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Cardiac CT in 2015: Clinical Role According to Current Multi-Societal Guidelines

  • Cardiac Computed Tomography (TC Villines, Section Editor)
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Abstract

Over the past decade, there has been a rapid expansion in the use of cardiac CT as well as in the data supporting its application in a variety of clinical settings. This has led to an increasing inclusion of cardiac CT in the various guidelines, appropriate use criteria, and societal position statements. This article aims to review the use of CT in cardiovascular risk stratification, the diagnosis of coronary artery disease in various clinical settings including acute presentations, and the expanding role of CT in non-coronary indications with a focus on the guidelines and the data that impacts the clinical application of CT in these varied scenarios.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Goff DCJ, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2935–59.

    Article  PubMed  Google Scholar 

  2. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.

    Article  PubMed  Google Scholar 

  3. Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56:1864–94.

    Article  PubMed  Google Scholar 

  4. Carr JJ, Hendel RC, White RD, et al. 2013 appropriate utilization of cardiovascular imaging: a methodology for the development of joint criteria for the appropriate utilization of cardiovascular imaging by the American College of Cardiology Foundation and American College of Radiology. J Am Coll Radiol. 2013;10:456–63.

    Article  PubMed  Google Scholar 

  5. Wolk MJ, Bailey SR, Doherty JU, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;63:380–406.

    Article  PubMed  Google Scholar 

  6. Shaw LJ, Min JK, Hachamovitch R, et al. Cardiovascular imaging research at the crossroads. JACC Cardiovasc Imaging. 2010;3:316–24.

    Article  PubMed  Google Scholar 

  7. Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015. A multicenter randomized trial assessing an initial anatomic approach with CT vs. a functional evaluation with stress testing in symptomatic patients. A detailed editorial accompanies this article. https://clinicaltrials.gov/ct2/show/NCT01471522 .

  8. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte MJ, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.

    Article  CAS  PubMed  Google Scholar 

  9. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–5.

    Article  CAS  PubMed  Google Scholar 

  10. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–45.

    Article  CAS  PubMed  Google Scholar 

  11. Kavousi M, Elias-Smale S, Rutten JH, et al. Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. Ann Intern Med. 2012;156:438–44.

    Article  PubMed  Google Scholar 

  12. Silverman MG, Blaha MJ, Krumholz HM, et al. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. 2014;35:2232–41. Demonstration of the impact of coronary calcium on prognosis on patients not at intermediate risk by traditional risk factors.

    Article  CAS  PubMed  Google Scholar 

  13. Tota-Maharaj R, Blaha MJ, McEvoy JW, et al. Coronary artery calcium for the prediction of mortality in young adults < 45 years old and elderly adults > 75 years old. Eur Heart J. 2012;33:2955–62.

    Article  CAS  PubMed  Google Scholar 

  14. Erbel R, Delaney JA, Lehmann N, et al. Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). Eur Heart J. 2008;29:2782–91.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56:1397–406.

    Article  PubMed  Google Scholar 

  16. Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33:1635–701.

    Article  CAS  PubMed  Google Scholar 

  17. Hadamitzky M, Taubert S, Deseive S, et al. Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease. Eur Heart J. 2013;34:3277–85.

    Article  PubMed  Google Scholar 

  18. Hulten E, Villines TC, Cheezum MK, et al. Usefulness of coronary computed tomography angiography to predict mortality and myocardial infarction among Caucasian, African and East Asian ethnicities (from the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter] Registry). Am J Cardiol. 2013;111:479–85.

    Article  PubMed  Google Scholar 

  19. Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC. Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;57:1237–47.

    Article  PubMed  Google Scholar 

  20. Maddox TM, Stanislawski MA, Grunwald GK, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA. 2014;312:1754–63.

    Article  CAS  PubMed  Google Scholar 

  21. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.

    Article  CAS  PubMed  Google Scholar 

  22. Meijboom WB, Meijs MF, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008;52:2135–44.

    Article  PubMed  Google Scholar 

  23. Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52:1724–32.

    Article  PubMed  Google Scholar 

  24. den Dekker MA, de Smet K, de Bock GH, Tio RA, Oudkerk M, Vliegenthart R. Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis. Eur Radiol. 2012;22:2688–98.

    Article  Google Scholar 

  25. Yan RT, Miller JM, Rochitte CE, et al. Predictors of inaccurate coronary arterial stenosis assessment by CT angiography. JACC Cardiovasc Imaging. 2013;6:963–72.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Halliburton SS, Abbara S, Chen MY, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 2011;5:198–224.

    Article  PubMed Central  PubMed  Google Scholar 

  27. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet. 2015. A prospective multicenter comparison of a coronary CT strategy vs. standard of care in the evaluation of patients with suspected angina.

  28. Goldstein JA, Gallagher MJ, O’Neill WW, Ross MA, O’Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863–71.

    Article  PubMed  Google Scholar 

  29. Hoffmann U, Bamberg F, Chae CU, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009;53:1642–50.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (coronary computed tomographic angiography for systematic triage of acute chest pain patients to treatment) trial. J Am Coll Cardiol. 2011;58:1414–22.

    Article  PubMed  Google Scholar 

  31. Hoffmann U, Truong QA, Schoenfeld DA, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012;367:299–308.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Litt HI, Gatsonis C, Snyder B, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med. 2012;366:1393–403.

    Article  CAS  PubMed  Google Scholar 

  33. Hulten E, Goehler A, Bittencourt MS, et al. Cost and resource utilization associated with use of computed tomography to evaluate chest pain in the emergency department: the rule out myocardial infarction using computer assisted tomography (ROMICAT) study. Circ Cardiovasc Qual Outcomes. 2013;6:514–24.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Truong QA, Hayden D, Woodard PK, et al. Sex differences in the effectiveness of early coronary computed tomographic angiography compared with standard emergency department evaluation for acute chest pain: the rule-out myocardial infarction with computer-assisted tomography (ROMICAT)-II trial. Circulation. 2013;127:2494–502.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Pursnani A, Chou ET, Zakroysky P, et al. Use of coronary artery calcium scanning beyond coronary computed tomographic angiography in the emergency department evaluation for acute chest pain: the ROMICAT II trial. Circ Cardiovasc Imaging. 2015;8.

  36. Hulten E, Pickett C, Bittencourt MS, et al. Outcomes after coronary computed tomography angiography in the emergency department: a systematic review and meta-analysis of randomized, controlled trials. J Am Coll Cardiol. 2013;61:880–92. A meta analysis and review of the major trials evaluating the use of cardiac CT in the emergency department.

    Article  PubMed  Google Scholar 

  37. Ayaram D, Bellolio MF, Murad MH, et al. Triple rule-out computed tomographic angiography for chest pain: a diagnostic systematic review and meta-analysis. Acad Emerg Med. 2013;20:861–71.

    Article  PubMed  Google Scholar 

  38. Hoffmann U, Venkatesh V, White RD, et al. ACR appropriateness criteria((R)) acute nonspecific chest pain-low probability of coronary artery disease. J Am Coll Radiol. 2012;9:745–50.

    Article  PubMed  Google Scholar 

  39. Raff GL, Chinnaiyan KM, Cury RC, et al. SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2014;8:254–71.

    Article  PubMed  Google Scholar 

  40. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e344–426.

    Article  PubMed  Google Scholar 

  41. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.

    Article  CAS  PubMed  Google Scholar 

  42. Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370:1790–8.

    Article  CAS  PubMed  Google Scholar 

  43. Barbanti M, Yang TH, Rodes Cabau J, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation. 2013;128:244–53.

    Article  PubMed  Google Scholar 

  44. Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation. 2013;127:397–407.

    Article  PubMed  Google Scholar 

  45. Kodali S, Pibarot P, Douglas PS, et al. Paravalvular regurgitation after transcatheter aortic valve replacement with the Edwards sapien valve in the PARTNER trial: characterizing patients and impact on outcomes. Eur Heart J. 2015;36:449–56.

    Article  PubMed  Google Scholar 

  46. Joshi SB, Mendoza DD, Steinberg DH, et al. Ultra-low-dose intra-arterial contrast injection for iliofemoral computed tomographic angiography. JACC Cardiovasc Imaging. 2009;2:1404–11.

    Article  PubMed  Google Scholar 

  47. Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr. 2012;6:366–80.

    Article  PubMed  Google Scholar 

  48. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44–164.

    Article  PubMed  Google Scholar 

  49. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999–3054.

    Article  PubMed  Google Scholar 

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G Weissman declares no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Medstar Heart and Vascular Institute/Georgetown University, 110 Irving St. NW, Rm 1F-1221, Washington, DC, 20010, USA

    Gaby Weissman

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  1. Gaby Weissman
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Correspondence to Gaby Weissman.

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This article is part of the Topical Collection on Cardiac Computed Tomography

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Weissman, G. Cardiac CT in 2015: Clinical Role According to Current Multi-Societal Guidelines. Curr Cardiovasc Imaging Rep 8, 34 (2015). https://doi.org/10.1007/s12410-015-9350-0

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