CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Stephan Achenbach, MD, FESC* and
Werner G. Daniel, MD, FESC, FACC
* Department of Internal Medicine II (Cardiology), University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany (Email: stephan.achenbach{at}med2.med.uni-erlangen.de).
We thank Dr. Wijpkema and colleagues for their interest in our editorial (1). They clearly outline the limitations of purely morphologic imaging of coronary artery lesions. Undoubtedly, assessment of the hemodynamic relevance of coronary artery stenoses—for example, by measuring the functional flow reserve—is very valuable for clinical decision making. This is the case, especially as they correctly state, "in case of intermediate coronary lesions ... in addition to coronary angiography." By no means does our editorial suggest that we would consider computed tomography (CT) capable of providing that kind of information. Nor do we suggest that CT can grade anatomic lesion severity with an accuracy similar to that of quantitative coronary angiography.
Measurement of functional flow reserve is helpful, but it is an invasive technology that can only be used after catheter-based coronary angiography has been performed. Computed tomography—if performed correctly and using state-of-the-art equipment—has the potential to identify patients who do not even have intermediate lesions and thus will not require an invasive, catheter-based diagnostic procedure. We completely agree with Dr. Wijpkema and colleagues that CT is anatomy oriented, but, like many others (2–6), still see a potentially very valuable role in working up symptomatic individuals with a low-to-moderate likelihood of coronary artery stenoses, avoiding the risk and expense of invasive testing in many patients. In order to put potential future applications on a firm ground, further research in this area is enthusiastically supported.
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1. Achenbach S, Daniel WG. Computed tomography of the coronary arteriesmore than meets the (angiographic) eye. J Am Coll Cardiol 2005;46:155-157.[Free Full Text]2. Rumberger J. Noninvasive coronary angiography using computed tomography. Ready to kick it up another notch? Circulation 2002;106:2036-2038.[Free Full Text] 3. Fayad Z, Fuster V, Nikolaou K, Becker C. Computed tomography and magnetic resonance imaging for noninvasive coronary angiography and plaque imagingcurrent and potential future concepts. Circulation 2002;106:2026-2034.[Free Full Text] 4. De Feyter PJ, Nieman K. Noninvasive multi-slice computed tomography coronary angiography. An emerging clinical modality J Am Coll Cardiol 2004;44:1238-1240.[Free Full Text] 5. Schroeder S, Bax JJ. Multi-slice computed tomographyuseful for non-invasive coronary angiography?. Int J Cardiovasc Imaging 2004;20:67-69.[CrossRef][Web of Science][Medline] 6. Garcia MJ. Noninvasive coronary angiographyhype or new paradigm?. JAMA 2005;293:2531-2533.[Free Full Text]
Related Article
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Quantification of Coronary Lesions by 64-Slice Computed Tomography Compared With Quantitative Coronary Angiography and Intravascular Ultrasound
- Jasper S. Wijpkema, René A. Tio, and Felix Zijlstra
J. Am. Coll. Cardiol. 2006 47: 891.
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