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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary computed tomography angiography in patients with stable coronary artery disease
David I Feldman1, Jacqueline Latina1, Jana Lovell1
1The Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, 600N. Wolfe Street, Halsted 560, Baltimore, MD 21287, United States.
Insights
Coronary computed tomography angiography (coronary CTA) is a leading noninvasive imaging method for coronary artery disease (CAD). Coronary CTA improves diagnostic accuracy and patient outcomes by guiding management and preventing myocardial infarction.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Coronary artery disease (CAD) management involves controlling angina and preventing cardiovascular events.
- Traditional noninvasive stress tests assess inducible myocardial ischemia but not the atherosclerotic burden.
- Patient survival in CAD is linked to the extent of coronary atherosclerosis, not just functional deficits.
Purpose of the Study:
- To highlight the role of coronary computed tomography angiography (coronary CTA) in evaluating CAD.
- To compare the effectiveness of coronary CTA with traditional functional testing.
- To emphasize the benefits of coronary CTA in improving patient outcomes and clinical management.
Main Methods:
- Review of noninvasive imaging modalities for CAD.
- Comparison of coronary CTA with functional stress testing (ECG, radionuclide scintigraphy, echocardiography, MRI).
- Evaluation of coronary CTA's impact on clinical management and patient outcomes.
Main Results:
- Coronary CTA is now a first-line noninvasive imaging modality for CAD.
- Coronary CTA improves diagnostic accuracy and positively influences clinical management.
- Management guided by coronary CTA leads to better patient outcomes, including prevention of myocardial infarction.
- Coronary CTA provides detailed atherosclerotic plaque characterization and lesion significance assessment.
Conclusions:
- Coronary CTA offers superior diagnostic accuracy and clinical management benefits over functional testing for CAD.
- Coronary CTA-guided management improves patient outcomes by preventing myocardial infarction.
- Detailed plaque characterization by coronary CTA enhances risk assessment and prognosis, potentially guiding further diagnostic procedures.
Abstract:
The treatment of coronary artery disease (CAD), which is defined by stable anatomical atherosclerotic and functional alterations of epicardial vessels or microcirculation, focuses on managing intermittent angina symptoms and preventing major adverse cardiovascular events with optimal medical therapy. When patients with known CAD present with angina and no acute coronary syndrome, they have historically been evaluated with a variety of noninvasive stress tests that utilize electrocardiography, radionuclide scintigraphy, echocardiography, or magnetic resonance imaging for determining the presence and extent of inducible myocardial ischemia. Patient event-free survival, however, is largely driven by the coronary atherosclerotic disease burden, which is not directly assessed by functional testing. Direct evaluation of coronary atherosclerotic disease by coronary computed tomography angiography (coronary CTA) has emerged as the first line noninvasive imaging modality as it improves diagnostic accuracy and positively influences clinical management. Compared to functional assessment of CAD, coronary CTA-guided management results in improved patient outcomes by facilitating prevention of myocardial infarction. Other strengths of coronary CTA include detailed atherosclerotic plaque characterization and the ability to assess functional significance of specific lesions, which may further improve risk assessment and prognosis and lead to more appropriate referrals for additional testing, such as invasive coronary angiography.
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