, FAHA, Paul

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Additional info for Cardiac CT Made Easy: An Introduction to Cardiovascular Multidetector Computed Tomography, Second Edition

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Figure 39 shows corresponding images of the nuclear stress test. Apical ischemia, corresponding to the LAD lesions, is documented. qxp 11/8/2006 8:49 PM Page 31 CLINICAL CARDIOVASCULAR APPLICATIONS 31 Case 5 A patient with equivocal stress test results and suspected atherosclerotic disease of the left main coronary artery was referred for further evaluation. The cardiac CT (right upper panel) shows ostial narrowing with suspected atherosclerotic plaque accumulation. Cardiac catheterization (left upper panel) confirmed ostial stenosis of the left main coronary artery.

Despite limited prospective data about the incremental value of calcium scores over ‘traditional’ multivariate risk-assessment models, the 2000 American Heart Association/American College of Cardiology (AHA/ACC) consensus statements concluded that calcium screening may be justified in selected patient groups with intermediate risk88. This hypothesis has been supported by data from recently published studies89–91. Contrast-enhanced CTA for plaque imaging Coronary calcium scores identify calcified plaque but significantly underestimate total atherosclerotic plaque burden (calcified and non-calcified plaque)81,82.

In patients with Ebstein’s anomaly, the displacement of the tricuspid valve towards the right ventricle can be seen (Figure 99). Reliable assessment of vegetations remains a strength of echocardiography19. However, thickening of the valve leaflets and tissue adjacent to the valves can be assessed (Case 17: Figures 100 and 101).

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