Computed Tomography Angiography
by Dr. med. Luise Gaede, Prof. Dr. med. Helge Möllmann, Prof. Dr. med. Tanja Rudolph, PD Dr. med. Johannes Rieber,
PD Dr. med. Florian Boenner, and Dr. med. Monique Tröbs in issue 12/2019
We would like to add the following to the very informative and structured article (1): non-invasive, good quality imaging of coronary arteries with low radiation exposure is available to almost every patient, using computer tomography angiography (CTA)—for instance, with third-generation dual-source scanners. Based on our experience of examining more than 6000 patients, absolute contraindications no longer exist. CTA has long been recognized in the English-speaking world as a method of choice for detection of coronary heart disease (CHD). In Germany, CTA inexplicably has a subordinate role, despite unambiguous, evidence-based current data, and is not reimbursed by statutory health insurance.
In the meantime, computer programs using FFA-CT (fractional flow reverse from computed tomography) are available that use the standard available CTA datasets to provide reliable statements on the hemodynamic relevance of stenosis, which are comparable to those from invasive pressure measurements. Patent litigation is still in the way of wider dissemination outside of trials. However, there are currently technical limitations, for example, in the presentation of main stem stenosis (similar to conventional FFR) or heavy calcification (2).
Nevertheless, it can be stated that an examination of coronary arteries is possible for a large number of patients that is fast, non-invasive, less burdensome, less expensive and provides reliable information about the hemodynamics of a stenosis. Taking into consideration the fact that, in contrast to cardiac catheter, CTA allows a distinction to be made between vulnerable and stable plaques, and that FFA-CT allows the entire coronary tree, rather than just individual segments, to be checked for significant stenosis, at least the perspective of diagnostic CTA / FFA-CT playing a significant role in a proposed revascularization therapy must be considered.
Prof. Dr. med. Johannes Görich
Prof. Dr. med. Sebastian Buß
Radiology practice, Heidelberg, Germany
Conflict of interest statement
Prof.Görich has received speaking honoraria from Siemens Healthineers.
Prof. Buß declares that no conflict of interest exists.
|1.||Gaede L, Möllmann H, Rudolph T, Rieber J, Boenner F, Tröbs M: Coronary angiography with pressure wire and fractional flow reserve—state of the art in the diagnosis of coronary stenosis. Dtsch Arztebl Int 2019; 116: 205–11 VOLLTEXT|
|2.||Fairbairn TA, Nieman K, Akasaka T, et al.: Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry. Eur Heart J 2018; 39: 3701–11 CrossRef MEDLINE PubMed Central|