Non-invasive detection of significant coronary artery disease with multi-section computed tomography angiography in patients with suspected coronary artery disease

Preoperative non-invasive testing aims to provide informed choices about the appropriateness of surgery, guide perioperative management, and assess the long-term risk of a cardiac event through identification of left ventricular dysfunction, heart valve abnormalities, and myocardial ischaemia. Preoperative non-invasive testing is not recommended routinely, but it should be considered in patients in whom initial clinical evaluation indicates increased risk for perioperative cardiac complications and who are scheduled for intermediate- or high-risk surgery. Pharmacological stress testing combined with myocardial perfusion imaging or echocardiography is more suitable than physical exercise for the detection of myocardial ischaemia in patients with limited exercise tolerance that is common in the preoperative setting. Alternatively, non-invasive coronary computed tomography angiography can identify obstructive coronary artery disease. A negative stress testing with imaging or the absence of high-risk coronary anatomy on computed tomography angiography is associated with a low incidence of perioperative cardiac events, but the positive predictive value is relatively low, that is, the risk is relatively low despite a positive result. In patients with extensive stress-induced ischaemia or extensive obstructive coronary artery disease detected by non-invasive testing, individualized perioperative management is recommended considering the potential benefit of the proposed surgical procedure, weighed against the predicted risk of adverse outcome.

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NON-INVASIVE FFR DERIVED FROM STANDARD ACQUIRED CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) DATASETS (FFRCT) FOR THE DIAGNOSIS OF MYOCARDIAL ISCHEMIA IN PATIENTS WITH CORONARY ARTERY DISEASE (CAD): FIRST DATA OF CLINICAL USE. COMPARISON WITH INVASIVE MEASUREMENT

Medical Visualization ◽

10.24835/1607-0763-2018-2-47-55 ◽

2018 ◽

pp. 47-55 ◽

Cited By ~ 2

Author(s):

E. S. Pershina ◽

V. E. Sinitsin ◽

E. A. Mershina ◽

I. M. Arkhipova ◽

S. P. Semitko ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Ischemia ◽

Computed Tomography Angiography ◽

Coronary Computed Tomography Angiography ◽

Stable Coronary Artery Disease ◽

Coronary Computed Tomography ◽

Non Invasive ◽

Artery Disease

Objectives: to determine the diagnostic performance of non-invasive FFR derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD).Methods.Prospective study included 16 patients ((m/f – 13/3 mean age 47.8 ± 2.3 years) with CAD and coronary stenosis 40–75% lumen reduction. Coronary CTA was performed prior to ICA with invasive FFR measurement. FFRCT was calculated and interpreted in a blinded fashion by an independent Core Laboratory (HeartFlow, USA). Results were compared to invasively measured FFR, with ischemia defined as FFRCT or FFR ≤ 0.80.Results. The area under the receiver operating characteristic curve (95% CI) for FFCT was 0.90. Per-vessel sensitivity and specificity to identify myocardial ischemia were 91% and 89% for FFRCT.Conclusion.FFRCT provides high diagnostic accuracy, and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard.

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Computed tomography angiography and other applications of computed tomography

10.1093/med/9780199687039.003.0022_update_001 ◽

2016 ◽

Author(s):

Michiel A de Graaf ◽

Arthur JHA Scholte ◽

Lucia Kroft ◽

Jeroen J Bax

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Computed Tomography Angiography ◽

Coronary Computed Tomography Angiography ◽

Acute Chest Pain ◽

Coronary Computed Tomography ◽

Non Invasive ◽

Artery Disease

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.

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