Authors

• Petar Medaković — Special Hospital Agram, Zagreb, Croatia — ORCID: 0000-0002-7173-8286
• Zrinka Biloglav — Special Hospital Agram, Zagreb, Croatia — ORCID: 0000-0002-3245-001X

Abstract

The European Society of Cardiology (ESC) published guidelines for the diagnosis and management of chronic coronary syndromes in 2019 that included new recommendations for coronary computed tomography angiography (CCTA). The new ESC guidelines promoted CCTA as a Class I examination, which means that CCTA or non-invasive functional imaging is recommended or indicated for myocardial ischemia as the initial test for diagnosing CAD in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone. Patients who are difficult to scan, such as those with extensive coronary calcifications (>400 Agatston Units), increased (>65 bpm) or irregular heart rate, or those who are obese (body mass index >30) and unable to hold their breath, have been already identified by the National Institute for Health and Care Excellence (NICE) in earlier scanner generations. For these patients, NICE recommends the new generation of scanners or even particular scanner models, as opposed to the ESC guidelines which do not recommend CCTA. In spite of differences between ESC and NICE recommendations, an experienced clinical team consisting of a radiographer, radiologist, and cardiologist can obtain good image quality from new-generation CT scanners, even from patients who are difficult to scan. Considering the burden of risk factors and the 2019 ESC guidelines, referrals to CCTA are expected to rise at the national level, as they have in other countries with a similar cardiovascular burden, although clinical practice may vary. Numerous public hospitals have purchased scanners that fulfil SCCT technical guidelines, but these are neither cardiac-dedicated nor recommended for patients who are difficult to scan. CT scanners for these patients should feature dual-source technology with two powerful current generators in order to provide good temporal resolution; they should also have a long z-detector array in order to ensure high spatial resolution and volume coverage. Good image quality requires appropriate patient preparation and the adjustment of scan protocols to individual patient characteristics. This is the only way patients can benefit from this high-tech radiological procedure, according to recent clinical guidelines.

Keywords

coronary artery disease, coronary computed tomography angiography, guidelines

DOI

Full Text

## Conclusion It is hoped that policy and decision makers will develop a comprehensive, economically justifiable plan to implement cardiac dedicated CT scanners in the near future. This is the only way patients can benefit from this high-tech radiological procedure, according to recent clinical guidelines.