As a global developer of AI-enabled software medical devices, our team closely follows advances in cardiac computed tomography (CT). In December 2020, the European Association of Cardiovascular Imaging (EACVI), a subspecialty community of the European Society of Cardiology (ESC), hosted the first Best of Imaging conference that highlighted recent developments in cardiovascular imaging.
In this post, we summarize what we consider to be the “best of” the EACVI – Best of Imaging conference presentations related to cardiac CT covering primary prevention, atherosclerotic plaque imaging, and artificial intelligence (AI).
CT in Evaluating Coronary Plaque
Dr. Maurovich-Horvat emphasized the value of CT as a non-invasive imaging modality for plaque imaging, recounting the results of the SCOT-HEART trial and the CREDENCE trial. The SCOT Heart trial demonstrated that patients with low-attenuation non-calcified plaque burden were nearly five times more likely to have subsequent myocardial infarction compared to patients with low plaque burden, outperforming cardiovascular risk factors. This outperformed traditional cardiovascular risk factors, luminal stenosis severity, CT calcium scoring, and total plaque burden. As Dr. Maurovich-Horvat explained, this study shows that imaging plaque is associated with improved outcomes.
Dr. Maurovich-Horvat continued that CT could be used as a “one-stop-shop” for imaging coronary artery disease by combining plaque burden with adverse plaque features, functional information from CT-FFR, and myocardial perfusion imaging techniques. However, Dr. Maurovich-Horvat reminded the audience that CT is not suitable for all patients. For patients with renal insufficiency, extensive coronary calcifications, post revascularization, known coronary disease, and morbid obesity, CT is not advised. In cases such as this, perfusion imaging may provide more useful information.
CT in Primary Prevention of Cardiovascular Disease
Dr. Leslee J. Shaw, Professor & Endowed Chair at Weill Cornell Medical College, advocated for the value of CT in guiding primary prevention in the session “Controversies in Computed Tomography.” Dr. Shaw began the session debate by speaking to the challenges with using risk factors at the patient level, explaining that atherosclerotic cardiovascular risk scores are meant for estimating population risk and thus, they largely overestimate risk in patients who are under 75 years of age.
Multiple randomized trials, including NHLBI Multi-Ethnic Study of Atherosclerosis (MESA): Coronary Artery Calcium (CAC) & 12-year ASCVD, have demonstrated a strong association with improved outcomes. Data from the EISNER trial suggest that CAC scoring can improve patient adherence. According to Dr. Shaw, the evidence from these randomized trials supports CAC-guiding to improve adherence to preventative care.
AI in Cardiovascular Imaging
Dr. Filippo Cademartiri, Chairman of the Department of Radiology at Asur Marche & Associate Professor of Radiology at Erasmus Medical Center University, described the growing role of AI in cardiovascular imaging from a physician’s perspective in the presentation “Artificial Intelligence in (Cardiac) Computed Tomography.”
The Future of Cardiac CT
 Newby, David & Williams, Michelle & Hunter, Amanda & Pawade, Tania & Shah, Anoop & Flapan, Andrew & Forbes, John & Hargreaves, Allister & Leslie, Stephen & Lewis, Steff & Mckillop, Graham & Mclean, Scott & Reid, John & Spratt, James & Uren, Neal & Steering, Trial & Timmis, Adam & Berry, Colin & Steedman, Tracey. (2015). CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): An open-label, parallel-group multicentre trial. The Lancet. 385. 10.1016/S0140-6736(15)60291-4.
 Rizvi A, Hartaigh BÓ, Knaapen P, Leipsic J, Shaw LJ, Andreini D, Pontone G, Raman S, Khan MA, Ridner M, Nabi F, Gimelli A, Jang J, Cole J, Nakazato R, Zarins C, Han D, Lee JH, Szymonifika J, Gomez MJ, Truong QA, Chang HJ, Lin FY, Min JK. Rationale and Design of the CREDENCE Trial: computed TomogRaphic evaluation of atherosclerotic DEtermiNants of myocardial IsChEmia. BMC Cardiovasc Disord. 2016 Oct 6;16(1):190. doi: 10.1186/s12872-016-0360-x. PMID: 27716131; PMCID: PMC5053174.
 Osawa, K., Nakanishi, R., & Budoff, M. (2016). Coronary Artery Calcification. Global heart, 11(3), 287–293. https://doi.org/10.1016/j.gheart.2016.08.001