Coronary CT angiography is a relatively simple, short-duration, non-invasive imaging method that is gaining increasing acceptance and application in clinical practice. This examination allows us to assess the anatomy of the coronary artery network and detect the presence of atherosclerotic plaques. The method also enables us to gather information about the composition of these plaques (soft, calcified, mixed) as well as the type of deformation they cause in the coronary arteries (positive - negative remodelling). These details are crucial for both diagnosis and therapeutic management of patients.
In the latest revised guidelines of the European Society of Cardiology, coronary CT angiography is included as an initial imaging test for diagnosing coronary artery disease in patients with symptoms and risk factors for coronary artery disease, for whom clinical examination and initial cardiological tests (electrocardiogram, heart ultrasound, treadmill test) cannot exclude the presence of coronary artery disease. The value of this imaging method lies not only in its ability to reliably and immediately, non-invasively identify the presence and severity of coronary artery stenosis but also in its significantly high negative predictive value, which approaches 100%. This means it can exclude the presence of obstructive coronary artery disease when the findings are normal.
The main indications for coronary CT angiography are:
- Investigation of suspected coronary artery disease in patients without a known history of coronary artery disease, who present with angina or equivalent symptoms.
- Low or medium-risk patients with angina who arrive at the emergency department.
- Patients with angina who have previously undergone cardiological tests with ambiguous results.
- Patients with risk factors for coronary artery disease who have a positive or uncertain treadmill test.
- Evaluation of coronary arteries prior to cardiac surgery.
- Evaluation of coronary arteries before percutaneous aortic valve replacement (TAVI).
- Suspected abnormal origin of coronary arteries.
- Evaluation of stent and graft patency in patients with a previous coronary artery bypass graft (CABG) as a routine check.
- Assessment of pulmonary vein anatomy before electrical isolation surgery for atrial fibrillation (ablation).
- There is also the possibility for functional assessment of the myocardium (volume measurement and evaluation of left and right ventricular ejection fraction).
Are all patients suitable candidates?
- Pregnancy is a contraindication for the test.
Additionally, there are conditions that significantly affect the quality of the images, and thus the following patients are not suitable candidates for the procedure:
- Patients with atrial fibrillation or other tachyarrhythmias or severe ectopic arrhythmias.
- Obese patients.
- Patients who cannot comply with respiratory commands during the examination.
How much radiation does a patient receive during a coronary CT angiography?
The amount of radiation a patient receives during a coronary CT angiography depends on the type of machine used. With modern CT scanners, this amount is very limited.
