Computed tomography provides anatomy -- we need ischemia!

August 31, 2008

Cardiac computed tomography has revolutionized cardiac imaging in recent years by providing exquisitely detailed cardiac anatomy, including, but not limited to, coronary anatomy. Non-invasive coronary angiography by computed tomography (CTA) is performed in ever increasing numbers, over 150 000 per year in the United States. However, the specific role of CTA in the diagnostic pathways of cardiology remains to be defined, and practice patterns of the technique often neglect established insights into coronary artery disease. The following characteristics of CTA need to be understood: Next, some fundamental insights into CAD should be remembered: Use of CTA is currently crystallizing in two scenarios. The first is the symptomatic patient in a low or intermediate pre-test--likelihood of significant CAD. Depending on individual preferences and cost issues a CTA (or scoring of coronary calcification, without contrast and with less radiation) may provide useful incremental information for risk-stratification and, importantly, obviate coronary angiography if it is negative. However, it should be borne in mind that in a population with a low pre-test likelihood of CAD (< 30%) the positive predictive value of CTA for diagnosing segmental coronary stenosis will drop into the 60% range or lower, while admittedly still preserving a high negative predictive value. The other scenario with a potential role for CTA is the emergency room, in particular in the context of "chest-pain units". Here, the promise is to very quickly exploit the "clearing" potential of a negative scan, which reliably predicts absence of CAD and also perhaps, with a modified protocol, to exclude other important causes of chest pain, such as major pulmonary embolism or aortic dissection. Unquestionably, this seems attractive. Again, mainly in the patients with low pre-test-likelihood of a true acute coronary syndrome an early CTA could reduce in-hospital time and perhaps even cost. In patients with higher likelihood or established CAD it is questionable whether the procedure will add much to or shorten the management, given the problems in grading stenosis severity and the well-established value of an invasive approach especially in troponin-positive patients.

In summary, CTA may facilitate management of symptomatic patients with low pre-test likelihood of CAD, in particular by conclusively showing absence of CAD. However, testing for inducible ischemia remains central for management decisions in both suspected and proven CAD and cannot be replaced by morphologic information. Furthermore, the use of CTA as a screening test for CAD in asymptomatic patients - discouraged by current recommendations anyway - should be abandoned.

European Society of Cardiology

Related Coronary Artery Disease Articles from Brightsurf:

Researchers use multi-ancestry comparison to refine risk factors for coronary artery disease
An international group led by researchers from the RIKEN Center for Integrative Medical Sciences have used a combination of genome-wide association analysis--or GWAS--and a trans-ancestry comparison of different GWAS studies, to come up with a more accurate predictor of coronary artery disease based on genetic factors.

Oral radiography can reveal chronic coronary artery disease
A study found a link between carotid artery calcification observable in radiographs and coronary artery disease as well as several oral infections.

A new strategy to counter insulin damage in coronary artery disease
By studying blood vessel tissue from 674 patients, a research team has discovered how insulin contributes to the dysfunction of blood vessels in atherosclerosis, one of the most common chronic health conditions worldwide.

3D fusion imaging improves coronary artery disease diagnosis
A new technique that combines CT and MRI can bolster coronary artery disease diagnosis and help to define appropriate treatment for patients suffering from the disease, according to a new study.

Associations between vaspin levels and coronary artery disease
In a new publication from Cardiovascular Innovations and Applications; DOI, Lutfu Askin, Okan Tanriverdi, Hakan Tibilli and Serdar Turkmen from the Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey consider associations between vaspin levels and coronary artery disease.

Waist size, not body mass index, may be more predictive of coronary artery disease
For years, women have been told that weight gain could lead to heart disease.

Women with coronary artery wall thickness at risk for heart disease
The thickness of the coronary artery wall as measured by MRI is an independent marker for heart disease in women, according to a new study.

SPIE journal reports advances in use of 3D models in assessing coronary artery disease
In an article published in SPIE's Journal of Medical Imaging (JMI), researchers announce critical advances in the use of 3D-printed coronary phantoms with diagnostic software, further developing a non-invasive diagnostic method for Coronary Artery Disease (CAD) risk assessment.

E-cigarettes linked to heart attacks, coronary artery disease and depression
Concerns about the addictive nature of e-cigarettes -- now used by an estimated 1 out of 20 Americans -- may only be part of the evolving public health story surrounding their use, according to data being presented at the American College of Cardiology's 68th Annual Scientific Session.

Is guideline-recommended therapy for coronary artery disease more likely in Medicare Advantage?
Medicare Advantage is Medicare's managed-care alternative to traditional fee-for-service Medicare.

Read More: Coronary Artery Disease News and Coronary Artery Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to