CT Angiography of the Heart and Coronaries

8/9/2019 CT Angiography of the Heart and Coronaries.

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Current Status and Indicationsfor Coronary CTA


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CT Angiography of the Heart and Coronaries


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CTA: Sensitivity Specificity

Leber JACC 2005 73% 97%

Mollet Circ 2005 99% 92%

Raff JACC 2005 86% 95%

Ropers AJC 2006 95% 93%

Fine AJC 2006 95% 96%

Leschka EHJ 2006 94% 97%

ETT 75% 70%

Stress Echo 85% 95%

SPECT 90% 88%


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CTA vs. IVUS

Achenbach Circ 05 Leber JACC05 Carracosa AJC 06 Sakakura Angio 06

Calcified (hard) Plaques 96%

Fibro-fatty (soft) Plaques 91%

Total Plaque Volume 84%

r = 0.8


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Variables in the Equation

-.673 .328 4.207 1 .040 .510 .268 .971

-.848 .345 6.036 1 .014 .428 .218 .842

19.352 3 .000

2.415 1.036 5.439 1 .020 11.191 1.470 85.182

2.985 1.045 8.155 1 .004 19.796 2.551 153.619

3.687 1.041 12.535 1 .000 39.910 5.185 307.183

FHx

CHOL

scoregroup

scoregroup(1)

scoregroup(2)

scoregroup(3)

B SE Wald df Sig. Exp(B) Lower Upper

95.0% CI for Exp(B)

M

ultivariate Cox RegressionM

odel

All Cause Mortality1132 consecutive CTA patients (10-20 month f/u): 44 deaths

Atypical Chest pain, 44% ER, 3 month MACE = 0

Is the patient at high or low risk?


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2=44, p


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0

5

10

15

20

25

Di

H

H

l

H

ilT

f

R

(%)

0 1 2 3 4 5 6

A

i

i

AD by CTA


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Coronary anomalies


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w


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CABG evaluation


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Sternal non-union


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Pleural and pericardial effusions post CABG


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Pericardial effusions


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Pericardial calcification


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Pulmonary emboli


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Aortic dissection


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Lung diseases


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GERD and Hiatal Hernia


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Non cardiac causes of chest pain

We reviewed:

All non-cardiac findings in 3000 patients with chest pain.

All non-cardiac findings in 10000 patients with no

symptoms.

All studies read both by a cardiologist and a radiologist.5% with threatening findings. 48% with findings that are

likely to contribute to their symptoms.

Recent prior studies suggest 23 69% of CTAs

have findings of potential significance.


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Symptomatic AsymptomaticGE D 31 13

Calci ied Lung Nodule 20 21

COPD 12% 4%

HiatalHernia 10 % 5%Pathologic Lymph Nodes 8 %


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Cardiac veins for EP


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Cardiomyopathies


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ARVD


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Valve disease


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Left atrial thrombus


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Tumors and VSDs


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ASDs and septal aneurysms


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Shunts


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Carotid disease


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Cardiac CT: Appropriate Indications

1) Screening for CAD

2) Chest pain

3) Evaluation of equivocal SPECT orETT

4) Post CABG evaluation

5) Arrhythmia evaluation6) TIA CVAs

7) Congenital Heart disease

8) Intracardiac Masses

9) Valvular Heart disease

10) Pulmonary Artery disease

11) Myocardial Infarction

12) LV and RV Function + LV Mass

13) Coronary Anomalies

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CT Angiography of the Heart and Coronaries