It’s in the Field of View!

Hecht, Harvey S.; Narula, Jagat; Leipsic, Jonathon

doi:10.1161/circresaha.117.312396

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…However, as the coronary arteries are in the field of view of every contrast chest CTA, they may be evaluated by EKG gating a single-phase prospective acquisition. The most appropriate clinical scenario for TRO CTA use may be aortic dissection and pulmonary embolus (in men >45 years old and women >55 years old) as the CTAs are infrequently positive (<15%) and do not provide an explanation for the presenting symptoms for which, because of its prevalence, CAD may be the culprit 37 . Thus, other than the availability of adequate scanner technology, to avoid an increase in contrast volume and radiation dose, and the operator expertise in the emergency department, it may be appropriate to use EKG gating for CTA performed for aortic dissection as well as pulmonary embolus studies in men older than 45 years and women older than 55 years, analyzing and reporting coronary arteries.…”

Section: ‘Triple Rule-out’ In the Emergency Departmentmentioning

confidence: 99%

Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation

Carrabba

Andreini

Buffa

et al. 2022

Journal of Cardiovascular Medicine

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In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.

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Section: ‘Triple Rule-out’ In the Emergency Departmentmentioning

confidence: 99%

Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation

Carrabba

Andreini

Buffa

et al. 2022

Journal of Cardiovascular Medicine

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SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

Narula

Chandrashekhar

Ahmadi

et al. 2021

Journal of Cardiovascular Computed Tomography

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193

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2.1.2. Diagnostic performance of functional imaging and CTA compared to >50% diameter stenosis by ICA The National Cardiovascular Data Registry 9 suggested that functional testing is suboptimal for detecting significant coronary stenoses. Of the 661,063 patients undergoing elective catheterization, 64% had testing before the invasive coronary angiogram (ICA); of those, only 51.9% were abnormal. The percentages of patients with <50% DS on subsequent ICA ranged from 55 to 56% after an abnormal exercise treadmill test (ETT), stress echocardiography (SE), single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI); for resting CTA, the percentage was 30%. In the oldest report, Fleischmann et al. evaluated 5874 patients in 41 studies from 1990 to 1997, and reported sensitivity and specificity of 85% and 77% for SE and 87% and 64% for SPECT, with 52% and 71% for exercise ECG. 10 DeJong et al. (Table 2A), in a meta-analysis of 5088 patients in 51 studies from 2000 to 2011 evaluated MRI, SE and SPECT with >50%DS by ICA as reference. 11 MRI was the most sensitive and specific (91% and 80%), with SE (87% and 72%) and SPECT (83% and 77%) roughly similar. Jaarsma et al. (Table 2B), reported on SPECT, MRI and positron emission tomography (PET) in 141 per-patient studies and 70 per-vessel studies. 12 Per-patient diagnostic odds ratio (DOR) was highest for PET (36.47) followed by MRI (26.42) and SPECT (16.31). In pervessel analysis, PET and MRI were equal (24.74 and 24.11), while SPECT was lowest (11.75). In a meta-analysis limited to 26 studies in which CTA was compared to either ETT or SPECT in the same group of patients, Nielsen et al. 13 (Table 2C) reported CTA sensitivities of 95e99%, specificities of 68e93% and DOR of 128e728. Corresponding ranges for ETT were 65e70%, 24e60% and 0.7e4 and for SPECT were 67e73%, 48e52% and 2e4. It is important to understand that available meta-analyses are also challenged by the small numbers of patients in some of the individual reports, potential referral bias, and often include a mixture of newer and older technology (e.g., planar and SPECT imaging). Finally, in a paper published too recently for meta-analysis inclusion, 391 symptomatic patients, 52% with intermediate and 46% with high risk pre-test probability, who were scheduled for ICA, underwent both CTA and SPECT with >50%DS by ICA as reference. 14 Sensitivity, specificity, positive and negative predictive values were 0.92, 0.75, 0.84 and 0.87 for CTA and 0.62, 0.68, 0.74 and 0.55 for SPECT. AUC was significantly higher for CTA (0.91 versus 0.69, p < 0.001.

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It’s in the Field of View!

Cited by 2 publications

References 8 publications

SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

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