Deciphering the Role of Cardiac Computed Tomography
Cardiac computed tomography (CT) provides accurate 3D assessment of the coronary arteries and cardiac structures and serves as an important adjunctive imaging modality in the preprocedural planning of percutaneous coronary and structural interventions. Using contemporary multidetector CT scanner technology, preprocedural CT is currently particularly relevant in guiding chronic total occlusion and left main coronary artery interventions, in assessment of stent patency and in providing an accurate assessment of the aortic annulus and iliofemoral arteries before transcatheter aortic valvular replacement. Notably, its role in providing comprehensive assessment of the coronary arteries, including the detection of vulnerable plaque and myocardial ischemia, is being determined. As future technological advances in CT continue to improve its diagnostic performance and reduce required radiation exposure, further expansion of its utilization is expected across the scope of interventional cardiology.
Transcatheter-based therapies have revolutionized the practice of cardiology and have provided significant improvements in the symptoms and survival of patients with coronary artery and structural heart disease. Invasive and noninvasive imaging play a crucial role in choosing patients who are suitable for these therapies, guiding the procedure and identifying post-procedural complications. While invasive angiography (ICA) is the mainstay imaging modality by providing real-time iterative feedback and guidance, its main limitation predominantly stems from its 2D projection format and the lack of information it provides regarding surrounding structures. Computed tomography (CT) offers 3D volumetric assessment of the heart and its surrounding structures. Using this dataset, elaborate multiplanar reconstructions can be performed that enable cardiologists to better understand cardiac anatomy across multiple planes. In this article, we highlight how CT is being increasingly utilized in assisting both coronary and structural interventions, and its future role in interventional cardiology.
Abstract and Introduction
Abstract
Cardiac computed tomography (CT) provides accurate 3D assessment of the coronary arteries and cardiac structures and serves as an important adjunctive imaging modality in the preprocedural planning of percutaneous coronary and structural interventions. Using contemporary multidetector CT scanner technology, preprocedural CT is currently particularly relevant in guiding chronic total occlusion and left main coronary artery interventions, in assessment of stent patency and in providing an accurate assessment of the aortic annulus and iliofemoral arteries before transcatheter aortic valvular replacement. Notably, its role in providing comprehensive assessment of the coronary arteries, including the detection of vulnerable plaque and myocardial ischemia, is being determined. As future technological advances in CT continue to improve its diagnostic performance and reduce required radiation exposure, further expansion of its utilization is expected across the scope of interventional cardiology.
Introduction
Transcatheter-based therapies have revolutionized the practice of cardiology and have provided significant improvements in the symptoms and survival of patients with coronary artery and structural heart disease. Invasive and noninvasive imaging play a crucial role in choosing patients who are suitable for these therapies, guiding the procedure and identifying post-procedural complications. While invasive angiography (ICA) is the mainstay imaging modality by providing real-time iterative feedback and guidance, its main limitation predominantly stems from its 2D projection format and the lack of information it provides regarding surrounding structures. Computed tomography (CT) offers 3D volumetric assessment of the heart and its surrounding structures. Using this dataset, elaborate multiplanar reconstructions can be performed that enable cardiologists to better understand cardiac anatomy across multiple planes. In this article, we highlight how CT is being increasingly utilized in assisting both coronary and structural interventions, and its future role in interventional cardiology.