CCTA Applications
CCTA has proved useful for diagnosing or excluding the presence of coronary artery stenosis or occlusion and for diagnosing and characterizing the presence of calcified and noncalcified coronary artery plaque. In addition to these applications CCTA promises other important emerging applications. It is an excellent method for diagnosing anomalous coronary arteries, coronary artery aneurysms and fistulae, and for evaluating the patency of bypass grafts and stents. In addition to the coronary artery anatomy, CCTA can also provide cardiac anatomic and functional information including characterization of myocardial wall thickness and function, and quantification of cardiac chamber volumes and ejection fraction. CCTA is also helpful for identifying and characterizing cardiac masses, cardiac tumors and thrombi, abnormalities of the pericardium and great vessels, and for diagnosing congenital anomalies and elucidating their often complex anatomy. Other common applications of CCTA are in pre-procedural planning for radiofrequency ablation of atrial fibrillation foci found in myocardial slips along the pulmonary veins, and for monitoring complications of the ablation procedure (including the potential development of pulmonary vein stenosis), and for pre-procedural evaluation of coronary sinus anatomy prior to biventricular pacemaker placement. Another potential application currently under investigation is the ability to assess myocardial perfusion, thereby allowing identification and characterization of myocardial ischemia and infarction.
Targeted Patient Population
Several patient groups are candidates for CCTA. These include asymptomatic patients with recognized cardiac risk factors (e.g., high blood pressure, high cholesterol, diabetes, smoking history, or a family history of heart disease), symptomatic patients who have chest pain with an unclear clinical examination or indeterminate or confusing noninvasive cardiac tests, and patients with suspected congenital anomalies. Patients undergoing pulmonary vein ablation or biventricular pacemaker placement may benefit from CCTA for pre-procedural planning. Post-procedure pulmonary vein ablation may also be assessed for the development of pulmonary vein stenosis. Patients with coronary artery bypass grafts or those with coronary artery stents can benefit from postoperative CCTA assessment of graft patency, stent restenosis, or other complications.
CCTA at NYU Medical Center
CCTA has been performed in NYU Medical Center’s Radiology department since July 2003. The department currently has the only Siemens 64-slice CT scanner in New York State, and has been performing dedicated cardiac CT angiography on this state-of-the-art scanner since November 2004. Development of cardiac CT and research on its applications is a cooperative effort between the NYU Radiology and Cardiology departments. These research efforts include the development of new cardiac imaging and image analysis methods and their evaluation in clinical applications. There are ongoing clinical research collaborations with Adult and Pediatric Cardiology and Cardiothoracic Surgery.
Conclusion
CCTA provides a valuable new technology for the evaluation and potential management of coronary artery disease, with a growing field of current and future applications. CCTA has emerged as a reliable and accurate method for performing noninvasive coronary angiography and assessing the heart. It may be used to detect and characterize the presence of coronary artery disease in asymptomatic individuals or in patients with confusing or unclear clinical symptomatology. It can also provide information regarding the 3-dimensional anatomy of the heart including the presence of cardiac masses, complex congenital conditions, abnormalities of the pericardium and great vessels. It is useful for assessing the presence of congenital anomalies, and can be used to plan the preoperative surgical approach in select groups of patients. Furthermore, patients may be imaged for postoperative complications, and for patency of bypass grafts and stents. Ultimately, CCTA may aid in monitoring the efficacy of medical therapy as well as becoming the definitive screening examination for coronary artery disease.
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