computed tomography angiography in patients with cocaine-associated chest painAbstract in EnglishINTRODUCTION: Cocaine is the third most commonly used illicit drug in the United States and the leading cause of emergency department visits among drug users.Chest pain is the most common cocaine-related presentation, being reported in 40% of patients. Its chronic use causes hypertensive crises, myocardium hypertrophy and accelerates the process of atherosclerosis.Cardiovascular magnetic resonance provides an accurate assessment of cardiac morphology and ventricular function with excellent reproductibility, and it is considered the gold standard method.Computed tomography angiography has emerged as a powerful tool to evaluate patients with suspected coronary artery disease at the same time that it helps in the prognostic assessment of the patient.The purpose of this study was to evaluate the incidence of previous myocardial infarction among young cocaine users (18 to 40 years) with chest pain related with the use of the drug by the assessment of myocardial fibrosis through cardiovascular magnetic resonance. Secondarily, was also meant the evaluation of the coronary tree by the computed tomography angiography.METHODS:We studied 24 cocaine users (crystalline, powder or granular forms) that frequently complained about chest pain related to the use of the cocaine.These patients underwent computed tomography angiography with assessment of calcium score and the evaluation of the segmented coronary arteries, and cardiovascular magnetic resonance to assess dimensions, volumes and ventricular function of the heart, and the presence of myocardial fibrosis.RESULTS:We studied 24 patients (22 male), mean age of 29.7 years. Most of the patients (79%) had frequently used inhalatory cocaine, 71% of them had also used the crack cocaine form.The calcium score turned out to be positive in only one patient [54 (Agatston) and 56 (volume)]. None of them showed significant coronary stenosis.Among the coronary segments evaluated, only one patient had calcified plaques at the anterior descending coronary artery (proximal and medium segments).The global analysis of the left ventricular function assessed by the ejection fraction (EF), end diastolic volume (EDV), end sistolic volume (ESV) and ventricular mass were considered normal in 100% of the patients. Mean EF, EDV and ESV were 60.7%, 147.7mL and 59.1mL respectivelly.Cardiac index was normal in all patients. None of the patients showed myocardial hypertrophy. Assessment of regional ventricular function by the evaluation of 17 segments was normal in all patients. None of the patients showed myocardial delayed-enhancement, indicative of myocardial fibrosis.CONCLUSION:Cardiovascular magnetic resonance did not detect the presence of delayed enhancement indicative of myocardial fibrosis among young cocaine users with low cardiovascular risk with complaints of chest pain during or after cocaine abuse. Computed tomography angiography confirmed low cardiovascular risk of these patients, since most of them (96%) had no atherosclerosis detected by this exam. Only one patient (4%) had coronary atherosclerosis detected, without significant coronary stenosiswww.teses.usp.br Fonte:http://www.radiology.com.br/materias/rad_materias.asp?flag=1&id_materia=945.