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Non-invasive imaging
Current applications and limitations of coronary computed tomography angiography in stable coronary artery disease
  1. Joanne D Schuijf1,
  2. Stephan Achenbach2,
  3. Pim J de Feyter3,
  4. Jeroen J Bax1
  1. 1Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
  2. 2Department of Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany
  3. 3Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
  1. Correspondence to Professor J J Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; j.j.bax{at}

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The introduction of non-invasive coronary angio-graphy with multidetector row computed tomo-graphy (CT) has the potential to substantially impact clinical cardiology. In the past, visualisation of coronary anatomy could only be obtained through invasive coronary angiography and therefore was restricted to patients with a high degree of clinical suspicion of haemodynamically relevant coronary artery stenoses, usually through evidence of ischaemia on non-invasive functional tests. The availability of a non-invasive approach is likely to change current indications and restrictions for angiographic evaluation. However, the technique is relatively new and is in continuous development. As a result, many potential clinical applications of coronary CT angiography (CCTA) have not been fully evaluated by clinical trials. Consequently, formal guidelines for the use of CCTA do not exist. In addition, some of the data obtained by recent trials may seem contradictory at first, resulting in uncertainty as to whether clinicians should utilise this technique in daily practice and, if so, which patients are most likely to benefit.1–3 w1–w3

In order to better appreciate the potential role of CCTA, the available data must be interpreted in the context of the particular strengths and limitations of the technique itself as well as characteristics of the investigated populations. The purpose of this article is to provide a perspective on potential applications of CCTA based on current technology and available clinical data.

Technical aspects in performing CCTA

Visualisation of the coronary arteries requires high spatial and temporal resolution. High temporal resolution is needed to obtain motion-free images of the coronary arteries which show rapid movement during the cardiac cycle. In addition, high spatial resolution is required to adequately visualise the small coronary artery segments that range in diameter from a few millimetres proximally to submillimetre size more distally. At present, invasive, catheter based coronary angiography still constitutes the ‘gold standard’ for coronary artery visualisation. …

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  • Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. Jeroen J Bax has research grants from Biotronik (Berlin, Germany), BMS Medical Imaging (North Billerica, Massachusetts), Boston Scientific (Natick, Massachusetts), Edwards Lifesciences (Irvine, California), GE Healthcare (Buckinghamshire, UK), Medtronic (Minneapolis, Minnesota) and St. Jude Medical (St Paul, Minnesota). Stephan Achenbach is partly supported by grant BMBF 01 EV 0708 from Bundesministerium für Bildung und Forschung (BMBF), Bonn, Germany. In addition he receives research support from Siemens Healthcare, Bayer Schering Pharma, Servier.

  • Provenance and peer review Commissioned; internally peer reviewed.