Baumann S, Overhoff D, Tesche C, Korosoglou G, Kelle S, Nassar M, Buss S J, Andre F, Renker M, Schoepf U J, Akin I, Waldeck S, Schoenberg S O, Lossnitzer D
First Department of Medicine - Cardiology, University Medical Centre Mannheim, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Deutschland.
Department for Radiology and Neuroradiology, German Federal Armed Forces Central Hospital Koblenz, Koblenz, Deutschland.
Herz. 2023 Feb;48(1):39-47. doi: 10.1007/s00059-022-05098-7. Epub 2022 Mar 4.
Computed tomography coronary angiography (cCTA) is a safe option for the noninvasive exclusion of significant coronary stenoses in patients with a low or moderate pretest probability for coronary artery disease (CAD). Furthermore, it also allows functional and morphological assessment of coronary stenoses. The European Society of Cardiology (ESC) guidelines on the diagnosis and management of chronic coronary syndrome published in 2019 have strengthened the importance of cCTA in this context and for this reason it has experienced a considerable upgrade. The determination of the Agatston score is a clinically established method for quantifying coronary calcification and influences the initiation of drug treatment. With technologies, such as the introduction of electrocardiography (ECG)-controlled dose modulation and iterative image reconstruction, cCTA can be performed with high image quality and low radiation exposure. Anatomic imaging of coronary stenoses alone is currently being augmented by innovative techniques, such as myocardial CT perfusion imaging or CT-fractional flow reserve (FFR) but the clinical value of these methods merits further investigation. The cCTA could therefore develop into a gatekeeper with respect to the indications for invasive coronary diagnostics and interventions.
计算机断层扫描冠状动脉造影（cCTA）是一种安全的检查方法，可用于无创排除冠心病（CAD）预测试概率较低或中等的患者的严重冠状动脉狭窄。此外，它还能对冠状动脉狭窄进行功能和形态学评估。欧洲心脏病学会（ESC）2019年发布的慢性冠状动脉综合征诊断和管理指南强化了cCTA在这方面的重要性，因此它有了相当大的改进。阿加斯顿评分的测定是一种临床公认的量化冠状动脉钙化的方法，并会影响药物治疗的启动。借助心电图（ECG）控制剂量调制和迭代图像重建等技术，cCTA可以在高图像质量和低辐射暴露的情况下进行。目前，心肌CT灌注成像或CT血流储备分数（FFR）等创新技术正在增强仅对冠状动脉狭窄进行的解剖成像，但这些方法的临床价值值得进一步研究。因此，cCTA可能会成为侵入性冠状动脉诊断和干预适应症的把关者。
