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Coronary Computed Tomography Angiography: Guidelines and Practical Steps

Mark P. Bowes, PhD

*Medical Writer, Portland, Oregon.
Address correspondence to: Mark P. Bowes, PhD, Medical Writer, 7135 SE 18th Avenue, Portland, OR, 97202. E-mail: mpbowes@gmail.com.

Disclosure Statement: Dr Bowes reports having no financial or advisory relationships with corporate organizations related to this activity.

ABSTRACT

Cardiovascular disease (CVD) is the leading cause of death in the United States, and a common reason for medical imaging. Coronary radiography after injection of radiopaque dye has been used since the 1960s to evaluate coronary artery lesions, but provides only limited information about atherosclerotic plaque and arterial calcification, which are important predictors of future CVD risk. Coronary computed tomography angiography (CTA) is a newer imaging method that provides high-resolution 2-dimensional and 3-dimensional reconstructions that make it possible to examine arterial obstructions, atherosclerotic plaque composition, calcification, and other important measures of CVD. Evidence-based guidelines have been developed by several medical societies and organizations to provide guidance on patient selection and imaging technique for the effective and safe use of coronary CTA. In general, CTA is considered to be most appropriate for patients who have low to intermediate risk of CVD based on risk factors such as age, sex, smoking status, and cholesterol levels. A thorough understanding of the indications, contraindications, and important safety concerns is essential to attain the best possible outcomes for patients undergoing coronary CTA. In addition, CTA requires an understanding of factors such as effective use of contrast agents, control of heart rate, and minimization of radiation exposure. This article provides an overview of the pathophysiology of coronary artery disease and the rationale for cardiac imaging, guideline recommendations regarding the place of CTA in evaluating patients with heart disease, and practical issues in obtaining the best possible image results.

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