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How to Utilize Coronary Computed Tomography Angiography in the Treatment of Coronary Artery Disease

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초록

Coronary computed tomography angiography (CCTA) has high negative predictive power for detecting coronary artery disease. However CCTA is limited by moderate positive predictive power in the detection of myocardial ischemia. This is not unexpectedbecause the diameter of a stenosis is a poor indicator of myocardial ischemia and discrepancy between the severity of stenosis andnoninvasive tests is not uncommon. The value of stenosis for predicting future development of acute coronary syndrome representedby plaque rupture has been questioned. CCTA identifies the characteristics of high-risk plaque including positive remodeling,low density plaque and spotty or micro-calcification. Also, additional evaluation of myocardial ischemia using computationalflow dynamics, and luminal attenuation gradient are expected to increase both diagnostic performance for hemodynamicallysignificant stenosis and the predictive power for future cardiovascular risk. Technical advances in CCTA would enable evaluationof both coronary artery stenosis and myocardial ischemia simultaneously with high predictive performance, and would improvevastly the clinical value of CCTA.

Abstract

Coronary computed tomography angiography (CCTA) has high negative predictive power for detecting coronary artery disease. However CCTA is limited by moderate positive predictive power in the detection of myocardial ischemia. This is not unexpectedbecause the diameter of a stenosis is a poor indicator of myocardial ischemia and discrepancy between the severity of stenosis andnoninvasive tests is not uncommon. The value of stenosis for predicting future development of acute coronary syndrome representedby plaque rupture has been questioned. CCTA identifies the characteristics of high-risk plaque including positive remodeling,low density plaque and spotty or micro-calcification. Also, additional evaluation of myocardial ischemia using computationalflow dynamics, and luminal attenuation gradient are expected to increase both diagnostic performance for hemodynamicallysignificant stenosis and the predictive power for future cardiovascular risk. Technical advances in CCTA would enable evaluationof both coronary artery stenosis and myocardial ischemia simultaneously with high predictive performance, and would improvevastly the clinical value of CCTA.

참고문헌 (50)

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