Noninvasive coronary artery imaging: Current clinical applications: Cardiac Society of Australia and New Zealand Guidelines

Abstract

Multidetector computed tomography (MDCT) is currently the preferred noninvasive modality that can reliably image coronary arteries. Magnetic resonance imaging (MRI) of the coronaries has limited indications of assessing suspected coronary anomalies and complex congenital heart disease performed at expert centres. The strength of MDCT is to rule out significant coronary artery disease (CAD) in a low-intermediate risk population with symptoms. This has been demonstrated in multi-centre trials. Other appropriate indications for coronary CTA include: Investigation of equivocal or uninterpretable stress tests. Evaluation of suspected coronary anomalies/complex congenital heart disease. Evaluation of new onset heart failure/cardiomyopathy of unknown aetiology. Mapping of coronary vasculature including internal mammary artery before repeat CABG.e.Evaluation of left bundle branch block.f.Excluding significant CAD in select population before valve surgery. It is not appropriate to perform coronary CTA on patients who are asymptomatic or have known significant CAD or high pre-test probability of CAD. Use of MDCT to evaluate acute chest pain in emergency department has been studied by a number of single centre trials. Whilst the results are encouraging, we await multi-centre randomised trials and cost-effectiveness studies before recommending routine use locally. The evaluation of stents and CABG patency has limited application in select scenarios. Reporting of stenosis severity should be in defined categories rather than specific numbers and comment made on the type of plaque involved. Radiation exposure should be kept to a minimum in line with the ALARA principle. All dose saving measures should be routinely employed where appropriate. Expertise in performance and interpretation of such scans is very important. © 2011.