2020: Entwicklungen in der kardialen Computertomographie

The development of cardiac computed tomography (CT) in the year 2020 was characterized by 3 dominant trends in coronary imaging, namely 1) the prognostic importance of coronary plaque formation, 2) the possibilities associated with its volumetric quantification and 3) the increase in importance attributed to coronary CT angiography (CTA) in the current guidelines, enhanced by its increasing use in the treatment of structural heart disease. The publication of the results of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) has underlined the importance of anatomic characterization of coronary heart disease by visualizing coronary plaques. Aided by machine learning/artificial intelligence, algorithms have been established for reproducible automated quantitative coronary plaque volumetry. These advances have led to questioning the significance of measuring myocardial ischemia, as it results secondarily from coronary plaque formation. Furthermore, the understanding of the pathophysiology of coronary heart disease has changed: the volume of (noncalcified) coronary plaque formation, its localization and dynamics as characteristics of vulnerability, appear to be more important than the focus on a large atheroma or expansive (outward) remodeling of individual plaques. In the guidelines coronary CTA has been promoted to the first-line diagnostic measure in both chronic and acute coronary syndromes without ST-elevation, with an equal strength of recommendation compared with classical imaging ischemia tests. Apart from this, cardiac CT is increasingly used for treatment planning of diseases, particularly of aortic and tricuspid valves, but also other structural heart diseases e.g. occlusion of the left atrial appendage (LAA).