Cardiac and coronary CT comprehensive imaging approach in the assessment of coronary heart disease

Abstract

Cardiac CT is a rapidly advancing technology. Non-invasive CT coronary angiography is an established technique for assessing coronary heart disease with accuracy similar to invasive coronary angiography. CT myocardial perfusion imaging can now identify perfusion defects in animal models and humans. MRI is the current 'gold standard' for the assessment of myocardial viability, but it is now also possible to assess delayed enhancement by CT. This has led to the possibility of a 'one-stop shop' for cardiovascular imaging that would provide information on anatomy, function, perfusion and viability in one rapid diagnostic test at a radiation dose equivalent to contemporary nuclear medicine imaging. This review discusses the current status of 'one-stop shop' cardiac CT assessment, clinical utility and directions for future research.

Diagnostic Performance of High-Sensitive Troponin T in Patients With Renal Insufficiency

“…Coronary computed tomography angiography to rule out significant coronary stenosis represents an option but is problematic in patients with renal insufficiency because of the necessary administration of contrast media. 12,13 Although our study is limited by its heterogeneous patient population, which ranged from patients with true ACS to trauma patients, it does reflect a real-life situation. The decision to order high-sensitive troponin T measurements was at the discretion of the physician in charge, and we do not have information as to how the physicians arrived at their decisions.…”

Myocardial perfusion scintigraphy: technical innovations and evolving clinical applications

“…Perfusion imaging by CT is also feasible following similar principles to first-pass gadolinium CMR and is currently under investigation 59. Stress echocardiography with the use of exercise or dobutamine identifies the presence of flow-limiting coronary stenosis in the form of ischaemia-induced regional wall motion abnormality with a sensitivity of 89% for exercise and 72% for dobutamine stress 60.…”

Non-Invasive Imaging of Coronary Artery Disease — The Expanding Role of Coronary Computed Tomographic Angiography in the Management of Low- to Intermediate-Risk Patients and Dealing with Intermediate Stenosis

“…Furthermore, up to 40% of the patients who do go on to have elective ICA are found to have sub-clinical stenosis in all coronary arteries. [4,5] This highlights the inadequate and inaccurate information provided by orthodox first-/second-line investigations in the assessment of symptomatic patients with suspected CAD.…”

“…Another reason why a good understanding of the pathophysiology of atherosclerosis is important is because the composition of the atherosclerotic plaque itself is having an incremental role in interpreting the significance of imaging findings. [4,7,8,12] During the process of atherosclerosis, 'bad' cholesterol, low-density lipoproteins, accumulate under the intimal wall; these lipids quickly become oxidised and are engulfed by tissue macrophages forming 'foam cells'. Another thing that happens, not necessarily in a sequential order, is that smooth muscle cells are moved away from their native sites in the media and these migrate into the intima.…”