Contrast agent volume in coronary computer tomography angiography—where are the limits?

摘要

Coronary artery disease (CAD) is still a major public health problem, remaining the most common cause of death and disability globally and being associated with relevant costs for our health care system (1,2). It can present in chronic or stable forms, currently named chronic coronary syndromes but also in acute forms ranging from unstable angina to myocardial infarction with cardiogenic shock or sudden cardiac death. The work-up of patients with known or suspected CAD is complex and usually involves a stepwise approach that includes clinical and demographic data, non-invasive tests and if required invasive coronary angiography (3). Recent data have revealed a lower pre-test probability in patients with CAD than previously anticipated (4). In parallel, a paradigm shift occurred in the evaluation of patients with suspected CAD, with the focus moving to non-invasive imaging techniques. Currently, the clinician can choose between imaging tests that aim at identifying myocardial ischemia such as stress-echocardiography, stress cardiac magnetic resonance imaging or myocardial scintigraphy and direct non-invasive anatomical imaging of the coronary tree using coronary computer tomography angiography (CCTA) (5). In the last decades, an abundance of studies was published, which cemented the central role of CCTA in the diagnostic approach of patients with known and suspected CAD.