Key result
Cardiac computed tomography serves as a fundamental gatekeeper for invasive coronary angiography by providing a comprehensive evaluation of coronary artery disease from anatomical plaque assessment to functional ischemia detection.
Why the study?
Traditional stress testing reliably detects obstructive coronary artery disease but lacks accuracy for non-obstructive disease, highlighting the evolving role of coronary computed tomography from anatomy to functional assessment.
CCTA has evolved from a purely anatomical imaging modality to a comprehensive tool capable of assessing both the anatomical burden and functional significance of coronary artery disease.
May reduce unnecessary ICA referrals in CAD; leaves open prospective outcome trials on CCTA gatekeeper strategy.
Ischaemic heart disease (IHD) is one of the world's leading causes of morbidity and mortality. Likewise, the diagnosis and risk stratification of patients with coronary artery disease (CAD) have always been based on the detection of the presence and extent of ischaemia by physical or pharmacological stress tests with or without the aid of imaging methods (e.g. exercise stress, test, stress echocardiography, single-photon emission computed tomography, or stress cardiac magnetic resonance). These methods show high performance to assess obstructive CAD, whilst they do not show accurate power to detect non-obstructive CAD. The introduction into clinical practice of coronary computed tomography angiography, the only non-invasive method capable of analyzing the coronary anatomy, allowed to add a crucial piece in the puzzle of the assessment of patients with suspected or chronic IHD. The current review evaluates the technical aspects and clinical experience of coronary computed tomography in the evaluation of atherosclerotic burden with a special focus about the new emerging application such as functional relevance of CAD with fractional flow reserve computed tomography (CT)-derived (FFRct), stress CT perfusion, and imaging inflammatory makers discussing the strength and weakness of each approach.
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Maragna et al. (2023) conducted a review in Ischaemic heart disease. Cardiac computed tomography was evaluated. Cardiac computed tomography serves as a fundamental gatekeeper for invasive coronary angiography by providing a comprehensive evaluation of coronary artery disease from anatomical plaque assessment to functional ischemia detection.
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