Prognostic value of cardiac CT
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CARDIAC RADIOLOGY
Prognostic value of cardiac CT Sara Seitun1 · Alberto Clemente2 · Erica Maffei3 · Patrizia Toia4 · Ludovico La Grutta4 · Filippo Cademartiri5 Received: 10 June 2020 / Accepted: 3 September 2020 © Italian Society of Medical Radiology 2020
Abstract In the past decades, coronary computed tomography angiography (CCTA) has become a powerful tool in the management of coronary artery disease. The diagnostic and prognostic value of CCTA has been extensively demonstrated in both large observational studies and clinical trials among stable chest pain patients. The quantification of coronary artery calcium score (CACS) is a well-established predictor of cardiovascular morbidity and mortality in asymptomatic subjects. Besides CACS, the main strength of CCTA is the accurate assessment of the individual total atherosclerotic plaque burden, which holds important prognostic information. In addition, CCTA, by providing detailed information on coronary plaque morphology and composition with identification of specific high-risk plaque features, may further improve the risk stratification beyond the assessment of coronary stenosis. The development of new CCTA applications, such as stress myocardial CT perfusion and computational fluids dynamic applied to standard CCTA to derive CT-based fractional flow reserve (FFR) values have shown promising results to guide revascularization, potentially improving clinical outcomes in stable chest pain patients. In this review, starting from the role of CACS and moving beyond coronary stenosis, we evaluate the existing evidence of the prognostic effectiveness of the CCTA strategy in real-world clinical practice. Keywords Cardiovascular imaging · Coronary computed tomography · Cardiac CT · Coronary artery disease · CAD · Chest pain · Prognosis · Atherosclerosis · Stratification · Risk assessment · FFR-CT · CACS · Calcium score · Risk factors
Introduction Coronary computed tomography angiography (CCTA) has evolved during the last two decades into an important tool in the management of patients with suspected coronary artery disease (CAD). Due to its high diagnostic accuracy with an excellent negative predictive value, CCTA can be safely used for the identification of CAD [1, 2]. Besides the * Filippo Cademartiri [email protected] 1
Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
2
Department of Radiology, CNR (National Council of Research)/Tuscany Region ‘Gabriele Monasterio’ Foundation (FTGM), Massa, Italy
3
Department of Radiology ‑ Area Vasta 1 ‑ ASUR Marche, Ospedale Civile “Santa Maria della Misericordia” di Urbino, Viale Federico Comandino, 70, 61029 Urbino, PU, Italy
4
Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
5
SDN IRCCS, Naples, Italy
diagnostic accuracy, large-scale registry studies and recent randomized controlled trials have demonstrated the value of CCTA for prediction of clinical outcomes [3–5]. In view of its diagnostic and prognostic performance, the current European Gui
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