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Computed Tomographic Angiography

Detection, Treatment, and Monitoring of Asymptomatic Individuals Susceptible to Atherosclerosis and Vulnerable to Cardiovascular Events

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Asymptomatic Atherosclerosis

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Sixty four slice coronary computed tomographic angiography (CTA), while traditionally employed as a substitute for stress testing in symptomatic patients, has increasing application in the “asymptomatic” population, and is additive to coronary artery calcium scanning.

  1. 1.

    Patients with atypical symptoms are often misclassified as “symptomatic”; CTA provides accurate information regarding obstruction, as well as risk stratification based on calcified and non-calcified plaque.

  2. 2.

    Using tomographic intravascular analysis (TIVA), CTA provides non-calcified and calcified plaque characterization, similar to intravascular ultrasound. High risk plaques, including thin cap fibroatheromas and plaque rupture, may be identified, as well as totally non-calcified plaque that may or may not result in measurable narrowing.

  3. 3.

    In the truly asymptomatic population, CTA is appropriate in younger patients with a family history of premature coronary disease, in whom coronary calcium screening is not even recommended and whose risk may be established by demonstration of non-calcified plaque. Stress testing is often used for risk stratification in patients with multiple risk factors; CTA is a more appropriate tool and should replace stress testing in this capacity.

  4. 4.

    Totally non-calcified plaque resulting in any measurable narrowing justifies aggressive medical treatment.

  5. 5.

    Non-calcified plaque quantitation and reduction in radiation and contrast will be required for CTA to replace coronary calcium screening.

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Authors and Affiliations

  1. Department of Interventional Cardiology, Lenox Hill Hospital, New York, NY, USA

    Harvey S. Hecht

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  1. Harvey S. Hecht
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Editors and Affiliations

  1. Endothelix, Inc., El Rio 8275, Houston, 77054, USA

    Morteza Naghavi

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Hecht, H.S. (2011). Computed Tomographic Angiography. In: Naghavi, M. (eds) Asymptomatic Atherosclerosis. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-179-0_23

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  • DOI: https://doi.org/10.1007/978-1-60327-179-0_23

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-178-3

  • Online ISBN: 978-1-60327-179-0

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