CCTA, THEY ARE GETTING THERE : CCTA + CT PERFUSION

Looks like the cardiac imaging boys are surely getting there. In the early part of this month, I wrote about the work of the East European work on CCTA FFR ( studying the vessel perfusion ) technique.
In the Aug 23rd issue of Circulation : Cardiac Imaging, there is a nice. small piece of work by the Austrians on CCTA / CT perfusion. Dr Gudrun Feuchtner and colleagues from the University of Innsbruck, Austria, studied 36 males and 3 females with intermediate coronary risk, with the standard CCTA using the 128 slice, dual source Siemens scanner, and then studied their myocardial perfusion at rest and after adenosine provocation. These patients were then subjected to invasive coronary angiogram as gold standard. There found a correlation of
Sensitivity : 98%
Specificity : 96%
Positive predictive value : 95%
Negative predictive value : 96% ( per vessel ).
All these numbers are very good. To top it all, the radiation exposure was only 1 mSv, and the scan time was said to be 0.3 sec., less than 1 heart beat.

Looks like the cardiac imaging boys are getting there. We have a much better scan now, that can look at anatomy and also myocardial perfusion. With the Latvia boys technique, we can also estimate vessel lesion FFR. If they are able to combine both the techiques ( myocardial perfusion with vessel FFR ), then ultimately the non invasive CCTA / CT perfusion / CTA FFR will probably replace the invasive coronary angiogram, and the coronary angiogram will then be use only as a guide to angioplasty. And if you are going for By-Pass surgery, then there little need for a coronary angiogram. Looks like the CCTA / CT perfusion / CCTA FFR will suffice.
Then the next question is cost. How much will a CCTA / CT perfusion / CCTA FFR cost?
Not to worry, the cardiologist will still do coronary angiogram as a prelude to angioplasty. At this point in time, I do not see any work on non-invasive angioplasty, so we are safe for awhile.
But watch this page. There is much work done and I am sure there will be more developments.