nach oben

Current Cardiovascular Imaging Reports

Erschienen in:

01.11.2016 | Spotlight on CT Imaging (T Schindler, Section Editor)

Current and Future Applications of Coronary CT Angiography with and Without FFR in the Emergency Room

verfasst von: Alan Ropp, Charles White

Erschienen in: Current Cardiovascular Imaging Reports | Ausgabe 11/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Multiple clinical trials have established the value of Coronary CT angiography (CCTA) for the evaluation of patients presenting to the ED with chest pain and a low to intermediate risk for acute coronary syndrome (ACS). CCTA can be used to evaluate these patients rapidly, effectively, and with relatively low cost and radiation dose.

Recent Findings

New research continues to accumulate, and despite much evidence to support its use in the ED setting, at least one recently published study has presented potentially contradictory results. Additionally, newer techniques that enhance the utility of CCTA, such as fractional flow reserve (FFR) and CT perfusion analysis have been developed and are becoming increasingly available. These applications provide important information about the hemodynamic significance of coronary lesions and are potentially useful in the ED setting to aid clinical decision making.

Summary

This review provides an update on the literature related to the use of CCTA in the ED, including a discussion of emerging advanced cardiac CT applications.

Bhuiya FA, Pitts SR, McCaig LF. Emergency department visits for chest pain and abdominal pain: United States, 1999–2008. NCHS Data Brief. 2010;43:1–8.PubMed

Halpern EJ, Levin DC, Zhang S, et al. Comparison of image quality and arterial enhancement with a dedicated coronary CTA protocol versus a triple rule-out coronary CTA protocol. Acad Radiol. 2009;16:1039–48.CrossRefPubMed

Rahmani N, Jeudy J, White CS. Triple rule-out and dedicated coronary artery CTA: comparison of coronary artery image quality. Acad Radiol. 2009;16:604–9.CrossRefPubMed

Madder RD, Raff GL, Hickman L, et al. Comparative diagnostic yield and 3-month outcomes of “triple rule-out” and standard protocol coronary CT angiography in the evaluation of acute chest pain. J Cardiovasc Comput Tomogr. 2011;5:165–71.CrossRefPubMed

Schertler T, Frauenfelder T, Stolzmann P, et al. Triple rule-out CT in patients with suspicion of acute pulmonary embolism: findings and accuracy. Acad Radiol. 2009;16:708–17.CrossRefPubMed

Burris II AC, Boura JA, Raff GL, Chinnaiyan KM. Triple rule out versus coronary ct angiography in patients with acute chest pain: results from the ACIC Consortium. J Am Coll Cardiol Img. 2015;8(7):817–25.CrossRef

Einstein AJ. Radiation risk from coronary artery disease imaging: how do different diagnostic tests compare? Heart. 2008;94:1519–21.CrossRefPubMed

Kontos MC, Jesse RL, Anderson FP, et al. Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain. CIR. 1999;99(16):2073–8.CrossRef

Kimura BJ, Bocchicchio M, Willis CL, et al. Screening cardiac ultrasonographic examination in patients with suspected cardiac disease in the emergency department. Am Heart J. 2001;142:324–30.CrossRefPubMed

10.

Horowitz RS, Morganroth J, Parrotto C, et al. Immediate diagnosis of acute myocardial infarction by two-dimensional echocardiography. Circulation. 1982;65:323–9.CrossRefPubMed

11.

Herzog BA, Wyss CA, Husmann L, et al. First head-to-head comparison of effective radiation dose from low-dose 64-slice CT with prospective ECG-triggering versus invasive coronary angiography. Heart. 2009;95:1656–61.CrossRefPubMed

12.

Laudon DA, Vukov LF, Breen JF, et al. Use of electron-beam computed tomography in the evaluation of chest pain patients in the emergency department. Ann Emerg Med. 1999;33:15–21.CrossRefPubMed

13.

Georgiou D, Budoff MJ, Kaufer E, et al. Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. J Am Coll Cardiol. 2001;38:105–10.CrossRefPubMed

14.

McLaughlin VV, Balogh T, Rich S. Utility of electron beam computed tomography to stratify patients presenting to the emergency room with chest pain. Am J Cardiol. 1999;84:327–8. A8.CrossRefPubMed

15.

Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.CrossRefPubMed

16.

Litt HI, Gatsonis C, Snyder B, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med. 2012;366:1393–403.CrossRefPubMed

17.

Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Am Coll Cardiol. 2011;58:1414–22.CrossRefPubMed

18.

Cury RC, Budoff M, Taylor AJ. Coronary CT angiography versus standard of care for assessment of chest pain in the emergency department. J Cardiovasc Comput Tomogr. 2013;7:79–82.CrossRefPubMed

19.

Hoffmann U, Truong QA, Schoenfeld DA, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012;367:299–308.CrossRefPubMedPubMedCentral

20.

Redberg RF, Coronary CT. Angiography for Acute Chest Pain. N Engl J Med. 2012;367:375–6.CrossRefPubMed

21.•

Sherwood MW, Newby LK. High-sensitivity troponin assays: evidence, indications, and reasonable use. J Am Heart Assoc. 2014;3:e000403. Recently published trial which demonstrated the use of hs-troponins led to improved time to discharge and thus blunted some of the benefits of CCTA.CrossRefPubMedPubMedCentral

22.

Dedic A, Lubbers MM, Schaap J, et al. Coronary CT angiography for suspected ACS in the era of high-sensitivity troponins. J Am Coll Cardiol. 2016;67(1):16–26.CrossRefPubMed

23.

American College of Radiology Appropriateness Criteria. Acute Nonspecific Chest Pain — Low Probability of Coronary Artery Disease. 2015.

24.

American College of Radiology Appropriateness Criteria. Chronic Chest Pain — Low to Intermediate Probability of Coronary Artery Disease. 2012.

25.

Motoyama S, Sarai M, Harigaya H, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54:49–57.CrossRefPubMed

26.

Pflederer T, Marwan M, Schepis T, et al. Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography. Atherosclerosis. 2010;211(2):437–44.CrossRefPubMed

27.

Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334:1703–8.CrossRefPubMed

28.

Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010;55:173–85.CrossRefPubMed

29.

Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012;308(12):1237–45.CrossRefPubMedPubMedCentral

30.

Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63(12):1145–55.CrossRefPubMed

31.••

Douglas PS, Pontone G, Hlatky MA, et al. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRCT: outcome and resource impacts study. Eur Heart J. 2015;36:3359–67. Recent clinical trial, which found that a workup utilizing FFRCT prevented a significant number of unnecessary ICAs with no increased risk of MACE.CrossRefPubMedPubMedCentral

32.••

Hlatky MA, De Bruyne B, Pontone G, et al. Quality of life and economic outcomes of assessing fractional flow reserve with computed tomography angiography: PLATFORM. J Am Coll Cardiol. 2015;66(21):2315–23. The PLATFORM trial, which demonstrated that evaluation strategies utilizing FFRCT resulted in lower resource utilization and cost within 90 days compared with traditional workups incorporating ICA. This method was also associated with greater improvements in quality of life when compared with other methods of noninvasive testing.CrossRefPubMed

33.•

Raff G. Personal communication—stress perfusion CT and CTA-FFRct: applicable in the ED? 2016. Personal correspondence regarding emerging proprietary technology promising under one hour turnaround times for FFRCT. Thus, making FFRCT feasible in the acute setting.

34.

Branch KR, Busey J, Mitsumori LM, et al. Diagnostic performance of resting CT myocardial perfusion in patients with possible acute coronary syndrome. Am J Roentgenol. 2013;200:W450–7.CrossRef

35.

Rochitte CE, George RT, Chen MY, et al. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J. 2014;35:1120–30.CrossRefPubMed

Titel: Current and Future Applications of Coronary CT Angiography with and Without FFR in the Emergency Room
verfasst von: Alan Ropp
Charles White
Publikationsdatum: 01.11.2016
Verlag: Springer US
Erschienen in: Current Cardiovascular Imaging Reports / Ausgabe 11/2016
Print ISSN: 1941-9066
Elektronische ISSN: 1941-9074
DOI: https://doi.org/10.1007/s12410-016-9391-z

Neu im Fachgebiet Kardiologie

25.04.2024 | Hypotonie | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Current and Future Applications of Coronary CT Angiography with and Without FFR in the Emergency Room

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie