Updated diagnostic & prognostic paradigm for CAD: a narrative review

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Cardiovascular diseases are the leading global cause of death.
• Early detection of coronary artery disease (CAD) remains a clinical challenge.
• Cardiac computed tomography (CCT) has evolved significantly since its introduction in 1998.

Purpose of the Study:

• To review the advancements and clinical utility of CCT in diagnosing and assessing prognosis of CAD.
• To highlight CCT's role as a first-line diagnostic tool in specific patient populations.
• To discuss the integration of CCT findings into updated clinical guidelines.

Main Methods:

• Review of technical and clinical validation phases of CCT over two decades.
• Analysis of diagnostic and prognostic value supported by technological advancements and dose reduction.
• Summary of findings from multiple registries and trials on CCT in CAD assessment.

Main Results:

• CCT demonstrates excellent diagnostic and prognostic value, with widening clinical indications.
• CCT is highly effective as a first-line test for symptomatic patients with suspected obstructive CAD and low-to-intermediate risk.
• CCT's high sensitivity and negative predictive value support its use over functional evaluation in many cases.

Conclusions:

• Recent guidelines emphasize CCT's crucial role in diagnosing suspected CAD.
• CCT provides reliable, fast diagnoses and optimizes resource utilization.
• The prognostic value of CCT, particularly regarding atherosclerotic phenotype, is an active area of research for personalized therapy.