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    MPI + CTA in patient with atypical chest pain

    Teaching Case

    Case presentation:

    • Female.
    • 59 y.o.
    • Atypical chest pain for the past 6 months.
    • Total Cholesterol = 190; HDL = 40; LDL = 88 (on statins).
    • Glucose: 0.93, HbA1C = 6.7 % (on insulin + metformin).

    Teaching points:

    • MPS investigates the pathophysiological consequences of luminal obstructive CAD, while CTA indicates the presence, extent and location of coronary atherosclerosis.
    • For pratical purposes, CTA excludes CAD (high NPV).
    • A negative CTA implies no need of MPS on follow-up.
    • A positive CTA (if performed initially) implies the need for a MPS for short-term prognosis and eventual revascularization, because of low PPV.
    • Combined anatomical and functional assessment may allow improved risk stratification.

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