Kardiologie up2date 2011; 7(2): 89-96
DOI: 10.1055/s-0030-1256585
Hotline – Diagnostische Verfahren und Bildgebung

© Georg Thieme Verlag KG Stuttgart · New York

Neue Kardio-CT-Guidelines – Implikationen für die Praxis?

Axel  Schmermund, Annett  Magedanz, Marco  Schmidt, Bernd  Nowak, Thomas  Voigtländer
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
21. Juli 2011 (online)

Abstract

Cardiac computed tomography (CT) allows for non-invasive evaluation of the coronary arteries. Coronary calcium is a measure of coronary atherosclerosis. Determining coronary calcium by using CT is useful for further risk stratification if the Framingham risk score defines an intermediate cardiovascular risk ranging between (6 - )10 % and 20 % in 10 years. In this case, many subjects’ risk can be reclassified on the basis of the calcium score, and the intensity of risk factor treatment can be adapted accordingly. Non-invasive coronary CT angiography (CTA) is a highly sensitive tool for detecting significant coronary stenoses. As opposed to the luminogram obtained with invasive coronary angiography, CTA also defines plaque build-up in the coronary wall. This occasionally results in an overestimation of stenosis severity. However, the negative predictive value is high, providing for the ability to rule out significant stenoses with a high degree of certainty.

Literatur

  • 1 Agatston A S, Janowitz W R, Hildner F J et al. Quantification of coronary artery calcium using ultrafast computed tomography.  J Am Coll Cardiol. 1990;  15 827-832
  • 2 McClelland R L, Chung H, Detrano R et al. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA).  Circulation. 2006;  113 30-37
  • 3 Schmermund A, Möhlenkamp S, Berenbein S et al. Population-based assessment of subclinical coronary atherosclerosis using electron-beam computed tomography.  Atherosclerosis. 2006;  185 177-182
  • 4 Detrano R, Guerci A D, Carr J J et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups.  N Engl J Med. 2008;  358 1336-1345
  • 5 Erbel R, Möhlenkamp S, Moebus S et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study.  J Am Coll Cardiol. 2010;  56 1397-1406
  • 6 Folsom A R, Kronmal R A, Detrano R C et al. Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA).  Arch Intern Med. 2008;  168 1333-1339
  • 7 Rozanski A, Gransar H, Shaw L J et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing – The EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial.  J Am Coll Cardiol. 2011;  57 1622-1632
  • 8 Greenland P, Alpert J S, Beller G A et al. American College of Cardiology Foundation; American Heart Association. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.  J Am Coll Cardiol. 2010;  56 50-103
  • 9 Budoff M J, Hokanson J E, Nasir K et al. Progression of coronary artery calcium predicts all-cause mortality.  JACC Cardiovasc Imaging. 2010;  3 1229-1236
  • 10 Polonsky T S, McClelland R L, Jorgensen N W et al. Coronary artery calcium score and risk classification for coronary heart disease prediction.  JAMA. 2010;  303 1610-1616
  • 11 Erbel R, Möhlenkamp S, Lehmann N et al. Kardiovaskuläre Risikofaktoren und Zeichen subklinischer Atherosklerose.  Dtsch Arztebl. 2008;  105(1–2) 1-8
  • 12 Miller J M, Rochitte C E, Dewey M et al. Diagnostic performance of coronary angiography by 64-row CT.  N Engl J Med. 2008;  359 2324-2336
  • 13 Achenbach S, Marwan M, Ropers D et al. Coronary computed tomography angiography with a consistent dose below 1mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition.  Eur Heart J. 2010;  31 340-346
  • 14 Einstein A J, Moser K W, Thompson R C et al. Radiation dose to patients from cardiac diagnostic imaging.  Circulation. 2007;  116 1290-1305
  • 15 Blankstein R, Shturman L D, Rogers I S et al. Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.  J Am Coll Cardiol. 2009;  54 1072-1084
  • 16 Budoff M J, Achenbach S, Blumenthal R S et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology.  Circulation. 2006;  114 1761-1791
  • 17 Mark D B, Berman D S, Budoff M J et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents.  J Am Coll Cardiol. 2010;  55 2663-2699
  • 18 . http://www.khk.versorgungsleitlinien.de [Zugriff: 2.5.2011]
  • 19 Chow B J, Abraham A, Wells G A et al. Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography.  Circ Cardiovasc Imaging. 2009;  2 16-23
  • 20 Hulten E A, Carbonaro S, Petrillo S P et al. Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis.  J Am Coll Cardiol. 2011;  57 1237-1247
  • 21 Hoffmann U, Bamberg F, Chae C U et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial.  J Am Coll Cardiol. 2009;  53 1642-1650
  • 22 Andreini D, Pontone G, Mushtaq S et al. Multidetector computed tomography coronary angiography for the assessment of coronary in-stent restenosis.  Am J Cardiol. 2010;  105 645-655
  • 23 Von Ballmoos M W, Haring B, Juillerat P, Alkadhi H. Meta-analysis: diagnostic performance of low-radiation-dose coronary computed tomography angiography.  Ann Intern Med. 2011;  154 413-420
  • 24 Perisinakis K, Seimenis I, Tzedakis A et al. Individualized assessment of radiation dose in patients undergoing coronary computed tomographic angiography with 256-slice scanning.  Circulation. 2010;  122 2394-2402

Prof. Dr. Axel SchmermundFESC 

Cardioangiologisches Centrum Bethanien, CCB

Im Prüfling 23
60389 Frankfurt

eMail: A.Schmermund@ccb.de

Dr. med. Annett Magedanz

Cardioangiologisches Centrum Bethanien, CCB

Im Prüfling 23
60389 Frankfurt

eMail: A.Magedanz@ccb.de

Dr. med. Marco Schmidt

Cardioangiologisches Centrum Bethanien, CCB

Im Prüfling 23
60389 Frankfurt

eMail: M.Schmidt@ccb.de

Prof. Dr. Bernd Nowak

Cardioangiologisches Centrum Bethanien, CCB

Im Prüfling 23
60389 Frankfurt

eMail: B.Nowak@ccb.de

PD Dr. med. Thomas Voigtländer

Cardioangiologisches Centrum Bethanien, CCB

Im Prüfling 23
60389 Frankfurt

eMail: T.Voigtlaender@ccb.de