DOI QR코드

DOI QR Code

Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

  • Yoon, Yeonyee Elizabeth (Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Lim, Tae-Hwan (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2013.05.03
  • 심사 : 2013.10.02
  • 발행 : 2014.02.01

초록

Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

키워드

참고문헌

  1. Raggi P, Gongora MC, Gopal A, Callister TQ, Budoff M, Shaw LJ. Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol 2008;52:17-23 https://doi.org/10.1016/j.jacc.2008.04.004
  2. Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, Tseng PH, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 2007;49:1860-1870 https://doi.org/10.1016/j.jacc.2006.10.079
  3. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291:210-215 https://doi.org/10.1001/jama.291.2.210
  4. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358:1336-1345 https://doi.org/10.1056/NEJMoa072100
  5. Polonsky TS, McClelland RL, Jorgensen NW, Bild DE, Burke GL, Guerci AD, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010;303:1610-1616 https://doi.org/10.1001/jama.2010.461
  6. Henneman MM, Schuijf JD, Pundziute G, van Werkhoven JM, van der Wall EE, Jukema JW, et al. Noninvasive evaluation with multislice computed tomography in suspected acute coronary syndrome: plaque morphology on multislice computed tomography versus coronary calcium score. J Am Coll Cardiol 2008;52:216-222 https://doi.org/10.1016/j.jacc.2008.04.012
  7. Yoon YE, Chang SA, Choi SI, Chun EJ, Cho YS, Youn TJ, et al. The absence of coronary artery calcification does not rule out the presence of significant coronary artery disease in Asian patients with acute chest pain. Int J Cardiovasc Imaging 2012;28:389-398 https://doi.org/10.1007/s10554-011-9819-0
  8. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008;52:1724-1732 https://doi.org/10.1016/j.jacc.2008.07.031
  9. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 2008;52:2135-2144 https://doi.org/10.1016/j.jacc.2008.08.058
  10. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359:2324-2336 https://doi.org/10.1056/NEJMoa0806576
  11. Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC. Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol 2011;57:1237-1247 https://doi.org/10.1016/j.jacc.2010.10.011
  12. Hadamitzky M, Distler R, Meyer T, Hein F, Kastrati A, Martinoff S, et al. Prognostic value of coronary computed tomographic angiography in comparison with calcium scoring and clinical risk scores. Circ Cardiovasc Imaging 2011;4:16-23 https://doi.org/10.1161/CIRCIMAGING.110.955351
  13. Chow BJ, Wells GA, Chen L, Yam Y, Galiwango P, Abraham A, et al. Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol 2010;55:1017-1028 https://doi.org/10.1016/j.jacc.2009.10.039
  14. Chow BJ, Small G, Yam Y, Chen L, Achenbach S, Al-Mallah M, et al. Incremental prognostic value of cardiac computed tomography in coronary artery disease using CONFIRM: COroNary computed tomography angiography evaluation for clinical outcomes: an InteRnational Multicenter registry. Circ Cardiovasc Imaging 2011;4:463-472 https://doi.org/10.1161/CIRCIMAGING.111.964155
  15. Cho I, Shim J, Chang HJ, Sung JM, Hong Y, Shim H, et al. Prognostic value of multidetector coronary computed tomography angiography in relation to exercise electrocardiogram in patients with suspected coronary artery disease. J Am Coll Cardiol 2012;60:2205-2215 https://doi.org/10.1016/j.jacc.2012.08.981
  16. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 2009;53:623-632 https://doi.org/10.1016/j.jacc.2008.10.043
  17. McEvoy JW, Blaha MJ, Nasir K, Yoon YE, Choi EK, Cho IS, et al. Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population. Arch Intern Med 2011;171:1260-1268 https://doi.org/10.1001/archinternmed.2011.204
  18. Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, et al. [Guidelines for percutaneous coronary interventions]. Ital Heart J Suppl 2005;6:427-474
  19. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006;113:e166-e286 https://doi.org/10.1161/CIRCULATIONAHA.106.173220
  20. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213-224 https://doi.org/10.1056/NEJMoa0807611
  21. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-2907 https://doi.org/10.1161/01.CIR.0000072790.23090.41
  22. Meijboom WB, Van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, et al. Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 2008;52:636-643 https://doi.org/10.1016/j.jacc.2008.05.024
  23. Gaemperli O, Schepis T, Valenta I, Koepfli P, Husmann L, Scheffel H, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology 2008;248:414-423 https://doi.org/10.1148/radiol.2482071307
  24. Rispler S, Keidar Z, Ghersin E, Roguin A, Soil A, Dragu R, et al. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol 2007;49:1059-1067 https://doi.org/10.1016/j.jacc.2006.10.069
  25. Sampson UK, Dorbala S, Limaye A, Kwong R, Di Carli MF. Diagnostic accuracy of rubidium-82 myocardial perfusion imaging with hybrid positron emission tomography/computed tomography in the detection of coronary artery disease. J Am Coll Cardiol 2007;49:1052-1058 https://doi.org/10.1016/j.jacc.2006.12.015
  26. Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Buechel RR, Kuest SM, et al. Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography. Eur Heart J 2011;32:1465-1471 https://doi.org/10.1093/eurheartj/ehr047
  27. Ko BS, Cameron JD, Meredith IT, Leung M, Antonis PR, Nasis A, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 2012;33:67-77 https://doi.org/10.1093/eurheartj/ehr268
  28. George RT, Jerosch-Herold M, Silva C, Kitagawa K, Bluemke DA, Lima JA, et al. Quantification of myocardial perfusion using dynamic 64-detector computed tomography. Invest Radiol 2007;42:815-822 https://doi.org/10.1097/RLI.0b013e318124a884
  29. Nakauchi Y, Iwanaga Y, Ikuta S, Kudo M, Kobuke K, Murakami T, et al. Quantitative myocardial perfusion analysis using multi-row detector CT in acute myocardial infarction. Heart 2012;98:566-572 https://doi.org/10.1136/heartjnl-2011-300915
  30. Steigner ML, Mitsouras D, Whitmore AG, Otero HJ, Wang C, Buckley O, et al. Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc Imaging 2010;3:179-186 https://doi.org/10.1161/CIRCIMAGING.109.854307
  31. Chow BJ, Kass M, Gagne O, Chen L, Yam Y, Dick A, et al. Can differences in corrected coronary opacification measured with computed tomography predict resting coronary artery flow? J Am Coll Cardiol 2011;57:1280-1288 https://doi.org/10.1016/j.jacc.2010.09.072
  32. Choi JH, Min JK, Labounty TM, Lin FY, Mendoza DD, Shin DH, et al. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis. JACC Cardiovasc Imaging 2011;4:1149-1157 https://doi.org/10.1016/j.jcmg.2011.09.006
  33. Choi JH, Koo BK, Yoon YE, Min JK, Song YB, Hahn JY, et al. Diagnostic performance of intracoronary gradient-based methods by coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenoses: a validation study with fractional flow reserve. Eur Heart J Cardiovasc Imaging 2012;13:1001-1007 https://doi.org/10.1093/ehjci/jes130
  34. Yoon YE, Choi JH, Kim JH, Park KW, Doh JH, Kim YJ, et al. Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve. JACC Cardiovasc Imaging 2012;5:1088-1096 https://doi.org/10.1016/j.jcmg.2012.09.002
  35. Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 2011;58:1989-1997 https://doi.org/10.1016/j.jacc.2011.06.066
  36. Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 2012;308:1237-1245 https://doi.org/10.1001/2012.jama.11274

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