Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Dec 3;9(12):3925.
doi: 10.3390/jcm9123925.

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

Francesca Baessato  1 , Marco Guglielmo  2 , Giuseppe Muscogiuri  2 , Andrea Baggiano  2 , Laura Fusini  2 , Stefano Scafuri  2 , Mario Babbaro  2 , Rocco Mollace  2 , Ada Collevecchio  3 , Andrea I Guaricci  4 , Mark Rabbat  5   6 , Antonello D'Andrea  7 , Gianluca Pontone  2
Affiliations
Review

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

Francesca Baessato et al. J Clin Med. .

Abstract

In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Recent studies evidence how defined plaque composition characteristics effectively relate to the risk of plaque instabilization and the overall ischemic burden. Fractional flow reserve from CCTA (FFR-CT) has been demonstrated as a reliable method for noninvasive functional evaluation of coronary lesions severity, while the assessment of perfusion imaging under stress conditions is growing as a useful tool for assessment of myocardial ischemia. Moreover, specific applications in procedural planning of transcatheter valve substitution and follow-up of heart transplantation have gained recent importance. This review illustrates the incremental role of CCTA, which can potentially revolutionize the diagnosis and management pathway within the wide clinical spectrum of CCS.

Keywords: coronary calcium score; coronary computed tomography; fractional flow reserve; perfusion imaging.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
T.F. 67 years-old, male; dyslipidaemia, smoker; typical exertional chest pain; exercise test negative; CCTA (a,b): subocclusive stenosis of mid-LAD; ICA (c): significant stenosis was confirmed and elective PCI was performed. CCTA: coronary computed tomography angiography; LAD: left anterior descending artery; ICA: invasive coronary angiography; PCI: percutaneous coronary intervention.
Figure 2
Figure 2
S.M. 54 years-old, male; dyslipidaemia, smoker, PAD; shortness of breath; CCTA (a): high risk plaque feature in left descending artery with spotty calcifications, positive remodeling; ICA (b): significant tandem-stenosis of LAD. PAD: peripheral artery disease; CCTA: coronary computed tomography angiography; ICA: invasive coronary angiography; LAD: left anterior descending artery.
Figure 3
Figure 3
S.M. 54 years-old, male; dyslipidaemia, smoker, PAD; breath shortness; CCTA (a): moderate mid-LAD stenosis (see also Figure 2); FFR-CT was performed (b): pressure drop after diagonal branch; ICA (c): significant tandem-stenosis of LAD (left anterior descending artery). CCTA: coronary computed tomography angiography; LAD: left anterior descending artery; FFR-CT: fractional flow reserve derived from coronary computed tomography; ICA: invasive coronary angiography.
Figure 4
Figure 4
D.R. 45 years-old, female; hypertension; atypical chest pain; CCTA (a): fibrocalcific plaque in left circumflex artery with moderate stenosis; stress-CTP perfusion sequences (c) matched with rest perfusion sequences (b): reversible perfusion defect in basal inferolateral wall. CCTA: coronary computed tomography angiography; CTP: computed tomography perfusion.
See this image and copyright information in PMC

References

    1. Knuuti J., Ballo H., Juarez-Orozco L.E., Saraste A., Kolh P., Rutjes A.W.S., Jüni P., Windecker S., Bax J.J., Wijns W. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: A meta-analysis focused on post-test disease probability. Eur. Heart J. 2018;39:3322–3330. doi: 10.1093/eurheartj/ehy267. - DOI - PubMed
    1. Pontone G., Andreini D., Quaglia C., Ballerini G., Nobili E., Pepi M. Accuracy of multidetector spiral computed tomography in detecting significant coronary stenosis in patient populations with differing pre-test probabilities of disease. Clin. Radiol. 2007;62:978–985. doi: 10.1016/j.crad.2007.02.022. - DOI - PubMed
    1. Blanke P., Naoum C., Ahmadi A., Cheruvu C., Soon J., Arepalli C., Gransar H., Achenbach S., Berman D.S., Budoff M.J., et al. Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. JACC Cardiovasc. Imaging. 2016;9:1280–1288. doi: 10.1016/j.jcmg.2015.12.027. - DOI - PubMed
    1. Schulman-Marcus J., Hartaigh B., Gransar H., Lin F., Valenti V., Cho I., Berman D., Callister T., DeLago A., Hadamitzky M., et al. Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry. JACC Cardiovasc. Imaging. 2016;9:364–372. doi: 10.1016/j.jcmg.2016.02.010. - DOI - PMC - PubMed
    1. Pontone G., Andreini D., Bartorelli A.L., Bertella E., Cortinovis S., Mushtaq S., Foti C., Annoni A., Formenti A., Baggiano A., et al. A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD. JACC Cardiovasc. Imaging. 2013;6:641–650. doi: 10.1016/j.jcmg.2013.01.015. - DOI - PubMed