The role of coronary computed tomography angiography in cardiology consultation

Cardiac computed tomography (CCT) has rapidly become an integral part of noninvasive diagnostic cardiovascular imaging. Coronary artery calcium scoring using either electronic beam computed tomography (CT) or multidetector row CT is useful in the reclassification of coronary artery disease (CAD) risk when combined with the clinical CAD risk scoring in asymptomatic individuals. Coronary computed tomography angiography (CCTA) has a very high negative predictive value for ruling out the presence of significant obstructive CAD in symptomatic patients with either chronic or acute chest pain. Newer generation of scanners and software algorithms allows CCT studies to be performed easily in more patients with much lower effective radiation exposure. CCTA allows infinite viewing angle of the heart and its associated vascular structure retrospectively and is thus an invaluable and unique diagnostic tool for the assessment of cardiac structure and morphology prior to invasive procedures. Moreover, CCT aids in the diagnosis and management of patients with complex congenital heart disease and suspected coronary anomalies. It often obviates the need for invasive coronary angiography prior to noncoronary cardiac surgery and early post-coronary artery bypass grafting or coronary stenting for evaluation of the patency of native, grafted, or stented coronary vessels. Novel research applications of CCTA in the assessment of stress and rest myocardial perfusion, cardiac viability, and atherosclerotic plaque imaging may further open the window of opportunity for CCT to be the ultimate multipurpose diagnostic imaging modality of the future.