Review article

Clinical results of minimally invasive coronary angiography using computed tomography☆

The aims of the study were: 1) to assess the baseline health-related quality of life (HRQOL) of patients with coronary artery disease (CAD) using the standard gamble; 2) to evaluate and compare patients' preference for catheter versus computed tomography (CT) coronary angiography using the wait tradeoff (WTO) and rating scales; and 3) to calculate test disutility for catheter and CT coronary angiography.

Thirty patients with CAD who underwent both CT and catheter angiography were interviewed by telephone within 6 months of testing. Patients were asked about their baseline symptoms and quality of life, their experience preparing for both CT and catheter angiography, their desire to undergo CT or catheter angiography, and immediate treatment versus having a waiting period between test results and treatment for a hypothetical “ideal test” with no side effects. Test disutility for CT and catheter angiography were calculated and compared.

The mean and median baseline HRQOL utility values were 0.72 and 0.91. The patients were willing to wait a mean (median) time of 12 (3) days after the ideal test for the test results to avoid undergoing CT angiography. They were willing to wait a mean (median) of 7 (3) days after the ideal test for test results, to avoid undergoing catheter angiography. There was no significant difference between waiting times or between patients' rating for their experience preparing for the two tests. Test disutility for CT angiography was 1.30 quality-adjusted life days (QALD) versus 2.16 QALD for catheter angiography (P > .05).

There was no significant difference in patient preference and test disutility between CT and catheter angiography in our small series. Future rigorously planned and adequately powered studies are required to confirm these findings in larger patient populations.

To determine the impact of coronary computed tomography angiography (CCTA) on treatment decisions made by cardiac surgeons and to explore barriers to implementation of CCTA as first-line imaging workup before coronary artery bypass.

Tertiary academic medical center retrospective cohort study. Questionnaires administered to three cardiac surgeons regarding diagnosis and treatment decisions with level of confidence in decision making for 30 chest pain patients, after reviewing deidentified catheter coronary angiogram (CCA) and CCTA images on the same patients, several weeks apart.

All surgeons tended to report more severe disease with CCTA than CCA (P < .05). Treatment decisions differed in 12 (40%), 14 (47%), and 18 (60%) patients within each individual surgeon based on CCTA images compared to CCA images (P = .11, .01, and .02, respectively). Confidence levels were significantly higher with CCA for the diagnosis and treatment of coronary artery disease for all three surgeons (P < .05). There was a tendency toward more invasive treatment choices (angioplasty, stent insertion, or coronary artery bypass graft) when making treatment decisions based upon CCTA images.

Severity of disease may be overestimated by cardiac surgeons when using CCTA as a decision-making test, tending toward more invasive treatment choices compared to CCA. Additionally, cardiac surgeons may be more confident with their diagnosis and treatment based on CCA. These may be important limitations in the application of CCTA in clinical practice and may reflect the maturation of CCTA use in practice, diffusion of the technology and/or a reflection of the technology itself.

Multidetector row computed tomography (MDCT) is a powerful noninvasive imaging tool with a number of advantages over previous computed tomography (CT) technology. The incorporation of multiple detector rows enables faster scanning and thinner collimation. As a result, the entire body can be imaged in a single breath hold with improved z-axis resolution. These improvements have also expanded the clinical applications of CT. MDCT is considered an acceptable alternative to conventional imaging techniques such as catheter angiography, intravenous urography, and barium enema. This article will provide an overview of MDCT technology and its use in the diagnosis of diseases affecting coronary and peripheral vasculature, head and neck, lungs, as well as the gastrointestinal and genitourinary tracts.

In recent years, major technical progress has been achieved in cardiac MRI and CT, and these methods allow complete and non-invasive multiparametric characterization of the cardiovascular system. MRI uses the magnetic properties of the hydrogen nucleus, radio-waves and powerful magnets, whilst CT uses conventional X-rays but novel, either multi-detector spiral or electron beam technology for image generation. Both MRI and CT are gold standard methods for the three dimensional analysis of cardiothoracic anatomy, although MRI is superior in most situations. MRI is a very powerful technique for analysis of global and regional myocardial function, myocardial perfusion and viability imaging. CT, on the other hand, has the advantage for coronary imaging, where the solution is greater than that of MRI, up to 400µm2. At the present time, neither CT nor MRI can replace invasive coronary angiography. The value of coronary calcium scoring by CT remains to be established in prospective large scale clinical trials. It is likely that both MRI and CT will play a major role in diagnostic cardiology in the future.