CCTA can visualize and help to diagnose the extent and severity of non-obstructive and obstructive CAD, as well as atherosclerotic plaque composition and high-risk features (e.g., positive remodeling, low attenuation plaque).¹
Coronary computed tomography angiography (CCTA) is a noninvasive diagnostic tool that can detect significant coronary artery stenoses and coronary atherosclerotic plaque.²
You can also subsequently calculate fractional flow reserve with CT (FFR-CT), e.g. with HeartFlow.
Who should you calculate FFR-CT on?
- Patients with coronary artery stenosis of 40% to 90% in a proximal or middle coronary segment on CCTA may benefit from measurement of FFR-CT ¹
CCTA has high Negative Predictive Value for excluding significant plaque or coronary stenosis ²
Current radiation dosimetry is low for CCTA, with effective doses for most patients in the 3 to 5 mSv range¹
The presence of significant stenosis in CCTA does not always mean the presence of ischemia-causing stenosis, ∴ presence of epicardial stenosis or atherosclerotic plaque on CCTA does not exclude the possibility of INOCA.²

Who is a poor candidate for CCTA?

Ideal HR for CCTA

Want HR <70 and ideally <60

Arrhythmia, including frequent PACs or PVCs
CEID, e.g. ICD
Extensive CAC
- Go back and check out prior CT scans and see if there is any calcium present (may not have been commented on by the radiology reads)
Prior history of Coronary Artery Disease (CAD)
Renal dysfunction
Contrast allergy
Obesity
- McGhie prefers to avoid CCTA if BMI > 35

Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Journal of the American College of Cardiology. 2021;78(22):e187-e285. doi:10.1016/j.jacc.2021.07.053 ↩ ↩² ↩³
Hwang, D., Park, S.-H., & Koo, B.-K. (2023). Ischemia With Nonobstructive Coronary Artery Disease. JACC: Asia, 3(2), 169–184. https://doi.org/10.1016/j.jacasi.2023.01.004 ↩ ↩² ↩³

🫀 Mirza's Cardiology Notes