Functional assessment of coronary artery disease by cardiac computed tomography

Author(s): Dr Stefania Rosmini, Dr Thomas A Treibel, Dr Alexia Rossi, Dr Francesca Pugliese, Ceri L Davies

Hospital: Barts Heart Centre, St Bartholomew's Hospital

Reference: RAD Magazine, 44, 516, 21-22


Computed tomography coronary angiography (CTCA) has become an established non-invasive test for the detection of coronary artery disease (CAD). Recently, outcome data and insights into the diagnosis and management of patients with stable chest pain have been provided by two important clinical trials, The Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) and Scottish Computed Tomography of the Heart (SCOT-HEART). These have led to a greater role of CTCA in the diagnostic pathway for stable chest pain.

The current American and European guidelines have placed CTCA firmly into the diagnostic pathway for stable CAD and the UK guidelines published by the National Institute of Health and Care Excellence (NICE) for the management of recent onset stable chest pain recommend CTCA as the first-line investigation of CAD. However, the positive predictive value of CTCA is limited, in particular by the presence of dense coronary artery calcification, resulting in false positive findings or inconclusive results, which may lead to unnecessary downstream investigations. Moreover, the inability to determine the functional significance of an imaged coronary stenosis represents a limitation in clinical decision-making as prognostic benefits of myocardial revascularisation are linked to the presence of myocardial ischaemia or functionally significant stenosis.

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