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Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials Derivation, Validation, and Prognostic Utility of a Prediction Rule for Nonresponse to Clopidogrel: The ABCD-GENE Score Use of Intravascular Ultrasound Imaging in Percutaneous Coronary Intervention to Treat Left Main Coronary Artery Disease Poor R-wave progression as a predictor of sudden cardiac death in general population and subjects with coronary artery disease In acute HF and iron deficiency, IV ferric carboxymaltose reduced HF hospitalizations, but not CV death, at 1 y Effects of Dapagliflozin on Symptoms, Function and Quality of Life in Patients with Heart Failure and Reduced Ejection Fraction: Results from the DAPA-HF Trial Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies Clinical impact of intravascular ultrasound-guided chronic total occlusion intervention with zotarolimus-eluting versus biolimus-eluting stent implantation: randomized study Clinical epidemiology of heart failure with preserved ejection fraction (HFpEF) in comparatively young hospitalized patients

Review ArticleVolume 12, Issue 6, June 2019

JOURNAL:JACC: Cardiovascular Imaging Article Link

The Future of Cardiovascular Computed Tomography Advanced Analytics and Clinical Insights

ED Nicol, BL Norgaard, P Blanke et al. Keywords: atherosclerosis; cardiac CT; FFRCT; machine learning; radiomics; TMVR

ABSTRACT


Cardiovascular computed tomography (CCT) has undergone rapid maturation over the last decade and is now of proven clinical utility in the diagnosis and management of coronary artery disease, in guiding structural heart disease intervention, and in the diagnosis and treatment of congenital heart disease. The next decade will undoubtedly witness further advances in hardware and advanced analytics that will potentially see an increasingly core role for CCT at the center of clinical cardiovascular practice. In coronary artery disease assessment this may be via improved hemodynamic adjudication, and shear stress analysis using computational flow dynamics, more accurate and robust plaque characterization with spectral or photon-counting CT, or advanced quantification of CT data via artificial intelligence, machine learning, and radiomics. In structural heart disease, CCT is already pivotal to procedural planning with adjudication of gradients before and following intervention, whereas in congenital heart disease CCT is already used to support clinical decision making from neonates to adults, often with minimal radiation dose. In both these areas the role of computational flow dynamics, advanced tissue printing, and image modelling has the potential to revolutionize the way these complex conditions are managed, and CCT is likely to become an increasingly critical enabler across the whole advancing field of cardiovascular medicine.