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Koronare CT-Angiographie und koronare Atherosklerose

Wo stehen wir heute?

Coronary CT angiography and coronary atherosclerosis

Where do we stand today?

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Zusammenfassung

De kardiale Computertomographie (CT) hat sich in den letzten Jahren erheblich weiterentwickelt. Wesentliches Einsatzgebiet ist die CT-Koronarangiographie zur Darstellung der Koronararterien und zum Nachweis und Ausschluss von Koronararterienstenosen, was Eingang in internationale Leitlinien sowohl für das Management der stabilen koronaren Herzkrankheit bzw. der chronischen Koronarsyndrome als auch für die diagnostische Aufarbeitung von Patientinnen und Patienten mit akuten Thoraxschmerzen gefunden hat. Zu beachten ist allerdings, dass die diagnostische Aussagekraft nur bei guter Bildqualität ausreichend hoch ist und dass deshalb Patientinnen und Patienten, bei denen keine uneingeschränkt gute Bildqualität zu erwarten ist, alternativen Diagnostikverfahren zugeführt werden sollten. Die Tatsache, dass die CT-Angiographie den Nachweis nicht nur von Koronarstenosen, sondern auch von nichtobstruktiver atherosklerotischer Plaque gestattet, ist zur Abschätzung des atherosklerotischen Ereignisrisikos interessant. Als recht gut gesichert kann gelten, dass bei Fehlen atherosklerotischer Plaque in der CT-Angiographie eine Statintherapie keine Risikosenkung bewirkt. Inwieweit die CT zur Indikationsstellung einer Statintherapie geeignet ist und ab welchem Schwellenwert das Vorliegen nichtobstruktiver Plaque Anlass zur Statintherapie sein sollte, ist derzeit Gegenstand intensiver Forschung.

Abstract

Cardiac computed tomography (CT) has made substantial progress in recent years. The main field of application is CT coronary angiography for visualization of the coronary arteries and for the detection and exclusion of coronary artery stenosis. This has been included in international guidelines for the management of stable coronary artery disease or chronic coronary syndrome as well as for the diagnostic work-up of patients with acute chest pain; however, it must be taken into account that the diagnostic validity is only sufficiently high when the image quality is good and therefore alternative diagnostic procedures should be included in patients where an unrestricted good image quality is not to be expected. The fact that CT angiography enables the detection not only of coronary stenosis but also of nonobstructive atherosclerotic plaque is interesting for the estimation of the risk of atherosclerotic events. It is practically certain that in the absence of detectable atherosclerotic plaque in CT angiography, statin treatment does not lower the risk of atherosclerotic events. To what extent CT is suitable to provide indications for statin treatment and the threshold for which the presence of nonobstructive plaque should prompt initiation of statin treatment are currently the subject of intensive research.

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  1. Medizinische Klinik 2, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland

    Stephan Achenbach

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Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Achenbach, S. Koronare CT-Angiographie und koronare Atherosklerose. Herz 48, 352–358 (2023). https://doi.org/10.1007/s00059-023-05207-0

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