CT coronary angiograms – fewer risks, deeper insight into the heart

16/11/2015
Photo: Screens with pictures of heart in 3D

The pictures are subsequently analyzed at a workstation; © beta-web

Until now, catheter-based coronary angiography was considered state-of-the-art for the diagnosis of coronary heart disease. The coronary blood vessels are examined with the help of a catheter. Yet this method is not without risk. An exam using a computer tomography scanner (CT) - the so-called CT coronary angiogram- represents a low-risk alternative.

Experts will discuss the pros and cons of coronary angiography and the CT-based method during the MEDICA EDUCATION CONFERENCE on Tuesday.


Coronary heart disease (CHD) is a disease resulting from a narrowing of the coronary arteries due to fat and calcium deposits. Until now, the most reliable method to detect these types of narrowings was the so-called coronary angiography. Here a catheter is threaded through an artery in the groin or arm into the heart and injected with a contrast agent. X-rays subsequently make the coronary arteries visible.

There are various risks with conventional cardiac catheterization. First of all, this is an invasive procedure. The catheter insertion can already cause injuries and trigger hemorrhages or aneurysms. During the course of the procedure with the catheter, plaques might loosen in the aorta and the coronary vessel might get damaged. The catheter might also trigger cardiac arrhythmia all the way to ventricular fibrillation, heart attack or strokes. "That’s why a coronary angiogram procedure should only be performed after very careful consideration," explains Professor Jörg Barkhausen, Director of the Clinic for Radiology and Nuclear Medicine at the University Hospital Schleswig-Holstein and a member of the MEDICA EDUCATION CONFERENCE program committee for radiology and nuclear medicine.

 
 
Foto: dreidimensionale plastische Darstellung des Herzens

With the software physicians are able to analyze single coronary blood vessels; © beta-web

CT provides a better view into the heart


That’s why non-invasive test alternatives are wanted more than ever. The CT coronary angiogram is not just a patient-friendly, non-invasive procedure but also a method to display the heart true to the original in 3D.

The contrast agent is simply administered via the vein. The images are taken once the maximum contrast agent density has been achieved in the coronary vascular tree which only takes a quarter of a second. The CT scanner takes x-rays layer-by-layer. They make it possible to make a volume assessment of the heart.

The pictures are subsequently analyzed at a workstation, a powerful computer, and assembled into three-dimensional image data. Collected findings can thus also be presented in graphic form. In doing so, the heart can be examined afterward from top to bottom for plaques or stents.

Excluding or proving CHD that requires intervention


Catheter-based coronary angiography could therefore soon become a thing of the past – at least as it pertains to diagnostics. "In most cases, a CT coronary angiogram can rule out or detect CHD that needs intervention. A cardiac catheterization is only needed if a stenosis is detected," explains Barkhausen. "This is why the German Agency for Health Technology Assessment recommends CT coronary angiography for patients with a medium risk of developing CHD as a ‘preliminary test‘ to avoid unreasonable invasive testing."

Find out more about which method is suited for which indicators during the "Cardiology: What imaging procedure to use for suspected coronary heart disease?" session.

MEDICA EDUCATION CONFERENCE, 11/17/2015 from 9:00 am - 10:30 am, CCD South, First Floor, Room 16

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Foto: Melanie Günther

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The article was conducted by Melanie Günther and translated from German by Elena O'Meara.
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