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Prognostic value of cardiac CT

La radiologia medica volume 125, pages 1135–1147 (2020)Cite this article

Abstract

In the past decades, coronary computed tomography angiography (CCTA) has become a powerful tool in the management of coronary artery disease. The diagnostic and prognostic value of CCTA has been extensively demonstrated in both large observational studies and clinical trials among stable chest pain patients. The quantification of coronary artery calcium score (CACS) is a well-established predictor of cardiovascular morbidity and mortality in asymptomatic subjects. Besides CACS, the main strength of CCTA is the accurate assessment of the individual total atherosclerotic plaque burden, which holds important prognostic information. In addition, CCTA, by providing detailed information on coronary plaque morphology and composition with identification of specific high-risk plaque features, may further improve the risk stratification beyond the assessment of coronary stenosis. The development of new CCTA applications, such as stress myocardial CT perfusion and computational fluids dynamic applied to standard CCTA to derive CT-based fractional flow reserve (FFR) values have shown promising results to guide revascularization, potentially improving clinical outcomes in stable chest pain patients. In this review, starting from the role of CACS and moving beyond coronary stenosis, we evaluate the existing evidence of the prognostic effectiveness of the CCTA strategy in real-world clinical practice.

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Affiliations

  1. Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy

    Sara Seitun

  2. Department of Radiology, CNR (National Council of Research)/Tuscany Region ‘Gabriele Monasterio’ Foundation (FTGM), Massa, Italy

    Alberto Clemente

  3. Department of Radiology - Area Vasta 1 - ASUR Marche, Ospedale Civile “Santa Maria della Misericordia” di Urbino, Viale Federico Comandino, 70, 61029, Urbino, PU, Italy

    Erica Maffei

  4. Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy

    Patrizia Toia & Ludovico La Grutta

  5. SDN IRCCS, Naples, Italy

    Filippo Cademartiri

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  1. Sara Seitun
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  2. Alberto Clemente
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  3. Erica Maffei
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  4. Patrizia Toia
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  5. Ludovico La Grutta
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  6. Filippo Cademartiri
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Correspondence to Filippo Cademartiri.

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Seitun, S., Clemente, A., Maffei, E. et al. Prognostic value of cardiac CT. Radiol med 125, 1135–1147 (2020). https://doi.org/10.1007/s11547-020-01285-w

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Keywords

  • Cardiovascular imaging
  • Coronary computed tomography
  • Cardiac CT
  • Coronary artery disease
  • CAD
  • Chest pain
  • Prognosis
  • Atherosclerosis
  • Stratification
  • Risk assessment
  • FFR-CT
  • CACS
  • Calcium score
  • Risk factors