From anatomy to function: new frontiers in cardiac CT

Coronary artery disease (CAD) is one of the UK’s leading causes of mortality. Technological advances to improve the non-invasive detection of coronary atheroma and provide information to guide the best strategy for clinical management have therefore been a focus for CT research. Cardiac gated CT was first attempted by Hounsfield in the 1970s but it was not until the advent of 64-slice CT scanners that CT of the coronaries became reliable enough for clinical practice.

We now have evidence that use of CT can improve clinical outcomes. In 2015, the SCOT-HEART trial first reported that adding cardiac CT to standard care for patients presenting to the chest pain service resulted in a 38% reduction in fatal and non-fatal myocardial infarction (MI) at 1.7 years with sustained reduction in death and non-fatal MI at five years. Subsequently, in 2016, NICE recommended cardiac CT as the first-line investigation to diagnose CAD in patients presenting with typical or atypical angina (or non-anginal chest pain with ECG changes) who had no history of ischaemic heart disease. This guidance marked a change from the 2010 guidelines, which had only recommended cardiac CT in patients with a low pre-test probability. The UK is one of the first countries to adopt a CT-first strategy, which has required concerted efforts from radiology departments to increase capacity for cardiac CT and to produce high quality diagnostic scans.

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