Excerpt

Cardiovascular computed tomography (CT) is one of the most impressive advances in the non-invasive diagnosis of cardiovascular disease in the last decade. Going beyond coronary calcium scoring, cardiovascular CT is capable of identifying calcified and non-calcified plaque, percent stenosis, cardiac structure and morphology, and left ventricular systolic function. The abilities to detect subclinical and obstructive atherosclerosis and exclude disease with high diagnostic certainty are its greatest attributes. Single-center and multi-center studies in various cohorts have established that CT coronary angiography (CTA) is an accurate non-invasive test for determining percent stenosis which can be performed with low radiation dose.1-7 However, it is important to point out that coronary CTA is an anatomical test that does not provide important physiological data. In fact, the value of CTA for predicting the presence of myocardial ischemia is limited.8-10 While coronary CTA has an excellent negative predictive value, it is more limited in determining the significance of stenoses in patients with disease. Thus, caution needs to be exercised when adopting cardiac CT clinically. The importance of coronary physiology for diagnosis, prognosis, and guidance of therapies must not be ignored. …