The role of cardiac computed tomography in predicting adverse coronary events

Abstract

Cardiac computed tomography (CCT) is now considered a first-line diagnostic test for suspected coronary artery disease (CAD) providing a non-invasive, qualitative, and quantitative assessment of the coronary arteries and pericoronary regions. CCT assesses vascular calcification and coronary lumen narrowing, measures total plaque burden, identifies plaque composition and high-risk plaque features and can even assist with hemodynamic evaluation of coronary lesions. Recent research focuses on computing coronary endothelial shear stress, a potent modulator in the development and progression of atherosclerosis, as well as differentiating an inflammatory from a non-inflammatory pericoronary artery environment using the simple measurement of pericoronary fat attenuation index. In the present review, we discuss the role of the above in the diagnosis of coronary atherosclerosis and the prediction of adverse cardiovascular events. Additionally, we review the current limitations of cardiac computed tomography as an imaging modality and highlight how rapid technological advancements can boost its capacity in predicting cardiovascular risk and guiding clinical decision-making.

Keywords: adverse coronary events; cardiac computed tomography; computational fluid dynamics; coronary artery calcium score; coronary artery disease; perivascular fat.

Figure 1

Current and emerging roles of cardiac computed tomography in predicting adverse coronary events. Comprehensive assessment of coronary artery disease with cardiac computed tomography (CCT) includes coronary artery calcium score, anatomic assessment to identify stenosis, plaque volume, and high-risk plaque features, hemodynamic assessment using computational fluid dynamics to compute fractional flow reserve (FFR) and endothelial shear stress (ESS), as well as derivation of perivascular fat attenuation index. Perivascular fat attenuation index figure is owned by: Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI, published under Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0). Link to license: https://creativecommons.org/licenses/by-nc/2.0/.