Journal ArticleDOI
Applications and limitations of cardiac computed tomography in the evaluation of coronary artery disease.
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TLDR
To justify greater use of CCTA in the current healthcare environment, future studies need to demonstrate improvements in patient outcomes, better accuracy compared with established tests, and/or reductions in healthcare costs.Abstract:
Cardiac computed tomography angiography (CCTA) has rapidly emerged in recent years as a promising noninvasive imaging modality for the evaluation of coronary artery disease. This is predominantly because of its proven ability to exclude coronary stenosis in patients without a history of coronary artery disease and with a low-intermediate pre-test likelihood. There is also increasing data on the utility of CCTA in risk stratification and assessment of prognosis. However, it is important to realize the shortcomings of the current technology before advocating its widespread use. Importantly, the utility of CCTA is limited when an abnormal study is anticipated. Because of current limitations on spatial and temporal resolution, CCTA cannot precisely assess the degree of stenosis as compared with invasive coronary angiography. This tendency of CCTA to overestimate stenosis severity along with its the poor positive predictive value can lead to increased downstream testing including additional stress testing and unnecessary invasive coronary angiography. Moreover, despite improvements in technology, the radiation burden of CCTA in real-world clinical practice remains significant. To justify greater use of CCTA in the current healthcare environment, future studies need to demonstrate improvements in patient outcomes, better accuracy compared with established tests, and/or reductions in healthcare costs.read more
Citations
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Journal ArticleDOI
Coronary Plaque Burden at Coronary CT Angiography in Asymptomatic Men and Women
Karen Rodriguez,Alan C. Kwan,Shenghan Lai,Joao A.C. Lima,Davis M. Vigneault,Veit Sandfort,Puskar Pattanayak,Mark A. Ahlman,Marissa Mallek,Christopher T. Sibley,David A. Bluemke +10 more
TL;DR: LD cholesterol level, systolic blood pressure, and diabetes were associated with noncalcified plaque burden at coronary CT angiography in asymptomatic individuals with low-to-moderate risk.
Journal ArticleDOI
Potential impact of clinical use of noninvasive FFRCT on radiation dose exposure and downstream clinical event rate
Nicolas Bilbey,Philipp Blanke,Christopher Naoum,Chesnel Dey Arepalli,Bjarne L. Nørgaard,Jonathon Leipsic +5 more
TL;DR: It is suggested that integrating FFRCT into the CTA clinical pathway may result in reduced cumulative radiation exposure, while promoting favorable clinical outcomes.
Journal ArticleDOI
Effect of iterative reconstruction and temporal averaging on contour sharpness in dynamic myocardial CT perfusion: Sub-analysis of the prospective 4D CT perfusion pilot study.
Sarah Feger,Carsten Kendziorra,Steffen Lukas,Ahmed Shaban,Björn Bokelmann,Elke Zimmermann,Matthias Rief,Marc Dewey +7 more
TL;DR: The use of both temporal averaging and iterative reconstruction degrades objective contour sharpness parameters of dynamic myocardial CTP, and further advances in image processing are needed to optimise contoursharpness of 4D myocardian CTP.
Journal Article
Coronary Angiographic Evaluation of Low-Risk Chest Pain in the Emergency Department: CT-STAT, or Maybe Not Quite That Fast?⁎⁎Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.
TL;DR: Coronary computed tomographic angiography is evolving into a mature imaging modality for assessment of patients with acute chest pain in the emergency department (ED).
References
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Journal ArticleDOI
Diagnostic Performance of Coronary Angiography by 64-Row CT
Julie M. Miller,Carlos E. Rochitte,Marc Dewey,Armin Arbab-Zadeh,Hiroyuki Niinuma,Ilan Gottlieb,Narinder Paul,Melvin E. Clouse,Edward P. Shapiro,John Hoe,Albert C. Lardo,David E. Bush,Albert de Roos,Christopher Cox,J. A. Brinker,Joao A.C. Lima +15 more
TL;DR: Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients, and the negative and positive predictive values indicate that multidetctor CTAngiography cannot replace conventional coronary angiographic at present.
Journal ArticleDOI
Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome.
Sadako Motoyama,Masayoshi Sarai,Hiroto Harigaya,Hirofumi Anno,Kaori Inoue,Tomonori Hara,Hiroyuki Naruse,Junichi Ishii,Hitoshi Hishida,Nathan D. Wong,Renu Virmani,Takeshi Kondo,Yukio Ozaki,Jagat Narula +13 more
TL;DR: Patients demonstrating positively remodeled coronary segments with low-attenuation plaques on CT angiography were at a higher risk of ACS developing over time when compared with patients having lesions without these characteristics.
Journal ArticleDOI
Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study.
W. Bob Meijboom,Matthijs F.L. Meijs,Joanne D. Schuijf,Maarten J Cramer,Nico R. Mollet,Carlos Van Mieghem,Koen Nieman,Jacob M. van Werkhoven,Jacob M. van Werkhoven,Gabija Pundziute,Gabija Pundziute,Annick C. Weustink,Alexander M. de Vos,Francesca Pugliese,Benno J. Rensing,J. Wouter Jukema,Jeroen J. Bax,Mathias Prokop,Pieter A. Doevendans,M. G. Myriam Hunink,Gabriel P. Krestin,Pim J. de Feyter +21 more
TL;DR: Among patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes.
Journal ArticleDOI
Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes.
Sadako Motoyama,Takeshi Kondo,Masayoshi Sarai,Atsushi Sugiura,Hiroto Harigaya,Takahisa Sato,Kaori Inoue,Masanori Okumura,Junichi Ishii,Hirofumi Anno,Renu Virmani,Yukio Ozaki,Hitoshi Hishida,Jagat Narula +13 more
TL;DR: The CT characteristics of plaques associated with ACS include positive vascular remodeling, low plaque density, and spotty calcification, and it is logical to presume that plaques vulnerable to rupture harbor similar characteristics.
Journal ArticleDOI
Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality.
James K. Min,Leslee J. Shaw,Richard B. Devereux,Peter M. Okin,Jonathan W. Weinsaft,Donald J. Russo,Nicholas J. Lippolis,Daniel S. Berman,Tracy Q. Callister +8 more
TL;DR: In patients with chest pain, CCTA identifies increased risk for all-cause death and a negative C CTA portends an extremely low risk for death.
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