Cardiac Computed Tomography and Computed Tomography Coronary Angiography: We Must Follow the Proper Indications

We read with great interest the article by Stein and colleagues1 about 64-slice computed tomography (CT) coronary angiography. During the past few years, we have assisted with the development of image techniques in the area of cardiology, especially in magnetic resonance imaging and multislice CT, creating a new relationship between cardiologist and radiologist. Multislice CT has been increasingly used to rule out coronary artery disease, but we must know not only the indications but also the limitations of this attractive technique.1 We would like to highlight 3 essential aspects:

First, the clinical role and utility of CT in the cardiology department have been perfectly defined by the appropriateness criteria published by the American College of Cardiology/American Heart Association and the indications by the European Society of Cardiology.2, 3, 4 The right scenario for CT angiography is a symptomatic patient with a low to intermediate pretest likelihood of coronary artery disease who is unable to undergo a stress test or with an inconclusive result, which leads to the second aspect of interest: Proper, careful selection of the patients is crucial. Those with a high suspicion of coronary artery disease are not good candidates for noninvasive angiography because they will probably require percutaneous coronary intervention; furthermore, the calcium score will probably be too high to make a proper diagnosis. The third point of interest is the usefulness of CT beyond coronariography: congenital heart disease, pulmonary veins, and pericardial or aortic disease. Of course, the radiation dose must always be taken into account, but by following the appropriateness criteria and with rational use, CT scan can be a useful tool for cardiologists.