As a consequence of improved technology, there is growing clinical interest in the use of multi-detector row computed tomography (MDCT) for non-invasive coronary angiography. Indeed, the accuracy of MDCT to detect or exclude coronary artery stenoses has been high in many published studies. This report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT (WG 5) of the European Society of Cardiology and the European Council of Nuclear Cardiology summarizes the present state of cardiac CT technology, as well as the currently available data concerning its accuracy and applicability in certain clinical situations. Besides coronary CT angiography, the use of CT for the assessment of cardiac morphology and function, evaluation of perfusion and viability, and analysis of heart valves is discussed. In addition, recommendations for clinical applications of cardiac CT imaging are given and limitations of the technique are described.

https://www.zora.uzh.ch/id/eprint/14228/4/Schroeder_EuropHeartJourn_2008V.pdf

Cardiac computed tomography: Indications, applications, limitations, and training requirements - Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology

Coronary artery calcium progression: an important clinical measurement? A review of published reports.

Objectives Accelerated cardiovascular morbidity and mortality occur in patients with rheumatoid arthritis (RA). We evaluated the presence, burden and compositional differences of coronary plaque in patients with RA without symptoms or diagnosis of coronary artery disease (CAD) compared against controls. Methods One hundred and fifty patients with RA and 150 matched controls underwent 64-slice CT angiography (CTA) for evaluation of coronary plaque. Numbers of segments with plaque per patient (Segment involvement score (SIS)), degree of segment stenosis (stenosis severity score (SSS)), plaque size (plaque burden score (PBS)), and composition were assessed using a standardised American Heart Association 15-segment model. Lesions were classified as non-calcified plaque (NCP), mixed (MP), and fully calcified plaque (CP). Results  Higher proportion of patients with RA had plaque when compared with controls (71% vs 45%, p Conclusions RA patients without CAD have higher prevalence, extent, and severity of all types of coronary plaque. Residual disease activity associates with presence of higher risk NCP and MP potentially contributing to future adverse cardiac events.

https://ard.bmj.com/content/annrheumdis/73/10/1797.full.pdf?with-ds=yes

Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease

Effect of statin treatment on coronary plaque progression - a serial coronary CT angiography study.

To clarify the potential role of coronary computed tomographic angiography (CCTA) in characterizing and prognosticating high-risk coronary plaques. A systematic review and meta-analysis were conducted to compare high-risk vs. low-risk plaques and culprit vs. non-culprit lesions in patients with acute coronary syndrome (ACS) vs. stable angina (SA). High-risk plaques were defined by at least one of the following features: non-calcified plaque (NCP), the presence of spotty calcified plaque (SCP), or increased remodelling index (RI). Results of included studies were pooled as odds ratios (OR) or weighted mean differences (WMD) with 95% confidence interval (CI). Eighteen eligible studies provided data to compare plaque types, plaque volume, and RI. Six studies provided data on ACS events in vulnerable high-risk vs. low-risk calcified plaques after 35 ± 2 months of follow-up. ACS patients had significantly higher number of NCP and SCP compared with SA patients with OR = 1.96 (1.47–2.60; 95% CI) P = 0.0001 and OR = 4.5 (2.98–6.83; 95% CI) P = 0.0001, respectively. Total plaque volume in ACS was not larger than SA: WMD = 22.9 (−22.1 to 67; 95% CI) mm3, P = 0.32, but NCP volume was significantly larger: WMD = 28.8 (10.9–46.7; 95% CI) mm3, P = 0.002. RI was higher in culprit lesions in ACS compared with SA and compared with non-culprit lesions in ACS patients: WMD = 0.48 (0.25–0.70; 95% CI) P = 0.0001 and 0.19 (0.07–0.30) P = 0.0001, respectively. The associated risk of future ACS was significantly higher in high-risk than in low-risk plaques: OR = 12.1 (5.24–28.1; 95% CI) P = 0.0001. CCTA can non-invasively characterize high-risk vulnerable coronary plaques and can predict future ACS events in patients with high-risk plaques.

Characteristics of high-risk coronary plaques identified by computed tomographic angiography and associated prognosis: a systematic review and meta-analysis

Purpose:Multislice detector computed tomography (MSCT) is an accurate noninvasive modality to detect and classify different stages of atherosclerosis. The aim of the New Age II Study was to detect coronary lesions in men without established coronary artery disease (CAD) but with a distinct cardiovas

Influence of a Lipid-Lowering Therapy on Calcified and Noncalcified Coronary Plaques Monitored by Multislice Detector Computed Tomography: Results of the New Age II Pilot Study

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Influence of a Lipid-Lowering Therapy on Calcified and Noncalcified Coronary Plaques Monitored by Multislice Detector Computed Tomography: Results of the New Age II Pilot Study