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Coronary computed tomography angiography for the assessment of chest pain: current status and future directions

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Abstract

Chest pain is one of the most common presenting symptoms leading to presentation to medical clinics and Emergency Departments worldwide. Defining the nature and etiology of chest pain can pose a diagnostic dilemma for clinicians, despite the availability of several diagnostic algorithms and guidelines to assist them in evaluating these patients. Most investigations in patients with acute chest pain are initially performed to either exclude or diagnose and manage potentially life-threatening conditions such as acute coronary syndrome, pulmonary embolism and aortic dissection. In cases of stable chest pain syndromes, the focus shifts to determining the presence, extent and severity of coronary artery disease. In recent years, coronary computed tomography angiography (CCTA) is being increasingly used worldwide in the assessment of both stable and acute chest pain syndromes. This review evaluates the current evidence regarding the clinical utility of CCTA in the stable and acute chest pain settings and outlines the latest advances in CCTA techniques, including functional assessment of coronary stenoses, and their potential clinical application to improve patient care in a cost-effective manner.

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Abbreviations

ACC:

American College of Cardiology

ACS:

Acute coronary syndrome

AHA:

American Heart Association

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CI:

Confidence interval

CMR:

Cardiac magnetic resonance imaging

CTP:

Computed tomography perfusion imaging

ECG:

Electrocardiography

ED:

Emergency department

ETT:

Exercise treadmill test

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

MPI:

Myocardial perfusion imaging

NSTEMI:

Non ST-elevation myocardial infarction

PET:

Positron emission tomography

SPECT:

Single-photon emission computed tomography

TAG:

Transluminal attenuation gradient

UA:

Unstable angina pectoris

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  1. Department of Medicine (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, 246 Clayton Road, Clayton, Melbourne, 3168, Australia

    Arthur Nasis, Ian T. Meredith, James D. Cameron & Sujith K. Seneviratne

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Nasis, A., Meredith, I.T., Cameron, J.D. et al. Coronary computed tomography angiography for the assessment of chest pain: current status and future directions. Int J Cardiovasc Imaging 31 (Suppl 2), 125–143 (2015). https://doi.org/10.1007/s10554-015-0698-7

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