Examples of novel approaches to the assessment of flow-limiting coronary artery disease (CAD) with cardiac computed tomography (CT). In the top panel,

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Examples of novel approaches to the assessment of flow-limiting coronary artery disease (CAD) with cardiac computed tomography (CT). In the top panel, representative views of a coronary CT angiogram (CTA; left), coronary angiogram (middle), and stress myocardial perfusion CT (right) images in a patient with CAD and prior stenting of the left anterior descending coronary artery (LAD) are presented. On the CTA, the stent (arrows) is totally occluded as evidenced by the loss of contrast enhancement distal to the stent. The coronary angiogram demonstrates a concordant total occlusion of the LAD. On the perfusion CT images, there is a black rim (arrows) involving the anterior and anterolateral walls, indicating the lack of contrast opacification during stress consistent with myocardial ischemia. (Images courtesy of CORE 320 investigators.) The lower panel illustrates an example of fractional flow reserve (FFR) estimates with coronary CTA (left) compared to the reference standard of invasive FFR. The FFR reflects the pressure differential between a coronary segment distal to a stenosis and the aorta. In normal coronary arteries, there is no gradient, and FFR is 1. An FFR <0.80 is consistent with a hemodynamically significant stenosis. (Images courtesy of Dr. James Min, Cornell University, New York.) Source: Noninvasive Cardiac Imaging: Echocardiography, Nuclear Cardiology, and Magnetic Resonance/Computed Tomography Imaging, Harrison's Principles of Internal Medicine, 19e Citation: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine, 19e; 2015 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/Books/1130/kas_ch270e_f013.png&sec=98721443&BookID=1130&ChapterSecID=79741825&imagename= Accessed: October 17, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved