https://orcid.org/0000-0001-6041-2531
A 64-year-old, asymptomatic man with non-severe hypercholesterolaemia [low-density lipoprotein cholesterol (LDL-C) 168 mg/dL, high-density lipoprotein cholesterol 64 mg/dL, and triglycerides 106 mg/dL] and a former smoking of <5 cigarettes per day during 2–3 teenage years, underwent a non-invasive cardiovascular risk assessment. Doppler ultrasound showed a diffuse atheromatous infiltration, mostly hypoechoic, with non-stenotic carotid and ilio-femoral plaques. Stress EKG evidenced a significant ventricular hyperexcitability at peak effort without ST-segment changes. Patient was then referred for a coronary computed tomography angiography (CTA) associated with a positron emission tomography (PET) imaging of 18F-sodium fluoride (NaF) based on a protocol approved by the institutional review board. CTA images showed a single mixed plaque extended to the ostium and the first segment of the right coronary artery (RCA), another smaller one in the left main coronary artery (LM) and minor calcifications in the left anterior descending artery (LAD) while Agatston score was 198: RCA: 169, LM: 22, and LAD: 7 (Panels A–C). NaF-PET/CTA images showed NaF focal uptake in the ostium of the RCA (Panel D; SUVmax: 1.9), and in the LM (Panels E and F; SUVmax: 2.5). No significant narrowing was measured, as confirmed by a negative maximal exercise 99mTc-MIBI stress scintigraphy. The patient was then prescribed 10 mg rosuvastatine and 75 mg aspirin per day and was advised to adopt a healthy diet and regular physical activity. Six months later, LDL-C decreased to 58 mg/dL, a second NaF-PET/CTA revealed unchanged CTA images and Agatston score (195; RCA: 163, LM: 23, and LAD: 9), and a decrease of focal NaF uptake in the coronary plaques (Panels G–L; respective SUVmax 1.2 and 1.5), without new hotspots. Our case suggests that NaF uptake may significantly decrease with statin therapy.
