TC Cardiaca nel Dolore ToracicoTC Cardiaca nel Dolore Toracico

Dr.ssa Paola GhioneDr.ssa Paola Ghione

Dr.ssa Camilla Zawaideh Dr.ssa Camilla Zawaideh

PROPRO

TC Cardiaca TC Cardiaca ultima generazioneultima generazione

J Cardiovasc Comput Tomogr. 2011 Dec

Eur Radiol. 2012 May

Apnea <3 sec

Dolore ToracicoDolore Toracico

JACC 2008

Dolore Toracico Dolore Toracico sintomi acutisintomi acuti

(4,5)

Taylor A.J. et al. Appropriate Use Criteria for Cardiac Computed Tomography. J.Am.Coll.Cardiol.2010 Oct 25

Schroeder et al. European Heart Journal 2008Schroeder et al. European Heart Journal 2008

Dolore Toracico Dolore Toracico sintomi acutisintomi acuti

Dolore Toracico Dolore Toracico sospetta CADsospetta CAD

Taylor A.J. et al. Appropriate Use Criteria for Cardiac Computed Tomography. J.Am.Coll.Cardiol.2010 Oct 25Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.

Dolore Toracico Dolore Toracico sospetta CADsospetta CAD

Fox et al. Guidelines on the Management of Fox et al. Guidelines on the Management of Stable Angina Pectoris,Stable Angina Pectoris, Eur H Journal 2006Eur H Journal 2006

… … Evitare ripetuti test diagnostici non conclusivi o dubbi Evitare ripetuti test diagnostici non conclusivi o dubbi

(per un’accuratezza diagnostica inferiore)?(per un’accuratezza diagnostica inferiore)?

Coronarografie solo diagnostiche 30 - 40%Coronarografie solo diagnostiche 30 - 40%

… … Evitare studi coronarografici Evitare studi coronarografici solosolo diagnostici diagnostici

(procedura non scevra da possibili complicazioni)?(procedura non scevra da possibili complicazioni)?

Dorenkamp et al. Direct costs and cost effectiveness of dual source CT and invasive coronary angiography in patient with an intermediate pre-test likelihood of CAD. Cardiovascular imaging 2011

Taylor A.J. et al. Appropriate Use Criteria for Cardiac Computed Tomography. J.Am.Coll.Cardiol.2010 Oct 25

Dolore Toracico Dolore Toracico CAD notaCAD nota

Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.Taylor A.J. et al. Appropriate Use Criteria for Cardiac Computed Tomography. J.Am.Coll.Cardiol.2010 Oct 25

Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.Taylor A.J. et al. Appropriate Use Criteria for Cardiac Computed Tomography. J.Am.Coll.Cardiol.2010 Oct 25

Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.Taylor A.J. et al. Appropriate Use Criteria for Cardiac Computed Tomography. J.Am.Coll.Cardiol.2010 Oct 25

Cademartiri F. et al. Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med. 2012 Apr 1.

Stent CoronariciStent Coronarici

Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008

By PassBy Pass

Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008 Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008 Schroeded et al. European Hear Journal 2008Schroeded et al. European Hear Journal 2008

Weustinket al. J Am Cardiol Img 2009Weustinket al. J Am Cardiol Img 2009

Valore PrognosticoValore Prognostico

JACC 2011JACC 2011

Valore PrognosticoValore Prognosticocaratterizzazione di placcacaratterizzazione di placca

ConclusioniConclusioniLa TC coronarica è un buono strumento per studiare l’anatomia, La TC coronarica è un buono strumento per studiare l’anatomia,

escludere la CAD ed il triple rule outescludere la CAD ed il triple rule out

Ridurre il numero di indagini invasive solo diagnosticheRidurre il numero di indagini invasive solo diagnostiche

Evidenziare Pazienti con stress test negativi per induzione di ischemia Evidenziare Pazienti con stress test negativi per induzione di ischemia ma con anomalie anatomichema con anomalie anatomiche

Implicazioni prognostiche importanti Implicazioni prognostiche importanti

Analisi costo beneficiAnalisi costo benefici

Esame sicuro Esame sicuro Bell et al. Periprocedural safety of 64-detector row coronary CT: result from the prospective

multicenter ACCURACY trial- Journal of Cardiovascular CT, 2010.

ConclusioniConclusioni

Metodica in evoluzione

Sens.Sens.90%90%

Spec.Spec.98%98%

DIBATTITODIBATTITO

Radiol Med. 2010 Feb;115(1):36-50.

Heart. 2010 Jun;96(12):933-8.

Prospectively ECG-triggered Step-and-Shot on a Dual Source CT

Eur J Radiol. 2012 May 9.

Circ Arrhythm Electrophysiol. 2012 May14.128-slice Dual Source CT128-slice Dual Source CT

J Cardiovasc Comput Tomogr. 2012 Apr 7

Eur. Radiol. 2010 Sep;20(9):2092-9.

Beta Bloccante

Obesi120 kV/350 mAs

sequential scanning protocol

J Comput Assist Tomogr. 2011 Dec

DIBATTITODIBATTITO

DIBATTITODIBATTITO

De Carli et al. J Nucl Cardiol 2007 De Carli et al. J Nucl Cardiol 2007

Schuijf et al. Relationship between Noninvasice Coronary Angiography Whit multi-slice CT Schuijf et al. Relationship between Noninvasice Coronary Angiography Whit multi-slice CT and Miocardial Perfusion Imaging. Journal of the American College of Cardiology 2006.and Miocardial Perfusion Imaging. Journal of the American College of Cardiology 2006.

N Engl J Med. 2011 Apr 28;364(17):1617-25. Epub 2011 Apr 4.

Stent CoronariciStent Coronarici

Copyright ©2011 American College of Cardiology Foundation. Restrictions may apply.

Performance Diagnostiche a confrontoPerformance Diagnostiche a confronto

Hamdan, A. et al. J Am Coll Cardiol Img 2011;4:50-61Hamdan, A. et al. J Am Coll Cardiol Img 2011;4:50-61