Cardiovascular computed tomography (CT) has undergone rapid maturation over the prior decade and is now of proven clinical utility in the diagnosis and management of coronary artery disease, in guiding structural heart disease intervention, and in the diagnosis and treatment of congenital heart disease. The next decade will undoubtedly witness further advances in hardware and advanced analytics that will potentially see an increasingly core role for cardiovascular CT at the center of clinical cardiovascular practice. In coronary artery disease assessment, this may be via improved hemodynamic adjudication and shear stress analysis using computational flow dynamics (CFD), more accurate and robust plaque characterization with spectral or photon-counting CT, or advanced quantification of CT data via artificial intelligence, machine learning, and radiomics. In structural heart disease, cardiovascular CT is already pivotal to procedural planning with adjudication of gradients both prior to and following intervention whereas, in congenital heart disease, cardiovascular CT is already used to support clinical decision making from neonates to adults, often with minimal radiation dose. In both these areas, the role of CFD, advanced tissue printing, and image modeling has the potential to revolutionize the way these complex conditions are managed; cardiovascular CT is likely to become an increasingly critical enabler across the whole advancing field of cardiovascular medicine.
Editors
Editor-in-Chief
Y.S. Chandrashekhar, MD, DM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Jonathan Leipsic, MD
CME/MOC/ECME Information
Target Audience
JACC Journal CME/MOC is intended for physicians who treat patients with cardiovascular disease.
Important Dates
Date of Release: June 3, 2019
Term of Approval/Date of CME/MOC/ECME Expiration: June 2, 2020
Learner Objectives
After reading this article the reader should be able to:
- Explain the current and developing role of cardiac computed tomography (CT) for ischemic, congenital, and structural heart disease.
- Discuss technological advancements in cardiac CT and the current path being taken by most vendors to help improve image quality while lowering radiation dose exposure.
- Explain the current state and future opportunities for cardiac CT to noninvasively identify, characterize, and quantify atherosclerosis to help advance an understanding of risk and mechanisms of ischemia.
- Introduce the current and evolving role of advanced analytics such as computational fluid dynamics to allow for treatment guidance of coronary stenosis and understanding of personalized risk of procedural comlications during transcatheter interventions.
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