Document Type

Conference Proceeding

Publication Date

5-1-2026

Abstract

Background: ACC/AHA guidelines provide class 1 and 2A recommendations respectively for coronary CTA and FFRCT in patients with chest pain and intermediate risk of CAD. We present a case in which novel applications of CTA excluded obstructive CAD, identified the correct diagnosis, and allowed optimization of medical therapy. Case: In a 72-year-old male with stable angina and HEART score 6, stress ECG was positive for angina and frequent PVCs (Fig 1A). Coronary CTA (Fig 1B) and FFRCCT (Fig 1C) showed non-obstructive CAD and intramyocardial bridging/severe systolic compression in the mid-LAD (Fig 1D). AI plaque analysis demonstrated a mixed plaque burden of 561 mm3 (Fig 1E). Symptoms and ECG changes were attributed to LAD systolic compression, managed with metoprolol. The high plaque burden was managed with rosuvastatin, ezetimibe, and possible PCSK9 inhibitor. Chest pain resolved on follow-up. Discussion: This case highlights the utility of coronary CTA for the evaluation of intermediate-risk chest pain. Systolicphase imaging allowed identification of myocardial bridging/systolic compression; CTA and FFRCT excluded obstructive CAD; and plaque analysis provided critical insight into the atherosclerotic burden and cardiovascular risk. Conclusion: Coronary CTA and CT-FFR are useful to exclude obstructive CAD. Novel applications of CTA include assessment of plaque burden and non-atherosclerotic causes of myocardial ischemia, to optimize medical therapy and reduce unnecessary procedures.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2026 Resident and Medical Student Day, May 1, 2026, Troy, MI

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