The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease
Coronary computed tomography angiography (CCTA) allows the assessment of the presence and severity of obstructive and nonobstructive atherosclerotic coronary artery disease. With software developments incorporating artificial intelligence-based automated image analysis along with improved spatial re...
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Elsevier
2024-11-01
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| Series: | Journal of the Society for Cardiovascular Angiography & Interventions |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772930324016107 |
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| author | Sophie E. van Rosendael, MD, PhD Arthur Shiyovich, MD Rhanderson N. Cardoso, MD Camila Veronica Souza Freire, MD Alexander R. van Rosendael, MD, PhD Fay Y. Lin, MD Gina Larocca, MD Solomon W. Bienstock, MD Ron Blankstein, MD Leslee J. Shaw, PhD |
| author_facet | Sophie E. van Rosendael, MD, PhD Arthur Shiyovich, MD Rhanderson N. Cardoso, MD Camila Veronica Souza Freire, MD Alexander R. van Rosendael, MD, PhD Fay Y. Lin, MD Gina Larocca, MD Solomon W. Bienstock, MD Ron Blankstein, MD Leslee J. Shaw, PhD |
| author_sort | Sophie E. van Rosendael, MD, PhD |
| collection | DOAJ |
| description | Coronary computed tomography angiography (CCTA) allows the assessment of the presence and severity of obstructive and nonobstructive atherosclerotic coronary artery disease. With software developments incorporating artificial intelligence-based automated image analysis along with improved spatial resolution of CT scanners, volumetric measurements of atherosclerotic plaque, detection of high-risk plaque features, and delineation of pericoronary adipose tissue density can now be readily and accurately evaluated for a given at-risk patient. Many of these expanded diagnostic measures have been shown to be prognostically useful for prediction of major adverse cardiac events. The incremental value of plaque quantification over diameter stenosis has yet to be thoroughly discovered in current studies. Furthermore, the physiological significance of lesions can also be assessed with CT-derived fractional flow reserve, myocardial CT perfusion, and more recently shear stress, potentially leading to selective invasive coronary angiography and revascularization. Along with these technological advancements, there has been additional high-quality evidence for CCTA including large randomized clinical trials supporting high-level recommendations from many international clinical practice guidelines. Current trials largely compare a CCTA vs functional testing strategy, yet there is minimal evidence on CCTA plaque-guided therapeutic trials to measure regression of atherosclerosis and prevention of major coronary artery disease events. In this review, we summarize current evidence on comprehensive risk assessment with CCTA and future directions. |
| format | Article |
| id | doaj-art-04f653a540434bd6b0281b6cc2d3d1af |
| institution | OA Journals |
| issn | 2772-9303 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Society for Cardiovascular Angiography & Interventions |
| spelling | doaj-art-04f653a540434bd6b0281b6cc2d3d1af2025-08-20T02:32:41ZengElsevierJournal of the Society for Cardiovascular Angiography & Interventions2772-93032024-11-0131110223010.1016/j.jscai.2024.102230The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery DiseaseSophie E. van Rosendael, MD, PhD0Arthur Shiyovich, MD1Rhanderson N. Cardoso, MD2Camila Veronica Souza Freire, MD3Alexander R. van Rosendael, MD, PhD4Fay Y. Lin, MD5Gina Larocca, MD6Solomon W. Bienstock, MD7Ron Blankstein, MD8Leslee J. Shaw, PhD9Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New YorkDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MassachusettsDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MassachusettsDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MassachusettsDepartment of Cardiology, Leiden University Medical Center, Leiden, the NetherlandsIcahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New YorkIcahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New YorkIcahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New YorkDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MassachusettsIcahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York; Corresponding authorCoronary computed tomography angiography (CCTA) allows the assessment of the presence and severity of obstructive and nonobstructive atherosclerotic coronary artery disease. With software developments incorporating artificial intelligence-based automated image analysis along with improved spatial resolution of CT scanners, volumetric measurements of atherosclerotic plaque, detection of high-risk plaque features, and delineation of pericoronary adipose tissue density can now be readily and accurately evaluated for a given at-risk patient. Many of these expanded diagnostic measures have been shown to be prognostically useful for prediction of major adverse cardiac events. The incremental value of plaque quantification over diameter stenosis has yet to be thoroughly discovered in current studies. Furthermore, the physiological significance of lesions can also be assessed with CT-derived fractional flow reserve, myocardial CT perfusion, and more recently shear stress, potentially leading to selective invasive coronary angiography and revascularization. Along with these technological advancements, there has been additional high-quality evidence for CCTA including large randomized clinical trials supporting high-level recommendations from many international clinical practice guidelines. Current trials largely compare a CCTA vs functional testing strategy, yet there is minimal evidence on CCTA plaque-guided therapeutic trials to measure regression of atherosclerosis and prevention of major coronary artery disease events. In this review, we summarize current evidence on comprehensive risk assessment with CCTA and future directions.http://www.sciencedirect.com/science/article/pii/S2772930324016107coronary artery diseasecoronary computed tomography angiographymajor adverse cardiac event |
| spellingShingle | Sophie E. van Rosendael, MD, PhD Arthur Shiyovich, MD Rhanderson N. Cardoso, MD Camila Veronica Souza Freire, MD Alexander R. van Rosendael, MD, PhD Fay Y. Lin, MD Gina Larocca, MD Solomon W. Bienstock, MD Ron Blankstein, MD Leslee J. Shaw, PhD The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease Journal of the Society for Cardiovascular Angiography & Interventions coronary artery disease coronary computed tomography angiography major adverse cardiac event |
| title | The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease |
| title_full | The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease |
| title_fullStr | The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease |
| title_full_unstemmed | The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease |
| title_short | The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease |
| title_sort | role of cardiac computed tomography angiography in risk stratification for coronary artery disease |
| topic | coronary artery disease coronary computed tomography angiography major adverse cardiac event |
| url | http://www.sciencedirect.com/science/article/pii/S2772930324016107 |
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