Emerging and evolving roles for CT in screening for coronary heart disease

Coronary heart disease (CHD) is highly prevalent and is the primary cause of death for both men and women, worldwide. Because the disease develops over many years, there are opportunities to intervene and alter the course of CHD, assuming that there are reliable means for determining which individuals with coronary atherosclerosis will develop symptomatic CHD. CT provides 2 distinct means for coronary artery disease assessment - coronary artery calcium (CAC) measurement using noncontrast CT and coronary CT angiography (cCTA). The recent refinement of electrocardiographic triggering and gating with CT has enabled these techniques to be performed with greater reliability and substantially lower radiation exposure. This has led to widening availability of these diagnostic techniques and rapid expansion of our understanding of their potential clinical use. Within the context of CHD, 2 applications are particularly compelling - risk stratification of asymptomatic individuals with the intent of targeting therapy to prevent CHD and as gatekeeper to cardiac catheterization to minimize unnecessary invasive diagnostic coronary procedures. This review highlights key insights from recent investigations of CHD development and CT application toward the management of individuals at risk of developing or suspected of having CHD.