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  3. Computed Tomography of the Coronary Arteries
  4. Computed Tomography of the Coronary Arteries, Second Edition – Bóksalan
  5. Computed tomography of the coronary arteries, second edition

Incidental findings were noted in patients Non-cardiac and cancer death rates were not significantly different between patients with and without incidental findings. In an observational study, Kim and colleagues evaluated the prevalence and characteristics of coronary atherosclerosis in asymptomatic subjects classified as low-risk by National Cholesterol Education Program NCEP guideline using CCTA. A total of 2, Main outcome measures were the incidence of atherosclerosis plaques and significant stenosis. In the subjects at low-risk, Especially, Mid-term follow-up The authors concluded that although an asymptomatic population classified as low-risk by the NCEP guideline has been regarded as a minimal risk group, the prevalence of atherosclerosis plaques and significant stenosis were not negligible.

However, considering very low event rate for those patients, CCTA should not be performed in low-risk asymptomatic subjects, although CCTA might have the potential for identification of high-risk groups in the selected subjects regarded as a minimal-risk group by NCEP guideline. Dorr and associates stated that clinical studies have consistently shown that there is only a very weak correlation between the angiographically determined severity of CAD and disturbance of regional coronary perfusion.

A non-invasive method combining the morphological image of the coronary anatomy with functional imaging of myocardial ischemia is therefore particularly desirable. The authors concluded that although the results are promising, due to the previously high costs, low availability and the additional radiation exposure, current data are not yet sufficient to give clear recommendations for the use of hybrid imaging in patients with a low-to-intermediate risk of CAD. The presence of cardiac symptoms, disease activity, and other co-morbidities was not associated with differences in coronary artery involvement.

The authors concluded that in patients with TA, there is a high prevalence of coronary arterial abnormalities at coronary CT angiography, regardless of disease activity or symptoms. Thus, these researchers noted that coronary CT angiography may add information on coronary artery lesions in patients with TA. Marwick et al. The authors note that functional testing prior to ICA is not widespread.

The authors reviewed the PROMISE trial outcomes and noted that although the findings are insufficient to conclude the possibility of either harm or benefit from the use of CCTA, a particularly salient feature was that although catheterization was performed in more CCTA patients in the 90 days following noninvasive testing, the likelihood of nonsignificant CAD was significantly lower in the CCTA group 3.

The authors state that CCTA is a promising noninvasive method for identification and exclusion of CAD, which may provide a diagnostic paradigm to curb unnecessary invasive testing. However, there is no definitive evidence to favor either a CCTA-guided or a stress testing—guided approach for evaluation of acute CP. Williams et al. The investigators found that despite similar overall rates vs. CCTA is generally contraindicated for decompensated heart failure; however, may be considered on a case-by-case basis Abbara et al, Jorgensen et al.

They further evaluated the use of noninvasive testing, invasive procedures, medications, and medical costs within days. Compared with functional testing, there was significantly higher use of statins Unadjusted rates of mortality 2. There was no improvement in death, myocardial infarction or major procedural complication after a median of 2-years of follow-up when compared with a functional-guided strategy.

Hoffman et al. The authors note that there are limited data from randomized trials comparing anatomic with functional testing for determining optimal management of patients with stable chest pain. The primary end point was death, myocardial infarction, or unstable angina hospitalizations over a median follow-up of In CTA, Prevalence of obstructive CAD and myocardial ischemia was low When test findings were stratified as mildly, moderately, or severely abnormal, hazard ratios for events in comparison with normal tests increased proportionally for CTA 2.

They noted that adding the Framingham Risk Score to functional test results significantly improved the prognostic value of functional testing. The authors concluded that in this population, the detection of non-obstructive CAD identifies additional at-risk patients while consideration of the Framingham Risk Score is important for proper risk stratification of patients with normal stress testing. These results may contribute to a better understanding of how to use this information to guide management of these patients. Newer generation CT scanners have emerged which allows for faster, higher-quality images.

A high-pitch spiral acquisition can be performed in less than one second and thus information from a single heartbeat can be generated. In combination with iterative reconstruction techniques, high-pitch spiral acquisition allows for cardiac CT with sub-milliSievert doses". Contraindications include acute MI, screening asymptomatic patients with low-to-intermediate risk of CAD, evaluation of coronary artery stents less than 3 mm, and evaluation of asymptomatic patients post CABG less than 5 years old and post sent placement less than 2 years old Bell et al.

CCTA with slower temporal resolution scanners, such as the slice single-source CT scanner, is not recommended in persons with significant arrhythmia or atrial fibrillation AF. These newer generation CT scanners allow faster temporal resolution and are capable of producing motion-free images Soman et al, Yang et al. Their aim was to evaluate the effects of mean heart rate HR and heart rate variation HRV on image quality and analyze the diagnostic accuracy. Diagnostic accuracy was analyzed in 30 of the 85 patients who underwent additional invasive coronary angiography ICA.

All subjects had AF longer than 1 year. On per-segment analysis, sensitivity, specificity, positive predictive value PPV , and negative predictive value NPV were Mean effective dose was 3. The Society of Cardiovascular Computed Tomography SCCT guidelines committee produced an update in which states that "the development of dual-source CT and wide-detector scanners may allow imaging of selected patients with higher and irregular heart rates such as atrial fibrillation with diagnostic imaging quality.

It should be acknowledged, however that coronary CTA in high or irregular heart rates typically is associated with a higher radiation dose. The presence of frequent premature complexes prior to scanning therefore should trigger consideration of aborting the examination. Prazeres et al. The study included subjects with AF who underwent 2 different acquisition protocols: double high-pitch DHP spiral acquisition and retrospective spiral acquisition. The image quality was ranked according to a qualitative score by 2 experts: 1, no evident motion; 2, minimal motion not influencing coronary artery luminal evaluation; and 3, motion with impaired luminal evaluation.

A third expert was included to resolve any disagreement. The results reflected that the DHP group 24 patients, segments showed more segments classified as score 1 than the retrospective spiral acquisition group There was significantly lower radiation exposure for the DHP group 3. The authors concluded that their comparison showed that a double high-pitch spiral protocol for CCTA acquisition resulted in lower radiation exposure and superior image quality in patients with AF compared with conventional spiral retrospective acquisition.

Vascular attenuation in the coronary arteries was measured. Contrast-to-noise ratio CNR was calculated. Image quality was subjectively evaluated using five-point scales. Image quality was considered diagnostic in The mean effective dose was 9. Chinnaiyan et al. The authors state that persons with BMI greater than or equal to 40 have an increased risk of cardiovascular morbidity and mortality but have not been able to obtain a CCTA due to reduced accuracy. The authors conducted an observational study of 50 patients with mean BMI Each patient served as their own control.

After a single DSCT acquisition, standard quarter-scan image reconstructions at a temporal resolution of 83 milliseconds were compared with temporal resolution reconstructions at , , and milliseconds. Images were evaluated for diagnostic adequacy score and for image noise, signal-to-noise ratio, and contrast-to-noise ratio. In each patient, the image reconstruction with the best visual diagnostic score was compared with the control image for quantitative measures.

2nd Edition

The guidelines states that "scan settings should be adjusted to the patient's body weight. Both tube voltage and tube current should be optimized to deliver the least necessary radiation for adequate image quality. In obese patients, higher tube current and tube voltage are required in order to preserve contrast to noise ratio. More importantly, tube current should be adjusted to the total volume of soft tissues within the scanned region. The specific adjustments are dependent on the scanner specifications Abbara et al. FFR is the ratio between the maximum blood flow in a narrowed artery and the maximum blood flow in a normal artery.

FFR is currently measured invasively using a pressure wire placed across a narrowed artery. An assessment by the BlueCross BlueShield Association Technology Evaluation Center BCBSA, concluded that invasive fractional flow reserve guideded percutaneous coronary intervention PCI results in better outcomes than an angiography alone guided strategy for persons who are undergoing revascularization. The assessment concluded that "The evidence is consistent with prior physiologic data and long-held beliefs that identifying stenoses is insufficient to determine when revascularization is likely to have benefit.

If revascularization is anticipated in patients with angina, evidence supports a conclusion that FFR-guided PCI results in better outcomes than an angiography alone-guided strategy. The technology is non-invasive and safe, and has a high level of diagnostic accuracy. The consultation technology document found that, using HeartFlow FFRCT may avoid the need for invasive coronary angiography and revascularisation.

Because the safety and effectiveness of FFRCT analysis has not been evaluated in other patient subgroups, HeartFlow FFRCT is not recommended in patients who have an acute coronary syndrome or have had a coronary stent, coronary bypass surgery or myocardial infarction in the past month. Documentation of ischemia around the time of revascularization is important to the appropriate use criteria AUC for percutaneous coronary interventions PCI.

Coronary artery calcium CAC scoring is a noninvasive test that has been reported to detect the presence of subclinical coronary artery disease CAD by measuring the location and extent of calcium in the coronary arteries. Purportedly, the presence of CAC has been shown to be strongly correlated with the extent of atherosclerotic plaque as well as the severity of CAD. Ultrafast computed tomography also known as electron-beam computed tomography [EBCT] has been shown to be able to quantify the amount of calcium in the coronary arteries, and thus has been primarily investigated as a tool to predict risk of CAD.

In ultrafast CT, an electron-beam is magnetically steered along stationary tungsten rings to produce a rotating X-ray beam. Research has indicated that EBCT is highly sensitive in detecting coronary artery calcification in comparison to other types of CT. Moreover, various studies have shown a strong correlation between EBCT calcium scores and quantities of atherosclerotic plaque.

However, there is skepticism about the relationship between EBCT calcium scores and the likelihood of coronary events because of the following factors:. Some advocates have argued that EBCT scores could be an effective substitute for standard risk factors in predicting the risk of coronary artery disease. However, citing evidence that shows that only a small proportion of asymptomatic individuals with calcified coronary arteries ultimately develop symptomatic coronary artery disease, a American Heart Association AHA scientific statement on coronary artery calcification concludes that the presence of coronary artery calcium is a poor predictor of coronary artery disease risk, and that there is no role for ultrafast CT as a general screening tool to detect atherosclerosis in people who have no symptoms of the disease and no risk factors.

More importantly, although a negative scan may mean a low probability of significant artery blockage in asymptomatic people with or without a previous cardiac event e. Detrano demonstrated that the addition of EBCT data provided no added value to the risk of coronary artery disease risk determined by the Framingham and National Cholesterol Education Program risk models. Several investigators have examined the potential role of ultrafast CT measurements of coronary artery calcium in ruling out coronary artery disease in patients with atypical anginal symptoms.

It must be realized, however, that ultrafast CT provides only anatomic and not physiologic information. Although ultrafast CT can be used to determine whether calcium is present in the coronary arteries, it can not replace stress testing and angiography in determining whether lesions result in significant coronary artery obstruction and ischemia.

Ultrafast CT is being investigated for this proposed use. The increased predictive value of ultrafast CT of the coronary arteries relative to traditional risk factor assessment is not yet defined. Although a greater amount of calcium may indicate a greater likelihood of obstructive disease, studies have shown that site-specificity and exact correlations are not well predicted, that is, ultrafast CT can not define the location or amount of obstruction with sufficient accuracy to be of use in predicting risk of coronary artery disease, in diagnosing coronary artery disease, or in planning surgical treatment.

Several studies have shown a variability in repeated measures of coronary calcium by ultrafast CT; therefore, use of serial ultrafast CT scans in individual patients to track the progression or regression of calcium is problematic. Although there is emerging evidence that ultrafast CT may help in identifying the presence of early coronary artery disease in people with known heart disease risk factors, there is no definitive evidence that ultrafast CT can substitute for coronary angiography because the absence of calcific deposits on an ultrafast CT scan does not imply the absence of atherosclerosis.

Conversely, the presence of calcium does not secure a diagnosis of significant angiographic narrowing.

There is still a need for further clarification regarding the relationship between calcification, atherosclerosis, and risk of plaque rupture. The critical issue that defines the utility or lack thereof of ultrafast CT is its prognostic value. The evidence in the peer-reviewed medical literature linking detectable coronary calcium to event outcomes such as future coronary bypass surgery, angioplasty, myocardial infarction, and coronary death is limited.

Large-scale prospective studies are still needed to define a role for ultrafast CT. Moreover, there is no evidence so far to support using the results of EBCT in an asymptomatic patient to select a therapy or to guide referral to invasive investigations. The clinical role of EBCT is yet to be established in terms of screening for disease or risk assessment.

Electron beam computed tomography is highly sensitive, but its specificity is low. In fact, when referral to angiography is based on the results of EBCT, referrals will be made for very few patients with normal results while many referrals will be made for those with abnormal results. The outcome will be that, in clinical practice, the observed sensitivity of EBCT will be increased, and the observed specificity will be reduced.

To date, there are no well-conducted studies that clearly demonstrate the incremental value of calcium scoring over traditional assessments of risk factors, and the clinical role of EBCT is yet to be established in terms of screening for disease or risk assessment. More research is needed to establish the effectiveness of EBCT in the role of risk factor reduction and prevention of cardiovascular disease.

Furthermore, Greenland stated that "To date, most research on EBT [electron-beam computed tomography] has been observational in nature, based entirely on self-referred patients" and that the "role of EBT remains uncertain" and that "additional randomized trials to define specific roles for EBT in risk prediction" are needed. These conclusions are consistent with those of the U. Preventive Services Task Force , which stated that there is "insufficient evidence to recommend for or against routine screening with EBCT [electron beam CT] scanning for coronary calcium for either the presence of severe [coronary artery stenosis] or the prediction of [coronary heart disease] events in adults at increased risk for coronary heart disease.

Further research is recommended in this area. The guidelines state that there are no data demonstrating that serial CAC testing leads to improved outcomes or changes in therapeutic decision making. Multi-slice or multi-row detector CT and spiral or helical CT has also been used to quantify calcium in the coronary arteries. Spiral or helical CT differs from conventional CT in that the patient is continuously rotated as he is moved.

Multi-slice CT is a technical advance over spiral CT, and uses multiple rows of detector arrays to rapidly obtain multiple slices with one pass. One study examined the accuracy of spiral CT in evaluating coronary calcification, using ultrafast CT as the gold standard for comparison, in 33 asymptomatic individuals who were referred for calcium scans. An assessment of spiral CT and multi-slice CT in screening persons with coronary artery disease by the Canadian Coordinating Office for Health Technology Assessment found no adequate long-term studies on clinical outcomes of people screened with multi-slice CT or spiral CT.

In addition, the assessment failed to identify studies that compared spiral CT and multi-slice CT with established screening modalities like risk factor algorithms. The authors noted that the low specificity of spiral CT and multi-slice CT gives rise to concern over false-positive results, and that false-positives may cause harm and expense due to inappropriate and invasive follow-up. In an editorial accompanying a meta-analysis of electron-beam CT for CAD by Pletcher et al , Ewy explained that "the clinical utility of fast computed tomography CT scanners i.

Electron beam CT is not ready for prime time. An assessment prepared for the National Coordinating Centre for Health Technology Assessment Waugh et al, found: "CT examination of the coronary arteries can detect calcification indicative of arterial disease in asymptomatic people, many of whom would be at low risk when assessed by traditional risk factors. The higher the CAC score, the higher the risk. Treatment with statins can reduce that risk.

How a 5 minute Heart CT can Help Predict a Heart Attack

However, CT screening would miss many of the most dangerous patches of arterial disease, because they are not yet calcified, and so there would be false-negative results: normal CT followed by a heart attack. There would also be false-positive results in that many calcified arteries will have normal blood flow and will not be affected by clinically apparent thrombosis: abnormal CT not followed by a heart attack.

There was insufficient evidence to support this. No study reported that calcification measuring plaque characterization reduces the incidence of coronary events or death. However, it is unclear if CAC predicts coronary heart disease in other racial or ethnic groups. These researchers collected data on risk factors and performed scanning for CAC in a population-based sample of 6, men and women, of whom The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.

There were coronary events, of which 89 were major events myocardial infarction or death from coronary heart disease. In comparison with participants with no CAC, the adjusted risk of a coronary event was increased by a factor of 7. No major differences among racial and ethnic groups in the predictive value of calcium scores were detected. Calcium scoring may be useful when performed with an otherwise indicated muti-slice cardiac CTA to assess the calcium burden of the coronary arteries to determine whether an adequate scan can be obtained.

The calcium score may be estimated with a scout scan, and the injection of contrast withheld if it appears that the patient has a prohibitively high calcium score. This allows one to avoid exposing the patient to unnecessary radiation from contrast if it is clear that the patient's calcium score is so high that an adequate image of the coronary vessels can not be obtained. In such cases, the patient may need invasive angiography to adequately assess the coronary vessels. Both traditional and chronic kidney disease-related cardiovascular risk factors contribute to this high prevalence rate.


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In patients with end-stage renal disease, CAD, especially acute myocardial infarction, is under-diagnosed. Dobutamine stress echocardiography and, to a lesser extent, stress myocardial perfusion imaging have proved useful in screening for CAD in such patients. Coronary artery calcium scoring is less useful. Acute myocardial infarction is associated with high short- and long-term mortality in dialysis patients.

Cardiac troponin I appears to be more specific than cardiac troponin T or creatine kinase MB subunits in the diagnosis of acute myocardial infarction. A total of consecutive asymptomatic subjects males; mean age of All patients underwent conventional coronary angiography CAG. Computed tomography coronary angiography has a high diagnostic accuracy for the detection of non-obstructive and obstructive CAD in high-risk asymptomatic patients with inconclusive or unfeasible stress test results. Hadamitzky et al compared CCTA with calcium scoring and clinical risk scores for the ability to predict cardiac events.

The end point was the occurrence of cardiac events cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and coronary re-vascularization later than 90 days after CCTA. Patients with obstructive CAD had a significantly higher event rate 2. The authors concluded that in patients with suspected CAD, CCTA not only detects coronary stenosis but also improves prediction of cardiac events over and above conventional risk scores and calcium scoring. In a prospective population-based study, Kavousi et al evaluated if newer risk markers for CHD risk prediction and stratification improve Framingham risk score FRS predictions.

A total of 5, asymptomatic, community-dwelling participants mean age of Traditional CHD risk factors used in the FRS age, sex, systolic blood pressure, treatment of hypertension, total and high-density lipoprotein cholesterol levels, smoking, and diabetes and newer CHD risk factors N-terminal fragment of prohormone B-type natriuretic peptide levels, von Willebrand factor antigen levels, fibrinogen levels, chronic kidney disease, leukocyte count, C-reactive protein levels, homocysteine levels, uric acid levels, CACS, carotid intima-media thickness, peripheral arterial disease, and pulse wave velocity.

Levels of N-terminal fragment of prohormone B-type natriuretic peptide also improved risk predictions but to a lesser extent c-statistic increase, 0. Improvements in predictions with other newer markers were marginal. Moreover, they stated that further investigation is needed to assess whether risk refinements using CACS lead to a meaningful change in clinical outcome. All-cause mortality and the composite of all-cause mortality and non-fatal myocardial infarction were measured.

During a median follow-up of 24 months interquartile range, 18 to 35 months , all-cause mortality occurred in individuals. Dedic et al noted that it is uncertain whether a diagnostic strategy supplemented by early CCTA is superior to contemporary standard optimal care SOC encompassing high-sensitivity troponin assays hs-troponins for patients suspected of acute coronary syndrome ACS in the emergency department ED. In a prospective, open-label, multi-center, randomized trial, these researchers examined if a diagnostic strategy supplemented by early CCTA improves clinical effectiveness compared with contemporary SOC.

They enrolled patients presenting with symptoms suggestive of an ACS at the ED of 5 community and 2 university hospitals in the Netherlands. Exclusion criteria included the need for urgent cardiac catheterization and history of ACS or coronary re-vascularization. The primary end-point was the number of patients identified with significant CAD requiring re-vascularization within 30 days. There was no difference in incidence of undetected ACS.

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The authors concluded that CCTA, applied early in the work-up of suspected ACS, is safe and associated with less out-patient testing and lower costs. However, they stated that in the era of hs-troponins, CCTA did not identify more patients with significant CAD requiring coronary re-vascularization, shorten hospital stay, or allow for more direct discharge from the ED. Calcium scores greater than have been taken as a relative contraindication for CCTA Maurya et al, Muhlestein and Moreno noted that it is well-known that there is a very high risk of cardiovascular complications among diabetic patients.

In spite of all efforts at aggressive control of diabetes and its complications, the incidence of cardiovascular morbidity and mortality remains high, including in patients with no prior symptoms, underscoring a possible advantage for appropriate screening of asymptomatic patients for the presence of obstructive CAD.

Computed Tomography of the Coronary Arteries

These investigators reviewed the results of studies designed to evaluate a possible role of CCTA in the screening of asymptomatic diabetic patients for possible obstructive CAD. The review of current literature indicated that there is still no method of CAD screening identified that has been shown to reduce the cardiovascular risk of asymptomatic diabetic patients. Thus, the use and value of screening for CAD in asymptomatic diabetic patients remains controversial. CCTA screening has shown promise and has been demonstrated to predict future risk, but as yet has not demonstrated improvement in the outcomes of these high-risk patients.

At the present state of knowledge, aggressive risk factor reduction appeared to be the most important primary prevention strategy for all asymptomatic high-risk diabetic patients.

Computed Tomography of the Coronary Arteries, Second Edition – Bóksalan

However, there remains a great need for better and more sensitive and specific screening methods, as well as more effective treatments that may allow clinicians to more accurately target diabetic patients who really are at high risk. The authors concluded that further large randomized and well-controlled clinical trials are needed to examine if screening for CAD could reduce cardiovascular event rates in patients with diabetes.

Guaricci and colleagues stated that the prognostic impact of diabetes mellitus DM on cardiovascular outcomes is well known. As a consequence of previous studies showing the high incidence of CAD in diabetic patients and the relatively poor outcome compared to non-diabetic populations, DM is considered as CAD equivalent, which means that diabetic patients are labeled as asymptomatic individuals at high cardiovascular risk.

Lessons learned from the analysis of prognostic studies over the past decade have challenged this dogma and now support the idea that diabetic population is not uniformly distributed in the highest risk box. Detecting CAD in asymptomatic high risk individuals is controversial and, what is more, in patients with diabetes is challenging, and that is why the reliability of traditional cardiac stress tests for detecting myocardial ischemia is limited.

The authors stated that CCTA represents an emerging non-invasive technique able to explore the atherosclerotic involvement of the coronary arteries and, thus, to distinguish different risk categories tailoring this evaluation on each patient. Lee and associates noted that it is well-known that diabetic patients have a high risk of cardiovascular events, and although there has been a tremendous effort to reduce these cardiovascular risks, the incidence of cardiovascular morbidity and mortality in diabetic patients remains high.

Thus, the early detection of CAD is necessary in those diabetic patients who are at risk of cardiovascular events. Significant medical and radiological advancements, including CCTA, mean that it is now possible to examine the characteristics of plaques, instead of solely evaluating the calcium level of the coronary artery. Recently, several studies reported that the prevalence of subclinical coronary atherosclerosis SCA is higher than expected, and this could impact on CAD progression in asymptomatic diabetic patients. In addition, several reports suggested the potential benefit of using CCTA for screening for SCA in asymptomatic diabetic patients, which might dramatically decrease the incidence of cardiovascular events.

For these reasons, the medical interest in SCA in diabetic patients is increasing. The authors concluded that the prevalence of SCA in diabetic patients is high, and the progression of coronary atherosclerosis leads to the onset of future CV events and is associated with a poor prognosis. Moreover, they stated that although CCTA screening has not yet been demonstrated as improving the outcomes of asymptomatic diabetic patients, it has been shown to be beneficial in predicting future risk, and is promising for screening with an additional technique.

In a few cases, patients with ages at the extremes of the decades listed may have probabilities slightly outside the high or low range. In addition, exercise stress testing is not useful in persons who are unable to exercise, persons on digoxin, persons who have a cardiac conduction abnormality that prevents achievement of an adequate heart rate response, persons on a medication e.

The American College of Cardiology defines an uninterpretable electrocardiogram as a ventricular paced rhythm, complete left bundle branch block, ventricular preexcitation arrhythmia Wolfe Parkinson White syndrome , or greater than 1 mm ST segment depression at rest. Review History. Clinical Policy Bulletin Notes. Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. Print Share. Note : Current guidelines from the American Heart Association recommend against routine stress testing for screening asymptomatic adults. Pre-operative assessment of persons scheduled to undergo 'high-risk" non-cardiac surgery, where an imaging stress test or invasive coronary angiography is being deferred unless absolutely necessary.

Pre-operative assessment for planned non-coronary cardiac surgeries including valvular heart disease, congenital heart disease, and pericardial disease, in lieu of cardiac catheterilzation as the initial imaging study, in persons with low or intermediate pretest risk of obstructive CAD. Detection and delineation of suspected coronary anomalies in young persons less than 30 years of age with suggestive symptoms e. Aetna considers CT angiography of cardiac morphology for pulmonary vein mapping medically necessary for the following indications: Evaluation of persons needing biventricular pacemakers to accurately identify the coronary veins for lead placement.

Evaluation of the pulmonary veins in persons undergoing pulmonary vein isolation procedures for atrial fibrillation pre- and post-ablation procedure. Aetna considers cardiac computed tomography CT angiography medically necessary for evaluation of aortic erosion in symptomatic members e. Aetna considers cardiac CT angiography experimental and investigational for persons with any of the following contraindications to the procedure because its effectiveness for indications other than the ones listed above has not been established: Body mass index BMI greater than 40 except when 3rd generation Dual-Source CT DSCT kv tube voltage is utilized.

Persons with extensive coronary calcification by plain film or with prior Agatston score greater than Background Cardiac CT Angiography Coronary computed tomography angiography CCTA is a noninvasive imaging modality designed to be an alternative to invasive cardiac angiography cardiac catheterization for diagnosing CAD by visualizing the blood flow in arterial and venous vessels. In a retrospective study, Kang et al evaluated coronary arterial lesions and assessed their correlation with clinical findings in patients with Takayasu arteritis TA by using coronary CT angiography.

Computed tomography angiographic, clinical, and laboratory findings of each patient were retrospectively reviewed. Statistical differences between coronary CT angiographic findings and clinical parameters were examined with uni-variate analysis. Of patients, 32 Mangold et al. The study included obese patients who had undergone CCTA performed with 3rd generation dual-source CT, prospectively ECG-triggered acquisition at kV, and automated tube current modulation. Patients were divided into three BMI groups: Calcium Scoring Coronary artery calcium CAC scoring is a noninvasive test that has been reported to detect the presence of subclinical coronary artery disease CAD by measuring the location and extent of calcium in the coronary arteries.

However, there is skepticism about the relationship between EBCT calcium scores and the likelihood of coronary events because of the following factors: Calcium does not collect exclusively at sites with severe stenosis. Substantial non-calcified plaque is frequently present in the absence of coronary artery calcification. Patients using methylxanthines e. Sick sinus syndrome or greater than than first-degree heart block in persons without a ventricular-demand pacemaker ;.

Coronary artery calcification: Pathophysiology, epidemiology, imaging methods, and clinical implications. Marwick TH. Screening for coronary artery disease. Med Clin North Am. Laudon DA. Use of electron-beam computed tomography in the evaluation of chest pain patients in the emergency department. Ann Emerg Med. O'Malley PG.

Why it's done

Rationale and design of the Prospective Army Coronary Calcium PACC Study: Utility of electron beam computed tomography as a screening test for coronary artery disease and as an intervention for risk factor modification among young, asymptomatic, active-duty United States Army Personnel. Am Heart J. Electron beam computed tomography coronary calcium as a predictor of coronary events. Electron beam computed tomography and coronary artery disease: Scanning for coronary artery calcification.

Mayo Clin Proc. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: A multicenter study. Quantification of coronary artery calcium by electron beam computed tomography for determination of severity of angiographic disease in younger patients. J Am Coll Cardiol. Relation of coronary calcium score by electron beam computed tomography to arteriography findings in asymptomatic and symptomatic adults.

Am J Cardiol. Vulnerable plaque: Relation of characteristics to degree of stenosis in human coronary arteries. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. Predictive value of electron beam computed tomography of the coronary arteries: month follow-up of asymptomatic subjects. Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease.

Computed tomography of the coronary arteries, second edition

Potential value of ultrafast computed tomography to screen for coronary artery disease. Does coronary artery screening by electron beam computed tomography motivate potentially beneficial lifestyle behaviors? Detection of coronary calcification with electron beam computed tomography: Evaluation of interexamination reproducibility and comparison of 3 image acquisition protocols.

Electron beam computed tomographic coronary calcium score cut points and severity of associated angiographic lumen stenosis. Quantification of coronary artery calcium using ultrafast computed tomography. The dye will naturally work its way out of your body. Drinking more water will help speed up this process. Your doctor or the technician will go over the results with you. Depending on what the images show, your doctor will advise you of any lifestyle changes , treatments, or procedures that need to be done. Common follow-up tests include a stress test and coronary catheterization.

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