Budoff Matthew J, Lakshmanan Suvasini, Toth Peter P, Hecht Harvey S, Shaw Leslee J, Maron David J, Michos Erin D, Williams Kim A, Nasir Khurram, Choi Andrew D, Chinnaiyan Kavitha, Min James, Blaha Michael
Division of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance CA, USA.
CGH Medical Center, Sterling, IL and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Prev Cardiol. 2022 Jan 20;9:100318. doi: 10.1016/j.ajpc.2022.100318. eCollection 2022 Mar.
In this clinical practice statement, we represent a summary of the current evidence and clinical applications of cardiac computed tomography (CT) in evaluation of coronary artery disease (CAD), from an expert panel organized by the American Society for Preventive Cardiology (ASPC), and appraises the current use and indications of cardiac CT in clinical practice. Cardiac CT is emerging as a front line non-invasive diagnostic test for CAD, with evidence supporting the clinical utility of cardiac CT in diagnosis prevention. CCTA offers several advantages beyond other testing modalities, due to its ability to identify and characterize coronary stenosis severity and pathophysiological changes in coronary atherosclerosis and stenosis, aiding in early diagnosis, prognosis and management of CAD. This document further explores the emerging applications of CCTA based on functional assessment using CT derived fractional flow reserve, peri‑coronary inflammation and artificial intelligence (AI) that can provide personalized risk assessment and guide targeted treatment. We sought to provide an expert consensus based on the latest evidence and best available clinical practice guidelines regarding the role of CCTA as an essential tool in cardiovascular prevention - applicable to risk assessment and early diagnosis and management, noting potential areas for future investigation.
在本临床实践声明中，我们呈现了由美国预防心脏病学会（ASPC）组织的专家小组对心脏计算机断层扫描（CT）在评估冠状动脉疾病（CAD）方面的当前证据及临床应用的总结，并评估了心脏CT在临床实践中的当前用途及适应症。心脏CT正成为CAD的一线非侵入性诊断测试，有证据支持心脏CT在诊断和预防方面的临床效用。冠状动脉CT血管造影（CCTA）相较于其他检测方式具有若干优势，这是由于其能够识别并描述冠状动脉狭窄的严重程度以及冠状动脉粥样硬化和狭窄中的病理生理变化，有助于CAD的早期诊断、预后评估及管理。本文档进一步探讨了基于使用CT衍生的血流储备分数、冠状动脉周围炎症和人工智能（AI）进行功能评估的CCTA的新兴应用，这些应用可提供个性化风险评估并指导靶向治疗。我们力图基于最新证据和最佳临床实践指南提供专家共识，以阐明CCTA作为心血管预防重要工具的作用——适用于风险评估、早期诊断及管理，并指出未来潜在的研究领域。
