CT Coronary Calcium Coronary artery calcification is an indicator of coronary atherosclerosis presence and can be assessed using ECG- gated noncontrast CT of the heart [11]. There are limited data on the use of CT coronary calcium in symptomatic patients at a high risk for CAD. CCS has been shown to provide value in symptomatic individuals presenting with chest pain for risk assessment for future events [12]. A zero CCS in patients undergoing CT scanning for suspected stable angina has a high negative predictive value (NPV) for the exclusion of obstructive CAD and is associated with a good medium-term prognosis [13]. In one large multicenter study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE] trial) that included patients with stable chest pain and no history of CAD, presence of measurable coronary artery calcification at the baseline was associated with clinical events [14]. A substudy of another larger multicenter trial (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]) demonstrated that in patients with high probability of CAD and no known CAD, the absence of coronary calcification does not exclude obstructive stenosis [15]. Conversely, a prospective randomized controlled trial (Computed Tomography vs. Exercise Testing in Suspected Coronary Artery Disease [CRESCENT]) showed that in patients with stable chest pain and no known CAD, the presence of a coronary calcium and even a high total coronary artery calcification score is not clearly associated with ischemia [16]. Chronic Chest Pain-High Probability of CAD CT Heart Function and Morphology CT heart function and morphology can provide assessment of ventricular morphology and function as well as assessment of myocardial perfusion and infarction.
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. CT Coronary Calcium Coronary artery calcification is an indicator of coronary atherosclerosis presence and can be assessed using ECG- gated noncontrast CT of the heart [11]. There are limited data on the use of CT coronary calcium in symptomatic patients at a high risk for CAD. CCS has been shown to provide value in symptomatic individuals presenting with chest pain for risk assessment for future events [12]. A zero CCS in patients undergoing CT scanning for suspected stable angina has a high negative predictive value (NPV) for the exclusion of obstructive CAD and is associated with a good medium-term prognosis [13]. In one large multicenter study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE] trial) that included patients with stable chest pain and no history of CAD, presence of measurable coronary artery calcification at the baseline was associated with clinical events [14]. A substudy of another larger multicenter trial (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]) demonstrated that in patients with high probability of CAD and no known CAD, the absence of coronary calcification does not exclude obstructive stenosis [15]. Conversely, a prospective randomized controlled trial (Computed Tomography vs. Exercise Testing in Suspected Coronary Artery Disease [CRESCENT]) showed that in patients with stable chest pain and no known CAD, the presence of a coronary calcium and even a high total coronary artery calcification score is not clearly associated with ischemia [16]. Chronic Chest Pain-High Probability of CAD CT Heart Function and Morphology CT heart function and morphology can provide assessment of ventricular morphology and function as well as assessment of myocardial perfusion and infarction.