Editorial on impact of cardiac CT in clinical practice
Non-invasive coronary imaging has been the focus of research and of several imaging modalities for several years if not decades. Electron-beam computed tomography (EBCT), magnetic resonance (MR), and finally computed tomography (CT) which finally made it to clinical arena.
Cardiac CT was actually “born” in 1999 after a few experiments with prior CT generations equipped with 2 detector rows. At that time a 4-detector-row (i.e., 4-slice) CT equipment was available for the first attempts. Temporal resolution was low (250 ms for one half rotation of the gantry; i.e., image) and patients had to be very stable, with very low and stable heart rate and capable of holding their breath for 40–45 seconds. However, the first images where already astonishing and it was clear that by improving the many (but actually not too many) parameters involved, cardiovascular computed tomography (CCT) had the potential to become the non-invasive imaging modality of choice for cardiac and coronary imaging. And this is exactly what happened in last 20 years (1-5). CCT has developed and has become the pivotal anatomical imaging technique for cardiac and vascular diseases in general. It is the first line in suspected coronary artery disease (CAD) detection and anatomical quantification but more recently it is also developing in the field of functional application relying on advanced software and/or standard dynamic perfusion techniques.
In clinical practice CCT is the go-to method when you have to decide if a patient is carrying or not significant obstructive lesions and if these lesions are more suitable for revascularization or for optimal medical therapy (1-5). After the results of the PROMISE trial, the SCOT-HEART trial, and the ISCHEMIA trial, all these concepts have translated in a long-awaited change of paradigm. First anatomy and then function at least when it comes to ischemia and obstructive CAD. This has been also implemented in recent guidelines.
The really interesting development that CCT has the duty and the honor to carry is however different. It is, in fact, the method that is leading the research and the future implementation of concepts of personalized medicine, precision medicine and radiomics on a population level.
This special series on cardiac CT in clinical practice would like to provide our readers an overview of all aspects of contemporary cardiac CT. The basics, fundamentals and evidence of cardiac CT clinical use are covered in detail in this series.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Cardiovascular Diagnosis and Therapy for the series “Impact of Cardiac CT in Clinical Practice”. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/cdt-2020-01). The series “Impact of Cardiac CT in Clinical Practice” was commissioned by the editorial office without any funding or sponsorship. FC served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from Jul 2019 to Jun 2021.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
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- Mollet NR, Cademartiri F, Nieman K, et al. Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris. J Am Coll Cardiol 2004;43:2265-70. [Crossref] [PubMed]
- Mollet NR, Cademartiri F, van Mieghem CA, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 2005;112:2318-23. [Crossref] [PubMed]
- SCOT-HEART Investigators; Newby DE, Adamson PD, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med 2018;379:924-33. [Crossref] [PubMed]
- Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 2015;372:1291-300. [Crossref] [PubMed]
