Stress echocardiography in the age of multi-detector computed tomography

Abstract

The introduction of 64-slice multi-detector computed tomography (CT) in 2005 made the non-invasive imaging of coronary arteries relatively easy to perform. Computed tomography coronary angiography (CTCA) has been shown to be highly accurate at detecting coronary artery disease (CAD), when compared with invasive X-ray coronary angiography and, in particular, has an excellent negative predictive value (NPV).1,2 There are also prognostic data confirming very low risk for patients with normal CTCA.3 One of the limitations of multidetector CT and despite very good temporal resolution of 150 ms, with half scan reconstruction, is the need for beta-Blockers to slow the heart rate to 65 bpm, for retrospective, and 60 bpm, for the low radiation dose, prospective gated acquisitions. This is to minimize coronary motion particularly of the right coronary artery. Dual-source CT, with twice the temporal resolution, can cope with faster heart rates, whereas the 320-slice CT can image the heart in one heart beat. The UK national institute of clinical excellence (NICE) have recently produced guidelines on the management of patients with chest pain of recent onset, endorsing the use of CTCA in their investigational algorithm. We discuss the radiation dose associated with …