Computed tomography-coronary angiography in the detection of coronary artery disease - Introduction

A Special Author Introduction
Journal of Cardiovascular Medicine
Official Journal of the Italian Federation of Cardiology
ISSN: 1558-2027 • Frequency: 12/year • Subscribe Now • Journal Website

By Anoeshka S. Dharampal, Alexia Rossi and Pim J. de Feijter

Coronary computed tomography (CT) is a useful non-invasive technique for assessment of coronary artery disease (CAD). Due to the technical developments coronary CT can be performed at low levels of radiation exposure and even submilisievert levels can be achieved with high quality images.

In the unenhanced coronary CT-scan the amount of coronary calcification is calculated and is expressed as the calcium score in Agatston units. This calcium score is an independent predictor and has incremental value beyond the traditional risk factors in asymptomatic patients, which can be used to reclassify the risk and adjust management in asymptomatic patients at intermediate risk of coronary artery disease.

The enhanced CT of the coronaries, CT coronary angiography (CTCA) is a valuable imaging technique providing anatomical information of coronary artery disease, severity of coronary artery stenoses, location and plaque composition. This anatomical information carries prognostic value independent from traditional risk factors in symptomatic patients. Currently CTCA is increasingly being used as first line diagnostic tool in patients with suspected CAD at low / intermediate pre-test risk to exclude obstructive CAD.

CTCA is not yet ready to replace invasive coronary angiography due to the over and underestimation of the severity of coronary artery disease. The anatomical information of coronary lesions provided by CTCA does not predict the functional significance of these lesions and often requires additional tests to assess presence of coronary flow limitation. New developments in CT-scanner technology such as Positron emission tomography-computed tomography (PET-CT), CT-perfusion and delayed enhancement will challenge and widen the application of CTCA beyond coronary lumen assessment providing information about myocardial ischemia and viability. Large randomized studies are ongoing exploring the change in patient outcome and cost effectiveness.

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