Cardiovascular CT: the role of cardiologists.
Cardiovascular CT: the role of cardiologists.
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DOI：
10.1136/heartjnl-2018-314557
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发表时间：
2019-09
期刊：
影响因子：
--
通讯作者：
Nicol ED
中科院分区：
文献类型：
--
作者：
Nazir MS;Nicol ED
CT是心血管疾病和结构性介入和器械植入的术前规划的一种日益重要的诊断工具。CT冠状动脉造影术（CTCA）在英国临床实践中获得了突出地位，因为它现在被推荐在国家健康与护理卓越研究所指南中作为一线测试，用于调查那些没有已知的冠状动脉疾病（CAD）的心绞痛症状。1 CTCA是一种很好的CAD排除测试（图1），但具有越来越强大的阳性预测值，特别是当与CT血流储备分数结合时，2目前作为NHS英格兰创新计划的一部分得到资助。最近的证据表明，将CTCA添加到快速访问胸痛诊所患者的标准治疗中，可将非致命性心肌梗死发生率降低40%以上。3在结构性心脏病中，例如在经导管主动脉瓣植入术之前，CT可以提供主动脉瓣环、根部和冠状动脉口的准确尺寸，以指导瓣膜尺寸和静脉通路（图2）。4在二尖瓣介入之前，可以获取关于二尖瓣环形态、钙化、着陆区和与左回旋支动脉的解剖关系的细节，以指导器械尺寸和植入。5此外，CT在电生理手术的检查中非常重要，可以在射频消融和左心房隔离术之前评估心房、肺静脉和左心耳的大小、位置和形态。6它越来越多地用于评估儿童和成人先天性心脏病，特别是当心脏MRI是禁忌症时。
CT is an increasingly pivotal diagnostic tool for cardiovascular disease and preprocedural planning for structural intervention and device implantation. CT coronary angiography (CTCA) has gained prominence in UK clinical practice as it is now recommended in the National Institute for Health and Care Excellence guidelines as the first-line test for the investigation of anginal symptoms in those without known coronary artery disease (CAD). 1 CTCA is an excellent rule-out test for CAD (figure 1) but has an increasingly robust positive predictive value, especially when combined with CT-fractional flow reserve, 2 which is currently being funded as part of an NHS England Innovation programme. Recent evidence has demonstrated the addition of CTCA to standard of care in patients from rapid access chest pain clinics reduced non-fatal myocardial infarction rates by over 40%. 3 In structural heart disease, such as prior to transcatheter aortic valve implantation, CT can provide accurate dimensions of the aortic annulus, root and coronary ostia to guide valve sizing and intravenous access route (figure 2). 4 Prior to mitral valve intervention, detail on mitral valve annulus morphology, calcification, landing zone and anatomical relation to the left circumflex artery can be acquired to guide device sizing and implantation. 5 Furthermore, CT is important in the workup for electrophysiology procedures to evaluate the size, position and morphology of the atria, pulmonary veins and left atrial appendage prior to radiofrequency ablation and left atrial exclusion. 6 It is increasingly used in the assessment of both paediatric and adult congenital heart disease, especially when cardiac MRI is contraindicated.
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