Coronary Artery Disease Assessment and Pre-procedural Planning Using Cardiac Computed Tomography

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 11779

Special Issue Editors


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Guest Editor
Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany
Interests: PAD; atherectomy; IVUS; lithotripsy
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Cardiology, Pneumology and Angiology, University Hospital Mannheim, Mannheim, Germany
Interests: coronary computed tomography; fractional flow reserve; CT-based FFR; percutaneous coronary intervention; extracorporeal membrane oxygenation; cardiac magnetic resonance imaging; cardiovascular imaging; instantaneous wave-free ratio

Special Issue Information

Dear Colleagues,

Due to recent technological advances and increasing scientific evidence, coronary computer tomography angiography (CCTA) has emerged as a central and well-established modality for the diagnostic workup of patients with coronary artery disease (CAD). CCTA can detect relevant coronary artery lumen narrowing and beyond that also precisely identify different stages of the atherosclerotic process, including early atherosclerotic changes as well as high-risk plaque features, as potential precursors of plaque ruptures, leading to acute coronary syndromes. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of coronary artery stenosis and, if required, acquire information related to cardiac and valvular function. Importantly, recent randomized trials have highlighted the prognostic relevance of CCTA in patients with CAD, which has helped to endorse CCTA as a primary method for the diagnostic work-up of CAD patients by current guidelines. In addition, CCTA is currently used for the planning of transcatheter aortic implantation (TAVI) and is increasingly being used for the preprocedural planning of interventions in the mitral and tricuspid valve. In this Special Issue, we invite articles reporting novel findings in this wide range of fascinating CCTA applications in cardiovascular medicine. Articles published in this issue will provide an overview of the current technical aspects, indications, pitfalls, as well as new horizons with CCTA.

Prof. Dr. Grigorios Korosoglou
Prof. Dr. Stefan Baumann
Guest Editors

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Published Papers (5 papers)

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Research

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10 pages, 2518 KiB  
Article
Human AI Teaming for Coronary CT Angiography Assessment: Impact on Imaging Workflow and Diagnostic Accuracy
by Florian Andre, Philipp Fortner, Matthias Aurich, Sebastian Seitz, Ann-Kathrin Jatsch, Max Schöbinger, Michael Wels, Martin Kraus, Mehmet Akif Gülsün, Norbert Frey, Andre Sommer, Johannes Görich and Sebastian J. Buss
Diagnostics 2023, 13(23), 3574; https://doi.org/10.3390/diagnostics13233574 - 30 Nov 2023
Viewed by 1176
Abstract
As the number of coronary computed tomography angiography (CTA) examinations is expected to increase, technologies to optimize the imaging workflow are of great interest. The aim of this study was to investigate the potential of artificial intelligence (AI) to improve clinical workflow and [...] Read more.
As the number of coronary computed tomography angiography (CTA) examinations is expected to increase, technologies to optimize the imaging workflow are of great interest. The aim of this study was to investigate the potential of artificial intelligence (AI) to improve clinical workflow and diagnostic accuracy in high-volume cardiac imaging centers. A total of 120 patients (79 men; 62.4 (55.0–72.7) years; 26.7 (24.9–30.3) kg/m2) undergoing coronary CTA were randomly assigned to a standard or an AI-based (human AI) coronary analysis group. Severity of coronary artery disease was graded according to CAD-RADS. Initial reports were reviewed and changes were classified. Both groups were similar with regard to age, sex, body mass index, heart rate, Agatston score, and CAD-RADS. The time for coronary CTA assessment (142.5 (106.5–215.0) s vs. 195.0 (146.0–265.5) s; p < 0.002) and the total reporting time (274.0 (208.0–377.0) s vs. 350 (264.0–445.5) s; p < 0.02) were lower in the human AI than in the standard group. The number of cases with no, minor, or CAD-RADS relevant changes did not differ significantly between groups (52, 7, 1 vs. 50, 8, 2; p = 0.80). AI-based analysis significantly improves clinical workflow, even in a specialized high-volume setting, by reducing CTA analysis and overall reporting time without compromising diagnostic accuracy. Full article
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15 pages, 1209 KiB  
Review
Cardiac Computed Tomography Angiography in CAD Risk Stratification and Revascularization Planning
by Chirag R. Mehta, Aneeqah Naeem and Yash Patel
Diagnostics 2023, 13(18), 2902; https://doi.org/10.3390/diagnostics13182902 - 11 Sep 2023
Viewed by 1247
Abstract
Purpose of Review: Functional stress testing is frequently used to assess for coronary artery disease (CAD) in symptomatic, stable patients with low to intermediate pretest probability. However, patients with highly vulnerable plaque may have preserved luminal patency and, consequently, a falsely negative stress [...] Read more.
Purpose of Review: Functional stress testing is frequently used to assess for coronary artery disease (CAD) in symptomatic, stable patients with low to intermediate pretest probability. However, patients with highly vulnerable plaque may have preserved luminal patency and, consequently, a falsely negative stress test. Cardiac computed tomography angiography (CCTA) has emerged at the forefront of primary prevention screening and has excellent agency in ruling out obstructive CAD with high negative predictive value while simultaneously characterizing nonobstructive plaque for high-risk features, which invariably alters risk-stratification and pre-procedural decision making. Recent Findings: We review the literature detailing the utility of CCTA in its ability to risk-stratify patients with CAD based on calcium scoring as well as high-risk phenotypic features and to qualify the functional significance of stenotic lesions. Summary: Calcium scores ≥ 100 should prompt consideration of statin and aspirin therapy. Spotty calcifications < 3 mm, increased non-calcified plaque > 4 mm3 per mm of the vessel wall, low attenuation < 30 HU soft plaque and necrotic core with a rim of higher attenuation < 130 HU, and a positive remodeling index ratio > 1.1 all confer additive risk for acute plaque rupture when present. Elevations in the perivascular fat attenuation index > −70.1 HU are a strong predictor of all-cause mortality and can further the risk stratification of patients in the setting of a non-to-minimal plaque burden. Lastly, a CT-derived fractional flow reserve (FFRCT) < 0.75 or values from 0.76 to 0.80 in conjunction with additional risk factors is suggestive of flow-limiting disease that would benefit from invasive testing. The wealth of information available through CCTA can allow clinicians to risk-stratify patients at elevated risk for an acute ischemic event and engage in advanced revascularization planning. Full article
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15 pages, 794 KiB  
Review
Combined CT Coronary Artery Assessment and TAVI Planning
by Matthias Renker, U. Joseph Schoepf and Won Keun Kim
Diagnostics 2023, 13(7), 1327; https://doi.org/10.3390/diagnostics13071327 - 3 Apr 2023
Cited by 11 | Viewed by 3118
Abstract
Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. [...] Read more.
Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT–FFR) and machine learning-based CT–FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field. Full article
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13 pages, 1034 KiB  
Review
Radiomics in Cardiac Computed Tomography
by Isabelle Ayx, Matthias F. Froelich, Stefan Baumann, Theano Papavassiliu and Stefan O. Schoenberg
Diagnostics 2023, 13(2), 307; https://doi.org/10.3390/diagnostics13020307 - 13 Jan 2023
Cited by 5 | Viewed by 2023
Abstract
In recent years, there has been an increasing recognition of coronary computed tomographic angiography (CCTA) and gated non-contrast cardiac CT in the workup of coronary artery disease in patients with low and intermediate pretest probability, through the readjustment guidelines by medical societies. However, [...] Read more.
In recent years, there has been an increasing recognition of coronary computed tomographic angiography (CCTA) and gated non-contrast cardiac CT in the workup of coronary artery disease in patients with low and intermediate pretest probability, through the readjustment guidelines by medical societies. However, in routine clinical practice, these CT data sets are usually evaluated dominantly regarding relevant coronary artery stenosis and calcification. The implementation of radiomics analysis, which provides visually elusive quantitative information from digital images, has the potential to open a new era for cardiac CT that goes far beyond mere stenosis or calcification grade estimation. This review offers an overview of the results obtained from radiomics analyses in cardiac CT, including the evaluation of coronary plaques, pericoronary adipose tissue, and the myocardium itself. It also highlights the advantages and disadvantages of use in routine clinical practice. Full article
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18 pages, 4336 KiB  
Review
Coronary Computed Tomography vs. Cardiac Magnetic Resonance Imaging in the Evaluation of Coronary Artery Disease
by Lukas D. Weberling, Dirk Lossnitzer, Norbert Frey and Florian André
Diagnostics 2023, 13(1), 125; https://doi.org/10.3390/diagnostics13010125 - 30 Dec 2022
Cited by 7 | Viewed by 2803
Abstract
Coronary artery disease (CAD) represents a widespread burden to both individual and public health, steadily rising across the globe. The current guidelines recommend non-invasive anatomical or functional testing prior to invasive procedures. Both coronary computed tomography angiography (cCTA) and stress cardiac magnetic resonance [...] Read more.
Coronary artery disease (CAD) represents a widespread burden to both individual and public health, steadily rising across the globe. The current guidelines recommend non-invasive anatomical or functional testing prior to invasive procedures. Both coronary computed tomography angiography (cCTA) and stress cardiac magnetic resonance imaging (CMR) are appropriate imaging modalities, which are increasingly used in these patients. Both exhibit excellent safety profiles and high diagnostic accuracy. In the last decade, cCTA image quality has improved, radiation exposure has decreased and functional information such as CT-derived fractional flow reserve or perfusion can complement anatomic evaluation. CMR has become more robust and faster, and advances have been made in functional assessment and tissue characterization allowing for earlier and better risk stratification. This review compares both imaging modalities regarding their strengths and weaknesses in the assessment of CAD and aims to give physicians rationales to select the most appropriate modality for individual patients. Full article
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