J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 8 ( 2 0 1 4 ) 3 2 8 e3 3 0
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Coronary vasospasm during CT angiography Takehiro Nakahara MD, PhDa,*, Takuji Toyama MDb, Yoshito Tsushima MD, PhDc, Masahiko Kurabayashi MD, PhDa a Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan b Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan c Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
article info
abstract
Article history:
A 71-year-old man, a heavy smoker, was admitted for evaluation of “chest oppression”
Received 12 May 2014
after every dinner. Cardiac CT with a beta-blocker showed coronary stenosis in the left
Received in revised form
circumflex. Although adenosine triphosphateestress perfusion single-photon emission CT
31 May 2014
revealed no ischemia, Holter electrocardiography belatedly indicated an ST elevation
Accepted 8 June 2014
associated with his symptoms while smoking. He was diagnosed to have vasospastic
Available online 17 June 2014
angina. Cardiac CT without a beta-blocker showed thin diffuse plaque and negative remolding without any significant stenosis at the same site. Asian patients have a ten-
Keywords:
dency to develop vasospastic angina. Although beta-blockers are recommended for cardiac
Cardiac CT
CT, the routine administration of beta-blockers in cardiac CT may have some risk for
Routine use
such cases.
Beta-blockers
ª 2014 Society of Cardiovascular Computed Tomography. All rights reserved.
Asian patients Vasospastic angina Landiolol
A 71-year-old man, who had been a heavy smoker (100 cigarettes per day) for 50 years, was admitted for evaluation of “chest oppression” after every dinner. He underwent Holter electrocardiography and cardiac CT to evaluate atypical chest pain with an intermediate risk.1 The dual-source CT (Somatom Definition Flash; Siemens, Forchheim, Germany) with a very-shorteacting beta-blocker (landiolol; Tmax, 3.7 minutes; T1/2, 5 minutes) and sublingual nitroglycerin showed coronary stenosis in the left circumflex (Fig. 1AeC). His blood
pressure temporarily decreased to 95/46 mm Hg during the test; however, it recovered to 110/54 mm Hg within a few minutes. He reduced smoking to 30 cigarettes per day and thereafter noticed “chest oppression” around 9 PM while smoking. Holter electrocardiography belatedly indicated an ST elevation associated with his symptoms while smoking (Fig. 2), and adenosine triphosphateestress perfusion singlephoton emission CT revealed no ischemia. He was diagnosed to have vasospastic angina.2 He refused catheter
Conflicts of interest: The authors report no conflicts of interest. * Corresponding author. E-mail address: [email protected] (T. Nakahara). 1934-5925/$ e see front matter ª 2014 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2014.06.005
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 8 ( 2 0 1 4 ) 3 2 8 e3 3 0
329
Fig. 1 e (AeC) The result of cardiac CT with a beta-blocker. (A) Angiographic view (AG view), (B) curved multiplanar reformation (CPR), (C) stretched CPR. These panels showed regional significant coronary stenosis in the left circumflex (LCx) (arrows). (DeF) The result of cardiac CT without a beta-blocker. (D) Angiographic view, (E) curved CPR, (F) stretched CPR. These panels showed thin diffuse plaque and negative remodeling without any significant stenosis at the same region (striped arrows).
angiography and stopped smoking, and his symptoms completely disappeared with medication. Cardiac CT without a beta-blocker showed thin diffuse plaque and negative remolding without any significant stenosis at the same site (Fig. 1DeF). Because beta-blockers can worsen vasospasm, one of the possible explanations was that his vasospasm during the first examination may have been provoked by the
beta-blocker. However, he did not show any critical problems, because landiolol’s effect subsides immediately. Asian patients have a tendency to develop vasospastic angina.3 Although beta-blockers are recommended for cardiac CT to optimize the image quality,4 the routine administration of beta-blockers in cardiac CT may have some risk for such cases.
Fig. 2 e Holter electrocardiography showed ST elevation (arrows) with symptom while smoking.
330
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 8 ( 2 0 1 4 ) 3 2 8 e3 3 0
references
1. Taylor AJ, Cerqueira M, Hodgson JM, et al; American College of Cardiology Foundation Appropriate Use Criteria Task Force; Society of Cardiovascular Computed Tomography; American College of Radiology; American Heart Association; American Society of Echocardiography; American Society of Nuclear Cardiology; North American Society for Cardiovascular Imaging; Society for Cardiovascular Angiography and Interventions; Society for Cardiovascular Magnetic Resonance. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American
Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr. 2010;4(6):407.e1e407.e33. 2. JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008): digest version. Circ J. 2010;74:1745e1762. 3. Sasayama S. Heart disease in Asia. Circulation. 2008;118:2669e2671. 4. Abbara S, Arbab-Zadeh A, Callister TQ, et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2009;3(3):190e204.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Coronary vasospasm during CT angiography Takehiro Nakahara MD, PhDa,*, Takuji Toyama MDb, Yoshito Tsushima MD, PhDc, Masahiko Kurabayashi MD, PhDa a Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan b Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan c Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
article info
abstract
Article history:
A 71-year-old man, a heavy smoker, was admitted for evaluation of “chest oppression”
Received 12 May 2014
after every dinner. Cardiac CT with a beta-blocker showed coronary stenosis in the left
Received in revised form
circumflex. Although adenosine triphosphateestress perfusion single-photon emission CT
31 May 2014
revealed no ischemia, Holter electrocardiography belatedly indicated an ST elevation
Accepted 8 June 2014
associated with his symptoms while smoking. He was diagnosed to have vasospastic
Available online 17 June 2014
angina. Cardiac CT without a beta-blocker showed thin diffuse plaque and negative remolding without any significant stenosis at the same site. Asian patients have a ten-
Keywords:
dency to develop vasospastic angina. Although beta-blockers are recommended for cardiac
Cardiac CT
CT, the routine administration of beta-blockers in cardiac CT may have some risk for
Routine use
such cases.
Beta-blockers
ª 2014 Society of Cardiovascular Computed Tomography. All rights reserved.
Asian patients Vasospastic angina Landiolol
A 71-year-old man, who had been a heavy smoker (100 cigarettes per day) for 50 years, was admitted for evaluation of “chest oppression” after every dinner. He underwent Holter electrocardiography and cardiac CT to evaluate atypical chest pain with an intermediate risk.1 The dual-source CT (Somatom Definition Flash; Siemens, Forchheim, Germany) with a very-shorteacting beta-blocker (landiolol; Tmax, 3.7 minutes; T1/2, 5 minutes) and sublingual nitroglycerin showed coronary stenosis in the left circumflex (Fig. 1AeC). His blood
pressure temporarily decreased to 95/46 mm Hg during the test; however, it recovered to 110/54 mm Hg within a few minutes. He reduced smoking to 30 cigarettes per day and thereafter noticed “chest oppression” around 9 PM while smoking. Holter electrocardiography belatedly indicated an ST elevation associated with his symptoms while smoking (Fig. 2), and adenosine triphosphateestress perfusion singlephoton emission CT revealed no ischemia. He was diagnosed to have vasospastic angina.2 He refused catheter
Conflicts of interest: The authors report no conflicts of interest. * Corresponding author. E-mail address: [email protected] (T. Nakahara). 1934-5925/$ e see front matter ª 2014 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2014.06.005
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 8 ( 2 0 1 4 ) 3 2 8 e3 3 0
329
Fig. 1 e (AeC) The result of cardiac CT with a beta-blocker. (A) Angiographic view (AG view), (B) curved multiplanar reformation (CPR), (C) stretched CPR. These panels showed regional significant coronary stenosis in the left circumflex (LCx) (arrows). (DeF) The result of cardiac CT without a beta-blocker. (D) Angiographic view, (E) curved CPR, (F) stretched CPR. These panels showed thin diffuse plaque and negative remodeling without any significant stenosis at the same region (striped arrows).
angiography and stopped smoking, and his symptoms completely disappeared with medication. Cardiac CT without a beta-blocker showed thin diffuse plaque and negative remolding without any significant stenosis at the same site (Fig. 1DeF). Because beta-blockers can worsen vasospasm, one of the possible explanations was that his vasospasm during the first examination may have been provoked by the
beta-blocker. However, he did not show any critical problems, because landiolol’s effect subsides immediately. Asian patients have a tendency to develop vasospastic angina.3 Although beta-blockers are recommended for cardiac CT to optimize the image quality,4 the routine administration of beta-blockers in cardiac CT may have some risk for such cases.
Fig. 2 e Holter electrocardiography showed ST elevation (arrows) with symptom while smoking.
330
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 8 ( 2 0 1 4 ) 3 2 8 e3 3 0
references
1. Taylor AJ, Cerqueira M, Hodgson JM, et al; American College of Cardiology Foundation Appropriate Use Criteria Task Force; Society of Cardiovascular Computed Tomography; American College of Radiology; American Heart Association; American Society of Echocardiography; American Society of Nuclear Cardiology; North American Society for Cardiovascular Imaging; Society for Cardiovascular Angiography and Interventions; Society for Cardiovascular Magnetic Resonance. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American
Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr. 2010;4(6):407.e1e407.e33. 2. JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008): digest version. Circ J. 2010;74:1745e1762. 3. Sasayama S. Heart disease in Asia. Circulation. 2008;118:2669e2671. 4. Abbara S, Arbab-Zadeh A, Callister TQ, et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2009;3(3):190e204.
