Chest pain: coronary CT in the ER

Abstract

Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection of subclinical CAD and plaque imaging offer the opportunity to improve risk stratification. Moreover, recent advances of the latest generation CT scanners allow combining both anatomical and functional imaging by stress myocardial perfusion. The role of cardiac CT in acute settings is already important and will become progressively more important in the coming years.

CT Myocardial Perfusion Imaging: A New Frontier in Cardiac Imaging

“…MRI is the most versatile imaging modality: it can be used for morphology, function, viability, and quantitative myocardial perfusion assessment [ 100 ]. Stress perfusion MRI performs better than SPECT for diagnosis of obstructive CAD, as reported in two large prospective randomized studies (MR-IMPACT and CE-MARC trials), and yields a similar diagnostic accuracy as PET, with a poll sensitivity of 89% and specificity of 76% [ 100 ]. Moreover spatial resolution of perfusion MRI (1-2 mm) is superior to that of SPECT, especially for the detection of subendocardial perfusion abnormalities [ 37 ].…”

“…Moreover spatial resolution of perfusion MRI (1-2 mm) is superior to that of SPECT, especially for the detection of subendocardial perfusion abnormalities [ 37 ]. Despite these excellent features, limitations to the clinical routine implementation of MRI perfusion assessment are the time-consuming image acquisition, the limited accessibility, and lack of widespread competence in cardiac MRI [ 37 , 100 ].…”

“…The introduction of ultrasound contrast agents (microbubbles) has optimized the detection of RWMA and has enabled simultaneous assessment of left ventricular perfusion and viability, improving the sensitivity of the technique [ 100 ].…”

Ischemic Cardiomyopathy: Contemporary Clinical Management

“…Computed tomography of the coronary arteries is an accurate noninvasive diagnostic test for coronary artery disease [59]. In addition, it provides information on cardiac valves and chambers [60].…”

Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population

“…Despite promising results, to date the clinical usefulness of noninvasive subclinical atherosclerosis evaluation in asymptomatic at‐risk individuals is still debated. The role of coronary computed tomography angiography (CCTA) in symptomatic patients is delineated, but it is still unknown in asymptomatic individuals with significant atherosclerosis because of a paucity of data . Accordingly, the aim of the study was to assess the prognostic benefit of carotid artery disease by ultrasound technique and subclinical coronary artery disease (CAD) using CCTA in an asymptomatic at‐risk adult population.…”