Multispiral computed tomography of the heart and arteries

The capabilities of the European Medical Center's Heart and Vascular Clinic allow for computed tomography of the heart, coronary arteries, and arteries of all other locations. The study is performed on a unique 256-slice tomograph Brilliance iCT. The study is conducted by an experienced cardiologist-radiologist, PhD, Dr. Vladimir Glagolev.

In Russia, mortality from cardiovascular diseases is more than 50%. One of the reasons is atherosclerosis of the coronary arteries, which leads to the development of coronary heart disease and myocardial infarction. Unfortunately, the usual research methods used to diagnose coronary heart disease, such as bicycle ergometry or treadmill test, stress echocardiography, and stress myocardial scintigraphy, do not have the necessary accuracy in detecting the degree of damage to the coronary arteries and do not allow determining the amount of surgical intervention for myocardial revascularization.

Until recently, invasive coronary angiography was the only method of accurate diagnosis of coronary heart disease, and it is deservedly the gold standard due to its high information content. However, this study is associated with the need to hospitalize the patient, as well as with rare but possible complications inherent in any invasive procedure. With the creation of high-speed multispiral computed tomography (MSCT), noninvasive assessment of the condition of the coronary arteries has become possible, which takes only a few minutes and does not require hospitalization.

Multispiral computed tomography allows you to obtain information not only about the condition of the coronary arteries, but also to evaluate the thoracic aorta and pulmonary artery, to exclude or confirm three serious urgent conditions as soon as possible: aortic dissection, pulmonary embolism and acute coronary syndrome. Accurate and early detection of these dangerous diseases allows you to start treatment in a timely and correct manner. 

Along with assessing the condition of the coronary bed, multispiral computed tomography of the coronary arteries (MSCT) allows you to study valve structures (calcification of the valves, valve development abnormalities, vegetation), reveals myocardial lesions (scars, aneurysms, hypertrophy, ruptures), the condition of the cavities of the heart and pericardium. Additional information is provided by the determination of the systolic function of the myocardium with the identification of areas of impaired contractility. An important value of multispiral computed tomography of coronary arteries is the possibility of morphological assessment of plaque, without the use of invasive intravascular ultrasound.

Numerous studies have been conducted, in which independent experts participated, to compare the results of multispiral computed tomography of the coronary arteries and the "gold standard" - coronary angiography. Analysis of the data obtained showed that multispiral computed tomography of the coronary arteries has a high sensitivity, specificity approaching almost 100%. The 3D model obtained during image reconstruction is indispensable in detecting anomalies in the development of coronary arteries and other large vessels, arteriovenous fistulas, and planning interventional interventions, especially in the presence of chronic occlusion of the coronary arteries.

MSCT allows you to assess the condition of shunts after aorto-coronary bypass surgery, as well as under certain conditions and after intravascular stent implantation operations. Thus, multispiral computed tomography of the coronary arteries combines the capabilities of several diagnostic techniques: coronary angiography, EchoCG, MRI of the heart and intravascular ultrasound.

The scientific literature describes the effectiveness of multispiral computed tomography of coronary arteries in assessing the prognosis of coronary heart disease. It was noted that patients with atherosclerotic plaques in the coronary arteries detected by computed tomography, even without hemodynamically significant narrowing (i.e., not leading to the development of angina pectoris), significantly increase the risk of acute coronary syndrome or even myocardial infarction, compared with patients with "clean" coronary arteries. Therefore, patients who have been diagnosed with a particular coronary artery lesion require regular follow-up by a cardiologist, as well as early initiation of non-drug and drug treatment to reduce cardiovascular risk.

MSCT angiography allows noninvasively assessing the condition of the aorta and peripheral arteries, not inferior in diagnostic significance to angiography performed in the operating room.

The main difficulties in multispiral computed tomography assessment of coronary arteries are: pronounced calcification of the coronary arteries, their small caliber (<2mm), examination of previously installed stents with a diameter of less than 2.5 mm, as well as examination of overweight patients. The study of coronary arteries on CT scans in patients with irregular heart rhythm, for example, with atrial fibrillation, frequent extrasystole, is not informative.

The creation of 265-slice tomographs made it possible to reduce the patient's radiation dose by improving the scanning time, but did not change the diagnostic capabilities in the presence of pronounced calcium in the arteries, since the principle of information acquisition by detectors remained unchanged. Calcium, which appears in the artery wall with the progression of atherosclerosis, or in a number of disorders of calcium metabolism (for example, in diseases of the parathyroid gland), causes computed tomography to "highlight" the lumen of the artery, leading to difficulties in assessing the degree of damage to this area. 

Due to the fact that multispiral computed tomography of the coronary arteries is performed with intravenous administration of an iodine-containing contrast agent, preliminary monitoring of kidney function is necessary, and sometimes special preliminary preparation. In case of severe renal dysfunction, it is preferable to choose an alternative study, as well as in the case of allergic reactions to a contrast agent. 

Taking into account the use of an iodine-containing contrast agent, one should not forget about its adverse interaction with metformin (siophor, glucophage). Therefore, metformin withdrawal is required 48 hours before and after the study.

The study is contraindicated during pregnancy, since multispiral computed tomography is associated with X-ray irradiation.

Correct recommendations for conducting research and patient preparation are the key to the safety of the diagnostic procedure and obtaining highly informative results that do not differ in effectiveness from invasive studies.