Coronary CT Angiography in Coronary Artery Disease: from Diagnosis to Prevention

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Authors

  • Zhonghua Sun Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin Univer- sity, GPO Box U1987 Perth, Western Australia 6845, Australia
  • Cheng-Hsun Lin Department of Medical Imaging and Radiological Science, Central Taiwan University of Sci- ence and Technology, Taichung, Taiwan

DOI:

https://doi.org/10.17140/HROJ-1-101

Keywords:

Coronary artery disease, Coronary computed tomography angiography, Diagnosis, Plaque, Prognosis

Abstract

Coronary CT angiography has emerged as reliable imaging tool for the diagnosis of
coronary artery disease. Coronary CT angiography has the ability to demonstrate excellent
visualization of anatomical changes in coronary artery with high diagnostic value in the detection
of lumen stenosis or occlusion, and characterization of coronary plaque composition.
Furthermore, coronary CT angiography offers prognostic value in the prediction of adverse
cardiac events. Although coronary CT angiography is limited to the assessment of coronary
anatomy and lumen changes, coronary CT angiography-derived computer modeling and hemodynamic
analysis has the potential to evaluate functional significance of coronary artery
disease. This review article aims to provide an overview of both diagnostic and prognostic
value of coronary CT angiography in coronary artery disease. Limitations of coronary CT
angiography are briefly discussed, while functional assessment of coronary artery disease
with use of coronary CT angiography-generated coronary artery models is highlighted.

References

Sun Z, Cao Y, Li HF. Multislice computed tomography angiog-raphy in the diagnosis of coronary artery disease. J Geriatr Car-diol. 2011; 8: 104-113. doi: 10.3724/SP.J.1263.2011.00104

Sun Z, Jiang W. Diagnostic value of multislice CT angiography in coronary artery disease: A meta-analysis. Eur J Radiol. 2006; 60: 279-286. doi: 10.1016/j.ejrad.2006.06.009

Sun Z, Lin CH, Davidson R, Dong C, Liao Y. Diagnostic val--ue of 64-slice CT angiography in coronary artery disease: A systematic review. Eur J Radiol. 2008; 67: 78-84. doi: 10.1016/j.ejrad.2007.07.014

Vanhoenacker P, Heijenbrok-Kal M, Van Heste R, et al. Di-agnostic performance of multidetector CT angiography for as-sessment of coronary artery disease: meta-analysis. Radiology. 2007; 244: 419-428. doi: 10.1148/radiol.2442061218

Abdulla J, Abildstrom Z, Gotzsche O, et al. 64-multislice detector computed tomography coronary angiography as po-tential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J. 2007; 28: 3042-3050.

Stein PD, Yaekoub AY, Matta F, Sostman HD. 64-slice CT for diagnosis of coronary artery disease: a system-atic review. Am J Med. 2008; 121: 715-725. doi: 10.1016/j. amjmed.2008.02.039

Mowatt G, Cook JA, Hillis GS, et al. 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008; 94: 1386-1393. doi: 10.1136/hrt.2008.145292

Sun Z. Cardiac CT imaging in coronary artery disease: cur-rent status and future directions. Quant Imaging Med Surg. 2012; 2: 98-105. doi: 10.3978/j.issn.2223-4292.2012.05.02

Sun Z, Choo GH, Ng KH. Coronary CT angiography: cur-rent status and continuing challenges. Br J Radiol. 2012; 85: 495-510. doi: 10.1259/bjr/15296170

Johnson T, Nikolaou K, Busch S, et al. Diagnostic accu-racy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol. 2007; 42: 484-491. doi: 10.1097/RLI.0b013e31806907d0

Pelliccia F, Pasceri V, Evangelista A, et al. Diagnostic accu-racy of 320-row computed tomography as compared with inva-sive coronary angiography in unselected, consecutive patients with suspected coronary artery disease. Int J Cardiovasc Imag-ing. 2013; 29: 443-452. doi: 10.1007/s10554-012-0095-4

Schlett CL, Banerji D, Siegel E, et al. Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-year outcomes of the ROMICAT trial. JACC Cardiovasc Imaging. 2011; 4: 481-491. doi: 10.1016/j.jcmg.2010.12.008

HouZh, Lu B, Gao Y, et al. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC Cardiovasc Imaging. 2012; 5: 990-999. doi: 10.1016/j.jcmg.2012.06.006

Carrigan TP, Nair D, Schoenhagen P, et al. Prognostic utility of 64-slice computed tomography in patients with suspect-ed but no documented coronary artery disease. Eur Heart J. 2009; 30: 362-371. doi: 10.1093/eurheartj/ehn605

Motoyama S, Sarai M, Harigay H, et al. Computed tomo-graphic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009; 54: 49-57. doi: 10.1016/j.jacc.2009.02.068

Pundziute G, Schuijf JD, Jukema JW, et al. Prognostic value of multislice computed tomography coronary angiography in pa-tients with known or suspected coronary artery disease. J Am Coll Cardiol. 2007; 49: 62-70. doi: 10.1016/j.jacc.2006.07.070

Sabarudin A, Sun Z, Ng KH. A systematic review of radia-tion dose associated with different generations of multidetector CT coronary angiography. J Med Imaging Radiat Oncol. 2012; 56: 5-17. doi: 10.1111/j.1754-9485.2011.02335.x

Sun Z, Ng KH. Prospective versus retrospective ECG-gated-multislice CT coronary angiography: A systematic review of radi-ation dose and image quality. Eur J Radiol. 2012; 81: e94-e100.

SabarudinA, Sun Z, Ng KH. Coronary CT angiography with-prospective ECG-triggering: A systematic review of image qual-ity and radiation dose. Singapore Med J. 2013; 54: 15-23.doi: 10.3978/j.issn.2223-3652.2012.02.04

Sabarudin A, Khairuddin Md Yusof A,Tay MF, Ng KH, Sun Z. Dual-source CT coronary angiography: effectiveness of radia-tiondose reduction with lower tube voltage. Radiat Prot Dosim. 2013; 153: 441-447. doi: 10.1093/rpd/ncs127

Rocha-Filho JA, Blankstein R, Shturman LD, et al. Incremen-tal value of adenosine-induced stress myocardial perfusion imag-ing with dual-source CT at cardiac CT angiography. Radiology. 2010; 254(2): 410-419. doi: 10.1093/rpd/ncs127

TashakkorAY, Nicolaou S, Leipsic J, Mancini GBJ. The emerg-ing role of cardiac computed tomography for the assessment of coronary perfusion: a systematic review and meta-analysis. Can J Cardiol. 2012; 28: 413-422. doi: 10.1016/j.cjca.2012.02.010

Techasith T, Cury RC. Stress myocardial CT perfusion: An update and future perspective. JACC Cardiovasc Imaging. 2011; 4: 905-916. doi: 10.1016/j.jcmg.2011.04.017

Sun Z. Coronary CT angiography: beyond morphologi-cal stenosis analysis. World J Cardiol. 2013; 5: 444-452. doi: 10.4330/wjc.v5.i12.444

Chaichana T, Sun Z, Jewkes J. Computation of haemodynam-ics in the left coronary artery with variable angulations. J Biomech. 2011; 44: 1869-1878. doi: 10.1016/j.jbiomech.2011.04.033

Chaichana T, Sun Z, Jewkes J. Impact of plaques in the left coronary artery on walls hear stress and pressure gradient in-coronary side branches. Comput Med Biomech Biomed Eng. 2014; 17:108-118. doi: 10.1080/10255842.2012.671308

Chaichana T, Sun Z, Jewkes J. Hemodynamic impacts of various types of stenosis in the left coronary artery bifurca-tions: Apatient-specific analysis. Phys Med. 2013; 29: 447- 452. doi: 10.1016/j.ejmp.2013.02.001

Chaichana T, Sun Z, Jewkes. Haemodynamic analysis of the effect of different types of plaque at the left coronary ar-tery. Comput Med Imaging Graph. 2013; 37: 197-206. doi: 10.1016/j.compmedimag.2013.02.001

Guo SL, Guo YM, Zhai YN, et al. Diagnostic accuracy of first generation dual-source computed tomography in the assessment of coronary artery disease: a meta-analysis from 24 studies. Int J Cardiovasc Imaging. 2011; 27: 755-771. doi: 10.1007/s10554-010-9690-4

Salavati A, Radmanesh F, Heidari K, et al. Dual-source computed tomography angiography for diagnosis and assess-ment of coronary artery disease: systematic review and meta-analysis. J Cardiovasc Comput Tomogr. 2012; 6: 78-90. doi: 10.1016/j.jcct.2011.10.018

Gaudio C, Pellicia F, Evangelista A, et al. 320-row com-puted tomography angiography vs conventional coronary an-giography in patients with suspected coronary artery disease: a systematic review and meta-analysis. Int J Cardiol. 2013; 168: 1562-564.

Li S, Ni Q, Wu H, et al. Diagnostic accuracy of 320-slice computed tomography angiography for detection of coronary artery stenosis: Meta-analysis. Int J Cardiol. 2013; 168: 2699- 705. doi: 10.1016/j.ijcard.2013.03.023

Sun Z. Comment on: Diagnostic accuracy of 320-slice computed tomography angiography for detection of coronary artery stenosis: meta-analysis (Int J Cardiol, http://dx.doi. org/10.1016/j.ijcard.2013.03.023). Int J Cardiol. 2013; 168: 4895-4896. doi: 10.1016/j.ijcard.2013.07.023

Sabarudin A, Sun Z, Yusof AK. Coronary CT angiography with single-source and dual-source CT: comparison of image quality and radiation dose between prospective ECG-triggered and retrospective ECG-gated protocols. Int J Cardiol. 2013; 168: 746-53. doi: 10.1016/j.ijcard.2012.09.217

Earls JP, Berman EL, Urban BA, et al. Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology. 2008;246:742-753. doi: 10.1148/ radiol.2463070989

Shuman W, Branch K, May J, et al. Prospective versus ret rospective ECG gating for 64-detector CT of the coronary arter-ies: comparison of image quality and patient radiation dose. Radi-ology. 2008;248:431-7. doi: 10.1148/radiol.2482072192

Xu L, Yang L, Zhang Z, et al. Low-dose adaptive sequential scan for dual-source CT coronary angiography in patients with high heart rate: comparison with retrospective ECG gating. Eur J Radiol. 2010; 76: 183-187. doi: 10.1016/j.ejrad.2009.06.003

vanBallmoos MW, Haring B, Juillerat P, Alkadhi H. Meta-analysis: diagnostic performance of low-radiation-dose coronary computed tomography angiography. Ann Intern Med. 2011; 154: 413-420. doi: 10.7326/0003-4819-154-6-201103150-00007

Sun Z, Ng KH. Diagnostic value of coronary CT angiography with prospective ECG-gating in the diagnosis of coronary artery disease: a systematic review and meta-analysis. Int J Cardiovasc Imaging. 2012; 28: 2109-2119. doi: 10.1007/s10554-011-0006-0

Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: A callfor new definitions and risk assess-ment strategies: Part II. Circulation. 2003; 108: 1772-1778. doi: 10.1161/01.CIR.0000087480.94275.97

Sun Z, Dimpudus FJ, Nugroho J, Adipranoto JD. CT virtual intravascular endoscopy assessment of coronary artery plaques: A preliminary study. Eur J Radiol. 2010; 75: e112-e119. doi: 10.1016/j.ejrad.2009.09.007

Lou YC, Sun Z, ChanT, et al. Significance of coronary calci-fication for prediction of coronary artery disease cardiac events-based on 64-slice computed tomography coronary angiogra-phy.Biomed Res Int. 2013; (2013): 472347. doi: http://dx.doi. org/10.1155/2013/472347

Chow BJ, Wells GA, Chen L, et al. Prognostic value of 64- slice cardiac computed tomographyseverity of coronary artery disease, coronary atherosclerosis, and leftventricular ejection fraction. J Am Coll Cardiol. 2010; 55:1017-1028. doi: 10.1016/j. jacc.2009.10.039

Miszalski-Jamka T, Klimeczek P, Banys R, et al. The compo-sition and extent of coronary artery plaque detected by multislice computed tomographic angiography provides incremental prog-nostic value in patients with suspected coronary artery disease. Int J Cardiovasc Imaging. 2012; 28: 621-631. doi: 10.1007/s10554- 011-9799-0

Yiu KH, de Graaf FR, Schuijf JD, et al. Age- and gender-specific differences in the prognostic value of CT coronary an-giography. Heart. 2012; 98: 232-237. doi: 10.1136/heartjnl-2011- 300038

Andreini D, Pontone G, Mushtaq S, et al. A long-term prog-nostic value of coronaryCT angiography in suspected coronary artery disease. JACC Cardiovasc Imaging. 2012; 5: 690-701. doi: 10.1016/j.jcmg.2012.03.009

Sozzi FB, Civaia F, Rossi P, et al. Long-term follow-up of patients with first-time chest pain having 64-slice computed to-mography. Am J Cardiol. 2011; 107: 516-521. doi: 10.1016/j. amjcard.2010.10.006

Hadamitzky M, Taubert S, Deseive S, et al. Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patientswith suspected coronary artery disease. Eur Heart J. 2013; 34:3 277-3285. doi: 10.1093/eur-heartj/eht293

Shaw LJ, Min JK, Narula J, et al. Sex differences in mor-talityassociated with computed tomographic angiographic measurements of obstructive and nonobstructive coronary ar-tery disease. Circ Cardiovasc Imaging. 2010; 3: 473-481. doi: 10.1161/CIRCIMAGING.109.860981

Dougoud S, Fuchs TA, Stehli J, et al. Prognostic value of coronary CT angiography on long-term follow-up of 6.9 years. Int JCardiovasc Imaging. 2014; 30: 969-976. doi: 10.1007/ s10554-014-0420-1

Abdulla J, Asferg C, Kofoed KF. Prognostic value of ab-sence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography: a sys-tematic review and meta-analysis. Int J Cardiovasc Imaging. 2011; 27: 413-420. doi: 10.1007/s10554-010-9652-x

Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Vil-linesTC. Prognostic value of cardiac computed tomogra-phy angiography: A systematic review and meta-analysis. J Am Coll Cardiol. 2011; 57: 1237-1247. doi: 10.1016/j. jacc.2010.10.011

Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary computed tomographic angiography for sys-tematic triage of acute chest painpatients to treatment) trial. J Am Coll Cardiol. 2011; 58: 1414-1422. doi: 10.1016/j. jacc.2011.03.068

Min JK, Dunning A, Lin FY, et al. Age- and sex-related differences in all-cause mortality risk based on coronary com-puted tomography angiographyfindings results from the Inter-national Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter Registry) of 23,854patients without known coronary artery disease. J Am Coll Cardiol. 2011; 58: 849-860. doi: 10.1016/j. jacc.2011.02.074

Min JK, Lin FY, Dunning AM, et al. Incremental prognos-tic significance of left ventricular dysfunction to coronary ar-tery disease detection by 64-detector row coronary computed tomographic angiography for the prediction of all-cause mor-tality: results from a two centre study of 5330 patients. Eur Heart J. 2010; 31: 1212-1219. doi: 10.1093/eurheartj/ehq020

Min JK, Feignoux J, Treutenaere J, Laperche T, Sablayrolles J. Theprognostic value of multidetector coronary CT angiogra-phy for theprediction of major adverse cardiovascular events: a multicenter observationalcohort study. Int J Cardiovasc Imaging. 2010; 26: 721-728. doi: 10.1007/s10554-010-9613-4

Hadamitzky M, Freissmuth B, Meyer T, et al. Prognostic value ofcoronary computed tomographic angiography for prediction of cardiacevents in patients with suspected coronary artery disease. JACC Cardiovasc Imaging. 2009; 2: 404 -411. doi: 10.1016/j. jcmg.2008.11.015

Achenbach S, Marwan M, Ropers D, et al. Coronary com-puted tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2010; 31: 340-346. doi: 10.1093/ eurheartj/ehp470

Lell M, Marvan M, Schepis T, et al. Prospectively ECG-trig-gered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience. Eur Ra-diol. 2009; 19: 2576-2583. doi: 10.1007/s00330-009-1558-4

Lee TY, Chhem RK. Impact of new technologies on dose reduction in CT. Eur J Radiol. 2010; 76: 28-35. doi: 10.1016/j. ejrad.2010.06.036

Leipsic J, Heilbron BG, Hague C. Iterative reconstruction for coronary CT angiography: findings its way. Int J Cardiovasc Im-aging. 2012; 28: 613-620. doi: 10.1007/s10554-011-9832-3

Sun Z, Ng KH. Coronary computed tomography angiography in coronary artery disease. World J Cardiol. 2011; 3: 303-310.

Matter CM, Stuber M, Nahrendorf M. Imaging of the unstable plaque: how far have we got? Eur Heart J. 2009; 30: 2566-2574. doi: 10.1093/eurheartj/ehp419

Hoffmann U, Moselewski F, Nieman K, et al. Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable angina by multidetector computed tomography. J Am Coll Cardiol. 2006; 47: 1655-1662. doi: 10.1016/j.jacc.2006.01.041

Nissen SE, Nicholls SJ, Sipahi I, et al. Effect of very high-intensitystatin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA. 2006; 295: 1556-1565. doi: 10.1001/ jama.295.13.jpc60002

Nissen SE, Tuzcu EM, Schoenhagen P, et al. Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med. 2005; 352: 29-38. doi: 10.1056/NEJMoa042000

Achenbach S, Ropers D, Kuettner A, et al. Contrast-enhanced-coronary artery visualization by dual-source computed tomog-raphy-initial experience. Eur J Radiol. 2006; 57: 331-335. doi: 10.1016/j.ejrad.2005.12.017

Brodoefel H, Burgstahler C, Tsiflikas I, et al. Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy. Radiology. 2008; 247: 346-355. doi: 10.1148/radiol.2472070906

Sato A, Hiroe M, Tamura M, et al. Quantitative mea-sures of coronary stenosis severity by 64-slice CT angiogra-phy and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfu-sion imaging. J Nucl Med. 2008; 49: 564-572. doi: 10.2967/ jnumed.107.042481

Hachamovitch R, Di Carli MF. Nuclear cardiology will re-main the‘‘gatekeeper’’ over CT angiography. J Nucl Cardiol. 2007; 14: 634-644. doi: 10.1016/j.nuclcard.2007.06.118

Tamarappoo BK, Gutstein A, Cheng VY, et al. Assessment of the relationship between stenosis severity and distribution of coronary artery stenoses on multislice computed tomographic angiographyand myocardial ischemia detected by single pho-ton emissioncomputed tomography. J Nucl Cardiol. 2010; 17: 791-802. doi: 10.1007/s12350-010-9230-6

Trzaska ZJ, Cohen MC. SPECT vs CT: CT is the not the first line test for the diagnosis and prognosis of stable coro-nary artery disease. J Nucl Cardiol. 2013; 20: 473-478. doi: 10.1007/s12350-013-9709-z

Alijzeeri A, Cocker MS, Chow BJW. CT vs SPECT: CT is the first-line test for the diagnosis and prognosis of stable coro-nary artery disease. J Nucl Cardiol. 2013; 20: 465-72.

Zhang JM, Zhong L, Su B, et al. Perspective on CFD stud-ies of coronary artery disease lesions and hemodynamics: A review. Int J Numer Metho Biomed Eng. 2014. doi: 10.1007/ s12350-013-9690-6

Knight J, Olgac U, Saur SC, et al. Choosing the optimal wall shear parameter for the prediction of plaque location-A patient-specific computational study in human right coronary arteries. Atherosclerosis. 2010; 211: 445-450. doi: 10.1016/j. atherosclerosis.2010.03.001

Wellnhofer E, Osman J, Kertzscher U, Affeld K, Fleck E, Gou¬bergrits L. Flow simulation studies in coronary arteries--impact of side-branches. Atherosclerosis. 2010; 213: 475-448. doi: 10.1016/j.atherosclerosis.2010.09.007

Holzapfel GA, Mulvihill JJ, Cunnane EM, Walsh MT. Computational approaches for analyzing the mechanics of ath-erosclerotic plaques: a review. J Biomech. 2014; 47: 859-869. doi: 10.1016/j.jbiomech.2014.01.011

Taylor CA, Fonte TA, Min JK. Computational fluid dy-namics applied to cardiac computed tomography for nonin-vasive quantification of fractional flow reserve: Scientific ba-sis. J Am Coll Cardiol. 2013; 61: 2233-2241. doi: 10.1016/j. jacc.2012.11.083

Zarins CK, Taylor CA, Min JK. Computed fractional flow reserve (FFRCT) derived from coronary CT angiography. J Car-diovasc Trans Res. 2013; 6: 708-714. doi: 10.1007/s12265-013- 9498-4

Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Re-sults from the prospective multicenter discover-flow (diagnosis of ischemia-causing stenoses obtained via noninvasive fractional flow reserve) study. J Am Coll Cardiol. 2011; 58: 1989-1997. doi: 10.1016/j.jacc.2011.06.066

Min JK, Berman DS, Budoff MJ, et al. Rationale and design of the DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic AngiOgraphy) study. J Cardiovasc Comput Tomogr. 2011; 5: 301-309. doi: 10.1016/j. jcct.2011.08.003

Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease: The NXT trial. J Am Coll Cardiol. 2014; 63: 1145-1155. doi: 10.1016/j. jacc.2013.11.043

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Published

2014-05-26

How to Cite

Zhonghua Sun, & Cheng-Hsun Lin. (2014). Coronary CT Angiography in Coronary Artery Disease: from Diagnosis to Prevention. Heart Research, 1(1), 1–9. https://doi.org/10.17140/HROJ-1-101

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