The Present State of Coronary Computed Tomography Angiography A Process in Evolution
The Present State of Coronary Computed Tomography Angiography A Process in Evolution
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DOI：
10.1016/j.jacc.2009.08.087
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发表时间：
2010-03-09
影响因子：
24
通讯作者：
Berman, Daniel S.
中科院分区：
文献类型：
--
作者：
Min, James K.;Shaw, Leslee J.;Berman, Daniel S.
在过去的5年里，自从64排心脏计算机断层扫描血管造影（CCTA）问世以来，科学证据的数量呈指数级增长，支持其在疑似冠状动脉疾病（CAD）患者的临床评估中的可行性。从那时起，关于CCTA在评估疑似CAD患者的算法中究竟适用于何处，一直存在相当大的争论。CCTA的支持者认为，到目前为止，现有证据的质量和范围支持用CCTA替代传统的CAD评估方法，而批评者则认为，CCTA的临床应用尚未得到充分证明，如果使用的话，应该受到限制。与CCTA临床应用的科学争论一致，许多人认为心脏成像的增长速度过高且不可持续。在这方面，所有的非侵入性成像模式，特别是新引入的模式，都经过了更高水平的审查，以证明其临床和经济有效性。我们在此描述了支持CCTA潜在的临床和成本效益的最新可获得的已发表的证据，并提请注意这类研究的重要性和局限性。这些观点可能会引发讨论，未来的研究将是必要的和可行的，以确定CCTA在疑似CAD患者的检查中的确切作用。[J]中华医学会心脏科杂志2010；55:957- 965)(C) 2010
In the past 5 years since the introduction of 64-detector row cardiac computed tomography angiography (CCTA), there has been an exponential growth in the quantity of scientific evidence to support the feasibility of its use in the clinical evaluation of individuals with suspected coronary artery disease (CAD). Since then, there has been considerable debate as to where CCTA precisely fits in the algorithm of evaluation of individuals with suspected CAD. Proponents of CCTA contend that the quality and scope of the available evidence to date support the replacement of conventional methods of CAD evaluation by CCTA, whereas critics assert that clinical use of CCTA is not yet adequately proven and should be restricted, if used at all. Coincident with the scientific debate underlying the clinical utility of CCTA, there has developed a perception by many that the rate of growth in cardiac imaging is disproportionately high and unsustainable. In this respect, all noninvasive imaging modalities and, in particular, more newly introduced ones, have undergone a higher level of scrutiny for demonstration of clinical and economic effectiveness. We herein describe the latest available published evidence supporting the potential clinical and cost efficiency of CCTA, drawing attention not only to the significance but also the limitations of such studies. These points may trigger discussion as to what future studies will be both necessary and feasible for determining the exact role of CCTA in the workup of patients with suspected CAD. (J Am Coll Cardiol 2010; 55: 957-65) (C) 2010 by the American College of Cardiology Foundation