No abstract

Coronary artery calcium (CAC) scoring has emerged as a useful tool in identifying patients who may benefit from more aggressive risk factor modification and for prognostication. Although a CAC score of 0 is associated with a very low prevalence of obstructive epicardial coronary artery disease and low event rates, it can also provide a false sense of reassurance. We present a case of a 39‐year‐old woman with a CAC score of 0 obtained as part of a coronary computerized tomography angiography study that was ultimately found to have significant left anterior descending artery disease requiring percutaneous coronary intervention and a stent.

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Background: With the proliferation of echocardiography, clinicians are detecting more patients with valve disease and identifying valve disease much earlier in its natural course. Understanding the gender and racial differences in prevalence of valve disease may help guide clinicians to allocate resources in researching strategies to prevent progression of valve disease. Methods: We identified 9,625 patients from the echocardiography laboratory database between September 2013 to April 2018 who had a LV ejection fraction ≥ 50%. Data related to left-sided valvular disease, baseline demographics, and clinical history were obtained from our clinical data repository. Crude analyses by sex and race were performed to identify the prevalence of certain valve lesions. Logistic regression was used to adjust these relationships by baseline demographics. Results: Our population was 58% female, 21% African-American (AA) with a mean age of 59 ± 17 years. For moderate/severe aortic stenosis (AS), AA had 2.4% compared to 7.5% in Caucasians (CA; p<0.001), and women had 4.8% compared to 8.5% for men (p<0.001). For moderate/severe aortic regurgitation (AR), AA had 4.1% compared to 7.5% in CA (p>0.2), and women had 4.0% compared to 5.4% for men (p=0.003). For moderate/severe mitral regurgitation, AA had 6.6% vs 7.8% for CA (p=0.056), and women had 8.3% vs 6.3% for men (p=0.003). Adjusting for age, race, sex, height, and weight, AA had lower odds ratio (OR) for AS than CA (OR: 0.47; 95% CI: 0.34-0.64; p<0.001), and women had less AS than men (OR: 0.60; 95% CI: 0.50-0.72; p<0.001), less AR (OR: 0.67; 95% CI: 0.54-0.83; p<0.001), but more MR (OR: 1.29; 95% CI: 1.08-1.53; p=0.004). Conclusion: African-Americans have a lower prevalence of moderate/severe aortic stenosis than Caucasians. Compared to men, women have a lower prevalence of moderate/severe aortic stenosis, lower prevalence of moderate/severe aortic regurgitation, but a higher prevalence of mitral regurgitation.