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In Western society, coronary artery disease (CAD) remains one of the leading causes of morbidity and mortality. Extensive effort is continuously invested in the optimisation of diagnosing CAD and selecting subsequent treatment. Within this area, the role of non-invasive imaging has increased enormously. As compared with exercise ECG testing, visualisation of ischaemia using nuclear perfusion imaging (or stress echocardiography or magnetic resonance imaging) has considerably improved detection of CAD as well as appropriate selection of patients in need of further invasive evaluation. More recently, however, a new non-invasive imaging modality has been introduced, namely non-invasive computed tomography coronary angiography (CTA). In contrast to the traditional non-invasive imaging techniques, electron beam computed tomography (EBCT) and multi-slice computed tomography (MSCT) permit direct visualisation of the coronary arteries and stenoses. These techniques have attracted a lot of attention, since non-invasive assessment of coronary atherosclerosis and stenoses was previously not possible. The CT techniques have been validated against invasive coronary angiography, and excellent accuracy for detection of coronary artery stenoses was demonstrated in selected patient populations. For EBCT, pooled analysis of 538 patients demonstrated a mean sensitivity of 87% with a specificity of 91%.1 For 64-slice CT, a recent meta-analysis of six studies with 501 patients revealed even higher accuracies, with a mean sensitivity of 93% and specificity of 96% for the detection of …
Competing interests: Jeroen J Bax has research grants from GE Healthcare and BMS Medical Imaging.
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