Clinical Applications of Cardiac Computed Tomography: A Focused Review for the Clinical Cardiologists

Cardiac computed tomography (CT) has become a cornerstone in the non-invasive evaluation and management of cardiovascular disease, offering clinicians detailed anatomical and functional information that directly influences patient care. This review focuses on three primary clinical applications: coronary artery calcium (CAC) scoring, coronary CT angiography (CCTA), and preprocedural planning for structural heart interventions. CAC quantification remains one of the most powerful prognostic tools for cardiovascular risk stratification, with robust evidence supporting its use in asymptomatic and selected symptomatic individuals. CCTA provides a high-resolution assessment of coronary anatomy and plaque characteristics, guiding both preventive and acute care strategies. In structural heart disease, CT is indispensable for accurate device sizing, procedural planning, and complication avoidance in interventions such as transcatheter valve replacement or repair. Beyond these core applications, cardiac CT supports the evaluation of pericardial, myocardial, aortic, and congenital heart disease, and plays a role in pulmonary embolism risk assessment. Technological innovations-including artificial intelligence, dual-energy imaging, and photon-counting CT-are enhancing image quality, reducing radiation exposure, and broadening the modality's prognostic capabilities. Collectively, these advances are solidifying cardiac CT as an integrated diagnostic and planning tool with a significant impact on clinical decision-making and patient outcomes.