Responsible Use of Computed Tomography in the Evaluation of Coronary Artery Disease and Chest Pain

Winchester, David E.; Wymer, David C.; Shifrin, Roger Y.; Kraft, Steven M.; Hill, James A.
April 2010
Mayo Clinic Proceedings;Apr2010, Vol. 85 Issue 4, p358
Academic Journal
Many options are available to clinicians for the noninvasive evaluation of the cardiovascular system and patient concerns about chest discomfort. Cardiac computed tomography (CT) is a rapidly advancing field of noninvasive imaging. Computed tomography incorporates coronary artery calcium scoring, coronary angiography, ventricular functional analysis, and information about noncardiac thoracic anatomy. We searched the PubMed database and Google from inception to September 2009 for resources on the accuracy, risk, and predictive capacity of coronary artery calcium scoring and CT coronary angiography and have reviewed them herein. Cardiac CT provides diagnostic information comparable to echocardiography, nuclear myocardial perfusion imaging, positron emission tomography, and magnetic resonance imaging. A cardiac CT study can be completed in minutes. In patients with a nondiagnostic stress test result, cardiac CT can preclude the need for invasive angiography. Prognostic information portends excellent outcomes in patients with normal study results. Use of cardiac CT can reduce health care costs and length of emergency department stays for patients with chest pain. Cardiac CT examination provides clinically relevant information at a radiation dose similar to well-established technologies, such as nuclear myocardial perfusion imaging. Advances in technique can reduce radiation dose by 90%. With appropriate patient selection, cardiac CT can accurately diagnose heart disease, markedly decrease health care costs, and reliably predict clinical outcomes.


Related Articles

  • Coronary vasomotion in patients with syndrome X: evaluation with positron emission tomography and parametric myocardial perfusion imaging. Meeder, Joan G.; Blanksma, Paul K.; van der Wall, Ernst E.; Willemsen, Antoon T. M.; Pruim, Jan; Anthonio, Rutger L.; de Jong, Richard M.; Vaalburg, Willem; Lie, Kong I. // European Journal of Nuclear Medicine;1997, Vol. 24 Issue 5, p530 

    The aim of this study was to elucidate further the causative mechanism of abnormal coronary vasomotion in patients with syndrome X. In patients with syndrome X, defined as angina pectoris and documented myocardial ischaemia during stress testing with normal findings at coronary angiography,...

  • The Potential Value of Ultrasonic Deformation Measurement in Differentiating Regional Ischaemic Substrates During Dobutamine Stress Echocardiography. Kowalski, M; Herbots, L; Weidemann, F; Dommke, C; Mertens, P; Mortelmans, L; Bijnens, B; Herregods, M.-C; Sutherland, G.R // European Journal of Echocardiography;2003, Vol. 4 Issue 1, p23 

    The differentiation between differing regional ischaemic substrates is crucial for decision-making in patients with coronary artery disease. This study demonstrates that quantification of dobutamine stress echocardiography using ultrasonic strain measurement has the potential to identify three...

  • Miyokard perfüzyon sintigrafisi, eforlu EKG ve koroner anjiografi sonuçlarının karşılaÅŸtırılması. Dostbil, Zeki; Çil, Habib; Atılgan, Zuhal Arıtürk; Tekbaş, Ebru; Kaya, Buğra; Kaya, Savaş // Dicle Medical Journal / Dicle Tip Dergisi;2010, Vol. 37 Issue 2, p104 

    Aim: Coronary artery disease is one of the most frequent causes of mortality and morbidity seen all over the world. In definite diagnosis of the atherosclerotic coronary artery stenosis, coronary angiography is used. In this study, additional contribution of the effort stress testing together...

  • Conservative Treatment of Spontaneous Dissection of Multiple Coronary Arteries Hunt, Benjamin; Chua, Roderick; Bett, Nicholas // Heart, Lung & Circulation;Nov2010, Vol. 19 Issue 11, p678 

    A young woman who presented with chest pain was shown with CT and selective coronary angiography to have spontaneous dissections of her left anterior descending and distal right coronary arteries. She was managed with enoxaparin, aspirin, clopidogrel and metoprolol: she was well with a normal...

  • Thallium-201 gated single-photon emission tomography for the assessment of left ventricular ejection fraction and regional wall motion abnormalities in comparison with two-dimensional echocardiography. Bacher-Stier, Claudia; Müller, Silvana; Pachinger, Othmar; Strolz, Silvia; Erler, Hermann; Moncayo, Roy; Wenger, Martin; Donnemiller, Eveline; Riccabona, Georg // European Journal of Nuclear Medicine;1999, Vol. 26 Issue 12, p1533 

    Abstract. Simultaneous assessment of myocardial perfusion and function by gated single-photon emission tomography (GS) after a single tracer injection provides incremental information and is feasible with technetium99m sestamibi. The present study validated the use of GS with thallium-201 for...

  • Myocardial perfusion scintigraphy and echocardiography for detecting coronary artery disease in hypertensive patients: a meta-analysis. Gargiulo, Paola; Petretta, Mario; Bruzzese, Dario; Cuocolo, Alberto; Prastaro, Maria; D'Amore, Carmen; Vassallo, Enrico; Savarese, Gianluigi; Marciano, Caterina; Paolillo, Stefania; Filardi, Pasquale // European Journal of Nuclear Medicine & Molecular Imaging;Nov2011, Vol. 38 Issue 11, p2040 

    Purpose: This meta-analysis summarized the accuracy of stress myocardial perfusion scintigraphy (MPS) and stress echocardiography for the diagnosis of coronary artery disease (CAD) in patients with arterial hypertension. Methods: We searched for studies in which stress MPS or stress...

  • Mayo Clinic Proceedings. Bax, Jeroen J.; Schuijf, Joanne D. // Mayo Clinic Proceedings;Jan2008, Vol. 83 Issue 1, p10 

    The article discusses the association of coronary calcification and myocardial perfusion scintigraphy (MPS). It has an essential role in diagnosis and management of patients presenting with known or suspected coronary artery disease. It is also the most commonly used and well-documented...

  • Multidetector-row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic, but atypical, chest pain. Herzog, Christopher; Britten, Martina; Balzer, Joern O.; Mack, M. G.; Zangos, Stefan; Ackermann, Hanns; Schaechinger, Volker; Schaller, Stefan; Flohr, Thomas; Vogl, Thomas J. // European Radiology;Feb2004, Vol. 14 Issue 2, p169 

    The aim of this study was to investigate the accuracy of multidetector-row cardiac CT (MDCT), calcium scoring (Ca-Sc), and MDCT coronary angiography (MD CTA) in the assessment of coronary atherosclerosis. Thirty-eight patients underwent invasive coronary angiography (CA) and MDCT (collimation...

  • Outcome of coronary plaque burden: a 10-year follow-up of aggressive medical management. Goh, Victor K.; Chu-Pak Lau; Mohlenkamp, Stefan; Rumberger, John A.; Achenbach, Stephan; Budoff, Matthew J. // Cardiovascular Ultrasound;2010, Vol. 8, p5 

    Background: The effect of aggressive medical therapy on quantitative coronary plaque burden is not generally known, especially in ethnic Chinese. Aims: We reasoned that Cardiac CT could conveniently quantify early coronary atherosclerosis in our patient population, and hypothesized that serial...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics