Predicting heart attack in a patient post-radiation therapy using plaque CCTA analysis and serum biomarker test. Case report

• Authors: Hassan Tariq , Shetal Amin , Millee Singh , Cesar Alberto Morales-Pabon , Kristina Vanessa Cahill , Eric Edward Harrison
• Languages of publication: EN

Abstracts

EN

Accelerated coronary artery disease (CAD) is a long term manifestation of chest irradiation that may progress to acute myocardial infarction (MI). We report the use of an algorithm-based biomarker test and coronary computed tomography angiography (CCTA) to identify accelerated CAD in a patient treated with chest irradiation and combination chemotherapy for non-Hodgkin’s lymphoma (NHL). Using a seven protein biomarker test with four incorporated clinical factors, we identified the patient had a 6 fold higher risk for future MI than expected for individuals at his age. Using CCTA, we characterized his plaques based on the following parameters: percent diameter stenosis (ranging from 30–70), percent area stenosis, percent necrotic core (NC), percent fibrotic core (FC), percent calcium core (CC), FC thickness, percent vessel wall to lumen, and NC to FC ratio. We identified a plaque in his left circumflex (LCX) with moderate percent diameter stenosis, high percent NC, low percent FC, absent FC thickness, high percent vessel wall to lumen ratio, and high NC to FC ratio as the most vulnerable to rupture and cause MI. The patient was educated about his risk of a future MI and started on maximum medical therapy. Nevertheless, he experienced a ST elevation MI (STEMI) in 185 days with occlusion at the vulnerable plaque site of his LCX. The recognition of a vulnerable plaque in a vulnerable patient may necessitate prophylactic stenting in vessels without severe obstruction. The serum biomarker test and CCTA plaque analysis may detect these patients in need of aggressive therapy.

Keywords

EN

cardiac biomarkers; chest irradiation; coronary artery disease; coronary computed tomography angiography; myocardial infarction risk assessment; plaque characterization

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Education
• Journal: OncoReview
• Year: 2014
• Volume: 4
• Issue: 2
• Pages: A54-61

Contributors

author

Hassan Tariq

• Saba University School of Medicine, Devens, MA, US

author

Shetal Amin

• Meharry Medical College, Nashville, TN, US

author

Millee Singh

• Cardiology, Tampa Bay Heart Institute, Northside Hospital, St. Petersburg, FL, US

author

Cesar Alberto Morales-Pabon

• Cardiology, Morsani School of Medicine, University of South Florida, Tampa, FL, US

author

Kristina Vanessa Cahill

• Cardiology, Morsani School of Medicine, University of South Florida, Tampa, FL, US

author

Eric Edward Harrison

• Cardiology, Morsani School of Medicine, University of South Florida, Tampa, FL, US

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• Document Type: report