Top

Published in:

01-10-2014 | Cardiac Computed Tomography (S Achenbach and T Villines, Section Editor)

Integrating Anatomical and Functional Assessment of Coronary Artery Disease: Can MDCT act as the lone Gatekeeper in the near Future?

Authors: Vítor Ramos, Nuno Dias Ferreira, Nuno Bettencourt

Published in: Current Cardiovascular Imaging Reports | Issue 10/2014

Abstract

Several multicenter trials have demonstrated the high diagnostic accuracy and clinical efficacy of modern coronary computed tomography angiography (CTA) when utilized to evaluate symptomatic patients with low-to-intermediate pretest probability of coronary artery disease (CAD). However, coronary CTA remains a purely anatomic test and further assessment with invasive coronary angiography or other non-invasive tests are occasionally required, with subsequent inherent risks and costs to patients and healthcare systems. Recently, remarkable advances in multidetector computed tomography technology has significantly improved temporal and spatial resolution of coronary CTA. In the past decade, initially in animal models and then in humans, stress myocardial perfusion imaging by computed tomography (CTP) evolved and is being increasingly studied. It is the purpose of this review to highlight recent updates in the CTP literature and try to figure how to place CTP in CAD management in the near future.

WHO Fact sheet N°310, updated July 2013. http://www.who.int/mediacentre/factsheets/fs310/en/index.html

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics 2012 update: a report from the american heart association. Circulation. 2012;125:e2–220.PubMedCrossRef

Widimsky P, Wijns W, Fajadet J, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2010;31:943–57.PubMedCentralPubMedCrossRef

Lakkis N, Tsyboulev V, Gibson CM, Murphy SA, Weintraub WS, DiBattiste PM, et al. Outcome of patients with acute coronary syndrome admitted to hospitals with or without onsite cardiac catheterization laboratory: a TACTICS-TIMI 18 substudy. Crit Pathw Cardiol. 2002;1(4):232–7.PubMedCrossRef

Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.PubMedCrossRef

Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213–24.PubMedCrossRef

Pijls NH, Fearon WF, Tonino PA, Siebert U, Ikeno F, Bornschein B, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME study. J Am Coll Cardiol. 2010;56:177–84.PubMedCrossRef

Pijls NHJ, van Schaardenburgh P, Manoharan G, Boersma E, Bech J-W, Van't Veer M, et al. Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis: 5-Year Follow-Up of the DEFER Study. J Am Coll Cardiol. 2007;49:2105–11.PubMedCrossRef

Shaw LJ, Cerqueira MD, Brooks MM, Althouse AD, Sansing VV, Beller GA, et al. Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. J Nucl Cardiol. 2012;19:658–69.PubMedCentralPubMedCrossRef

10.

Phillips LM, Hachamovitch R, Berman DS, Iskandrian AE, Min JK, Picard MH, et al. Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA. J Nucl Cardiol. 2013;20(6):969–75.PubMedCentralPubMedCrossRef

11.

Melikian N, De Bondt P, Tonino P, De Winter O, Wyffels E, Bartunek J, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv. 2010;3(3):307–14.PubMedCrossRef

12.

Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the Short-Term Survival Benefit Associated With Revascularization Compared With Medical Therapy in Patients With No Prior Coronary Artery Disease Undergoing Stress Myocardial Perfusion Single Photo Emission Computed Tomography. Circulation. 2003;107:2900–7.PubMedCrossRef

13.

Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362(10):886–95.PubMedCentralPubMedCrossRef

14.

Maron DJ, Stone GW, Berman DS, Mancini GB, Scott TA, Byrne DW, et al. Is cardiac catheterization necessary before initial management of patients with stable ischemic heart disease? Results from a Web-based survey of cardiologists. Am Heart J. 2011;162(6):1034–43.PubMedCrossRef

15.

Arora N, Matheny ME, Sepke C, Resnic FS. A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. Am Heart J. 2007;153:606–11.PubMedCrossRef

16.

Bettencourt N, Ferreira N, Chiribiri A, Schuster A, Sampaio F, Santos L, et al. Additive value of magnetic resonance coronary angiography in a comprehensive cardiac magnetic resonance stress-rest protocol for detection of functionally significant coronary artery disease: a pilot study. Circ Cardiovasc Imaging. 2013;6(5):730–8.PubMedCrossRef

17.

Schuetz GM, Zacharopoulou NM, Schlattmann P, Dewey M. Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. Ann Intern Med. 2010;152(3):167–77.PubMedCrossRef

18.

Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O'Leary D, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308(8):788–95.PubMedCentralPubMedCrossRef

19.

Chow BJ, Small G, Yam Y, Chen L, Achenbach S, Al-Mallah M, et al. Incremental prognostic value of cardiac computed tomography in coronary artery disease using CONFIRM: Coronary computed tomography angiography evaluation for clinical outcomes: an InteRnational Multicenter registry. Circ Cardiovasc Imaging. 2011;4:463–72.PubMedCrossRef

20.

Pontone G, Andreini D, Bartorelli AL, Bertella E, Cortinovis S, Mushtaq S, et al. A Long-Term Prognostic Value of CT Angiography and Exercise ECG in Patients With Suspected CAD. J Am Coll Cardiol Img. 2013;6(6):641–50.CrossRef

21.

Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W, et al. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology. 2007;244(2):419–28.PubMedCrossRef

22.

Alkadhi H, Scheffel H, Desbiolles L, Gaemperli O, Stolzmann P, Plass A, et al. Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. Eur Heart J. 2008;29(6):766–76.PubMedCrossRef

23.

Vavere AL, Arbab-Zadeh A, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, et al. Coronary artery stenoses: accuracy of 64-detector row CT angiography in segments with mild, moderate, or severe calcification: a subanalysis of the CORE-64trial. Radiology. 2011;261:100–8.PubMedCentralPubMedCrossRef

24.

Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Eng J Med. 2008;359:2324–36.CrossRef

25.

Weustink AC, Nieman K, Pugliese F, Mollet NR, Meijboom WB, van Mieghem C, et al. Diagnostic accuracy of computed tomography angiography in patients after bypass grafting: comparison with invasive coronary angiography. JACC Cardiovasc Imaging. 2009;2:816–24.PubMedCrossRef

26.

Onuma Y, Dudek D, Thuesen L, Webster M, Nieman K, Garcia-Garcia HM, et al. Five-Year Clinical and Functional Multislice Computed Tomography Angiographic Results After Coronary Implantation of the Fully Resorbable Polymeric Everolimus-Eluting Scaffold in Patients With De Novo Coronary Artery Disease: The ABSORB Cohort A Trial. JACC Cardiovasc Interv. 2013;6(10):999–1009.PubMedCrossRef

27.

Jespersen L, Hvelplund A, Abildstrøm SZ, Pedersen F, Galatius S, Madsen JK, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33(6):734–44.PubMedCrossRef

28.

Sharaf B, Wood T, Shaw L, Johnson BD, Kelsey S, Anderson RD, et al. Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) angiographic core laboratory. Am Heart J. 2013;166(1):134–41.PubMedCentralPubMedCrossRef

29.

Gosling O, Loader R, Venables P, Rowles N, Morgan-Hughes G, Roobottom C. Cardiac CT: are we underestimating the dose? A radiation dose study utilizing the 2007 ICRP tissue weighting factors and a cardiac specific scan volume. Clin Radiol. 2010;65(12):1013–7.PubMedCrossRef

30.

Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA. 2009;301(5):500–7.PubMedCrossRef

31.

Hausleiter J, Meyer TS, Martuscelli E, Spagnolo P, Yamamoto H, Carrascosa P, et al. Image quality and radiation exposure with prospectively ECG-triggered axial scanning for coronary CTangiography: the multicenter, multivendor, randomized PROTECTION-III study. JACC Cardiovasc Imaging. 2012;5(5):484–93.PubMedCrossRef

32.

Achenbach S, Dilsizian V, Kramer CM, Zoghbi WA. The year in coronary artery disease. JACC Cardiovasc Imaging. 2009;2(6):774–86.PubMedCrossRef

33.

Meijboom WB, Van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, et al. Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol. 2008;52(8):636–43.PubMedCrossRef

34.

Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003.PubMedCrossRef

35.

Balachandran KP, Berry C, Norrie J, Vallance BD, Malekianpour M, Gilbert TJ, et al. Relation between coronary pressure derived collateral flow, myocardial perfusion grade, and outcome in left ventricular function after rescue percutaneous coronary intervention. Heart. 2004;90(12):1450–4.PubMedCentralPubMedCrossRef

36.

Fischer JJ, Samady H, McPherson JA, Sarembock IJ, Powers ER, Gimple LW, et al. Comparison between visual assessment and quantitative angiography versus fractional flow reserve for native coronary narrowings of moderate severity. Am J Cardiol. 2002;90(3):210–5.PubMedCrossRef

37.

Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379:453–60.PubMedCentralPubMedCrossRef

38.

Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H, et al. MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 2008;29:480–9.PubMedCrossRef

39.

Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K, et al. MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial. Eur Heart J. 2013;34(10):775–81.PubMedCrossRef

40.

Valenta I, Dilsizian V, Quercioli A, Ruddy TD, Schindler TH. Quantitative PET/CT measures of myocardial flow reserve and atherosclerosis for cardiac risk assessment and predicting adverse patient outcomes. Curr Cardiol Rep. 2013;15(3):344.PubMedCrossRef

41.

Taylor CA, Fonte TA, Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol. 2013. J Am Coll Cardiol. 2013;61(22):2233–41.PubMedCrossRef

42.

Nakazato R, Park HB, Berman DS, Gransar H, Koo BK, Erglis A, et al. Noninvasive Fractional Flow Reserve Derived From Computed Tomography Angiography for Coronary Lesions of Intermediate Stenosis Severity: Results From the DeFACTO Study. Circ Cardiovasc Imaging. 2013;6(6):881–9.PubMedCrossRef

43.

Yoon YE, Choi JH, Kim JH, Park KW, Doh JH, Kim YJ, et al. Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve. JACC Cardiovasc Imaging. 2012;5(11):1088–96.PubMedCrossRef

44.

Bettencourt N, Rocha J, Ferreira N, Pires-Morais G, Carvalho M, Leite D, et al. Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease. J Cardiovasc Comput Tomogr. 2011;5(6):392–405.PubMedCrossRef

45.

Kurata A, Mochizuki T, Koyama Y, Haraikawa T, Suzuki J, Shigematsu Y, et al. Myocardial perfusion imaging using adenosine triphosphate stress multi-slice spiral computed tomography: alternative to stress myocardial perfusion scintigraphy. Circulation. 2005;69(5):550–7.CrossRef

46.

Kido T, Kurata A, Higashino H, Inoue Y, Kanza RE, Okayama H, et al. Quantification of regional myocardial blood flow using first-pass multidetector-row computed tomography and adenosine triphosphate in coronary artery disease. Circulation. 2008;72(7):1086–91.CrossRef

47.

George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA, et al. Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging. 2009;2(3):174–82.PubMedCentralPubMedCrossRef

48.

Magalhães TA, Cury RC, Pereira AC, Moreira VM, Lemos PA, Kalil-Filho R, et al. Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stents. J Cardiovasc Comput Tomogr. 2011;5(6):449–58.PubMedCrossRef

49.•

Bettencourt N, Chiribiri A, Schuster A, Ferreira N, Sampaio F, Pires-Morais G, et al. Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease. J Am Coll Cardiol. 2013;61(10):1099–107. Larger unicenter study.PubMedCrossRef

50.

Blankstein R, Shturman LD, Rogers IS, Rocha-Filho JA, Okada DR, Sarwar A, et al. Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol. 2009;54(12):1072–84.PubMedCrossRef

51.

Rocha-Filho JA, Blankstein R, Shturman LD, Bezerra HG, Okada DR, Rogers IS, et al. Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. Radiology. 2010;254(2):410–9.PubMedCentralPubMedCrossRef

52.

Tamarappoo BK, Dey D, Nakazato R, Shmilovich H, Smith T, Cheng VY, et al. Comparison of the extent and severity of myocardial perfusion defects measured by CT coronary angiography and SPECT myocardial perfusion imaging. JACC Cardiovasc Imaging. 2010;3(10):1010–9.PubMedCrossRef

53.

Okada DR, Ghoshhajra BB, Blankstein R, Rocha-Filho JA, Shturman LD, Rogers IS, et al. Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT. J Nucl Cardiol. 2010;17(1):27–37.PubMedCentralPubMedCrossRef

54.

Cury RC, Magalhães TA, Borges AC, Shiozaki AA, Lemos PA, Júnior JS, et al. Dipyridamole stress and rest myocardial perfusion by 64-detector row computed tomography in patients with suspected coronary artery disease. Am J Cardiol. 2010;106(3):310–5.PubMedCrossRef

55.

Ho KT, Chua KC, Klotz E, Panknin C. Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT. JACC Cardiovasc Imaging. 2010;3(8):811–20.PubMedCrossRef

56.

Feuchtner G, Goetti R, Plass A, Wieser M, Scheffel H, Wyss C, et al. Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia: comparison with magnetic resonance imaging. Circ Cardiovasc Imaging. 2011;4(5):540–9.PubMedCrossRef

57.

Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, et al. Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology. 2011;260(3):689–98.PubMedCrossRef

58.

Ko SM, Choi JW, Song MG, Shin JK, Chee HK, Chung HW. Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography. Eur Radiol. 2011;21(1):26–35.PubMedCrossRef

59.

Wang Y, Qin L, Shi X, Zeng Y, Jing H, Schoepf UJ, et al. Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT: comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging. AJR Am J Roentgenol. 2012;198(3):521–9.PubMedCrossRef

60.•

Weininger M, Schoepf UJ, Ramachandra A, Fink C, Rowe GW, Costello P, et al. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energymyocardial perfusion CT for the assessment of acute chest pain: initial results. Eur J Radiol. 2012;81(12):3703–10. Evaluation of CTP diagnostic accuracy in a emergency department.PubMedCrossRef

61.

Kim SM, Choi JH, Chang SA, Choe YH. Additional value of adenosine-stress dynamic CT myocardial perfusion imaging in the reclassification of severity of coronary artery stenosis at coronary CT angiography. Clin Radiol. 2013;68(12):e659–68.PubMedCrossRef

62.

Choo KS, Hwangbo L, Kim JH, Park YH, Kim JS, Kim J, Chun KJ, Jeong DW, Lim SJ. Adenosine-stress low-dose single-scan CT myocardial perfusion imaging using a 128-slice dual-source CT: a comparison with fractional flow reserve. Acta Radiol. 2013; Apr 2. [Epub ahead of print]

63.

Greif M, von Ziegler F, Bamberg F, Tittus J, Schwarz F, D'Anastasi M, et al. CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR. Heart. 2013;99(14):1004–11.PubMedCrossRef

64.

Ko BS, Cameron JD, Meredith IT, Leung M, Antonis PR, Nasis A, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J. 2012;33(1):67–77.PubMedCrossRef

65.•

George RT, Arbab-Zadeh A, Miller JM, Vavere AL, Bengel FM, Lardo AC, et al. Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging. 2012;5(3):333–40. Rest scan performed first previous to stress; also with delayed enhancement acquisition.PubMedCrossRef

66.

Nasis A, Ko BS, Leung MC, Antonis PR, Nandurkar D, Wong DT, et al. Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study. Eur Radiol. 2013;23(7):1812–21.PubMedCrossRef

67.•

Rief M, Zimmermann E, Stenzel F, Martus P, Stangl K, Greupner J, et al. Computed tomography angiography and myocardial computed tomography perfusion in patients with coronary stents: prospective intraindividual comparison with conventional coronary angiography. J Am Coll Cardiol. 2013;62(16):1476–85. Aditional value of CTP in patients with coronary stents.PubMedCrossRef

68.••

Rochitte CE, George RT, Chen MY, Arbab-Zadeh A, Dewey M, Miller JM, 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(17):1120–30. Larger study to date and first multicenter with 381 patients studied.PubMedCrossRef

69.

Techasith T, Cury RC. Stress myocardial CT perfusion: an update and future perspective. JACC Cardiovasc Imaging. 2011;4(8):905–16.PubMedCrossRef

70.

Zoghbi GJ, Dorfman TA, Iskandrian AE. The effects of medications on myocardial perfusion. J Am Coll Cardiol. 2008;52(6):401–16.PubMedCrossRef

71.

Cury RC, Magalhães TA, Paladino AT, Shiozaki AA, Perini M, Senra T, et al. Dipyridamole stress and rest transmural myocardial perfusion ratio evaluation by 64 detector-row computed tomography. J Cardiovasc Comput Tomogr. 2011;5(6):443–8.PubMedCrossRef

72.

Bischoff B, Bamberg F, Marcus R, Schwarz F, Becker HC, Reiser M. Optimal timing for first-pass stress CT myocardial perfusion imaging. Int J Cardiovasc Imaging. 2013;29(2):435–42.PubMedCrossRef

73.

Gerber BL, Belge B, Legros GJ, Lim P, Poncelet A, Pasquet A, et al. Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation. 2006;113(6):823–33.PubMedCrossRef

74.

Ko SM, Choi JW, Hwang HK, Song MG, Shin JK, Chee HK. Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosine-induced stress dual-energy CT for detection of significant coronary stenosis. AJR Am J Roentgenol. 2012;198(3):512–20.PubMedCrossRef

75.

Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;81(12):3703–10.

Title: Integrating Anatomical and Functional Assessment of Coronary Artery Disease: Can MDCT act as the lone Gatekeeper in the near Future?
Authors: Vítor Ramos
Nuno Dias Ferreira
Nuno Bettencourt
Publication date: 01-10-2014
Publisher: Springer US
Published in: Current Cardiovascular Imaging Reports / Issue 10/2014
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI: https://doi.org/10.1007/s12410-014-9292-y

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Integrating Anatomical and Functional Assessment of Coronary Artery Disease: Can MDCT act as the lone Gatekeeper in the near Future?

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 10/2014

Molecular Intravascular Imaging Approaches for Atherosclerosis

Dual Energy Imaging in Cardiovascular CT: Current Status and Impact on Radiation, Contrast and Accuracy

Development of 3D IVOCT Imaging and Co-Registration of IVOCT and Angiography in the Catheterization Laboratory

Patterns of Opacification in Coronary CT Angiography: Contrast Differences and Gradients

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page