How Coronary CT Angiogram Can Be A Game Changer for Cardiologists
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How Coronary CT Angiogram Can Be A Game Changer for Cardiologists

  • Highlights

  • CCTA preempts undetected cases of CAD

  • Replaces invasive angiography

  • Offers a host of benefits

  • Costs may reach Rs.50 million


CCTA or Coronary CT angiography is a non-invasive heart imaging test that helps to accurately detect the coronary artery disease (CAD), pre-empting both the scenarios of undetected cases, and unnecessary invasive angiography.
As per a report published in The New England Journal of Medicine, only 37.6% of four lakh patients, had occlusive coronary disease. While the remaining 62.4% did not have symptoms of coronary stenosis, yet they had to go for unnecessary invasive coronary angiography. The report was by Patel MR, et al.
There are instances where patients don't show signs of other risk factors such as high cholesterol, high blood pressure, or diabetes, and yet suffer CAD. Due to the missing symptoms they avoid a CT scan, and the CAD goes untreated.

CCTA Versus Invasive Angiography

CCTA is used for:
-Diagnosis of in-stent restenosis
-Diagnosis of CAD
-Evaluation of coronary bypass graft patency
A study titled Cardiovascular Imaging, was published in JACC in February 17, 2016. The study aimed to see whether CCTA is comparable to conventional invasive angiography. According to Budoff, CCTA and invasive angiography have similar abilities to detect stenosis as defined by fractional flow reserve (FRR).

CCTA can replace invasive angiography. CCTA has additional benefits of being non-invasive. FFR-CT can also be added for further validation.

Advantages of CCTA

-Spatial resolution advance scanners can see coronary vessels with even 2 mm
-Contrast resolution gives good quality pictures
-It is non-invasive unlike the invasive imaging where catheter is inserted into the body through the groin region
-Temporal resolution helps to scan within 2 seconds and therefore no beta-blockers are required
-Best CCTA uses minimal radiation of 0.2 mSv, which is equivalent to only two chest X-rays
-CCTA can also replace both treadmill stress test

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Stress tests look at the electrical activity of the heart, and the blood flow patterns while the heart is under stress. Stress tests find areas of reduced blood flow to the heart, which imply a blockage of the coronary artery. However, CCTA looks directly at the coronary arteries, and gives an estimate of the amount of blockage. Advance technologies in CCTA is FFR-CT. It is developed by HeartFlow. It uses colour coded map. With a host of benefits, CCTA is going to prove as another disrupter in the health domain. The GE CT Scanner was 'Made in India' and costs Rs. 10 million.

Siemens 128 Slice CT Scanner having spatial resolution of 0.24 mm costs Rs 35 Lakh. Highly advanced CT scanner may cost between USD 250,000 and USD 800,000 or Rs. 16 million to Rs. 50 million. Cardiologists can easily absorb these costs with a doctor loan.

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