Cardiac CT angiography in current practice: An American society for preventive cardiology clinical practice statement✰

Figures

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  Fig. 1. Three dimensional, volume rendered image of the coronary arteries revealing largely normal vessels. The negative predictive power exceeds 99% for obstructive disease.

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  Fig. 2. Coronary CT angiogram of the left anterior descending artery (LAD) demonstrated (a) topologically in volume rendered technique, (b) visually in curved multiplanar reformat, and (c) quantitatively in straightened multiplanar reformat across different 3D views. This patient demonstrates high atherosclerotic plaque burden that is comprised primarily of non-calcified (yellow and red) rather than calcified plaque (blue).The ability to visualize both stenosis and plaque makes this modality unique among non-invasive imaging tests.

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  Fig. 3. A 62 year old man with atypical chest pain. Computed tomographic angiography reveals severe atherosclerosis (mostly calcified plaque) without obstructive disease. The image demonstrates the ability to visualize the lumen clearly despite high calcium burdens.

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  Central Figure Legend: (A1) Presence of positive remodeling (yellow arrows) and low attenuation plaques (LAP, red arrow) are the most important determinants of plaque vulnerability. (A2) Stable plaques lack both these features. Major adverse cardiac events by the presence of 1 or both features in a follow up of — patients for 2 years (A3), and 300 patients for up to 10 years. (A4) Patients with HRP had 45 and 10 folds higher likelihood of adverse outcomes, respectively. Presence of obstructive disease over and above HRP features (A5) and interval progression in plaque magnitude (A6) increased the likelihood of adverse events further. Greater number of adverse plaque characteristics were associated with greater of adverse outcomes (A7) and the HRP characteristics were associated with abnormal fractional flow reserve regardless of luminal stenosis (A8). (Reprinted with permission of Elsevier from[1].)