CHRONIC CORONARY INSUFFICIENCY: INNOVATIONS IN CARDIAC TOMOGRAPHY

Cardiac tomography in chronic coronary atherosclerotic disease is based on the interpre-tation of two main parameters: coronary calcium score, for the definition of cardiovascular risk in asymptomatic patients, and anatomical evaluation of coronary stenosis by angiotomography, for the diagnosis of coronary atherosclerotic disease in symptomatic patients. Calcium score, combined with clinical evaluation of the patient, is the most accurate complementary method for stratification and restratification of cardiovascular risk, while angiotomography has become the preferred investigation method in patients with suspected stable angina, especially in those with pre-test intermediate probability. Angiotomography presents recent technological advances that have brought the capacity for functional and histological assessments of co-ronary atherosclerosis, such as fractional flow reserve by tomography (FFR-CT) and dynamic myocardial perfusion by tomography (PMD-CT), which optimize diagnostic accuracy by improving the specificity and positive predictive value of the test, as well as high-risk plaque (HRP) and analysis of the fat attenuation index, which provide more accurate prognostic information, especially for cases in which no significant stenoses are identified.