Expanding Clinical Indications for Cardiac CT: A Review of Its Current Utility in American and European Guidelines

Purpose of Review: Cardiac computed tomography (CCT) is now an essential noninvasive imaging modality for evaluating a broad range of cardiovascular conditions. This review summarizes the most recent recommendations from the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC), providing an updated overview of the evolving role of CCT in risk assessment, chest pain evaluation, structural heart disease, arrhythmias, and perioperative management. Recent Findings: Compared to prior guidelines issued between 2008 and 2015, the number of CCT-related recommendations has significantly increased from 42 to 51 in the ACC/AHA guidelines, and from 20 to 31 in the ESC guidelines. This growth reflected the broadening role of CCT in the assessment of coronary artery disease, acute and stable chest pain, valvular and congenital heart disease, arrhythmias, and perioperative risk stratification. Additionally, the review highlighted emerging applications such as CT-derived fractional flow reserve (FFR-CT) and CCT-guided planning for structural interventions. Summary: By consolidating and contextualizing current recommendations, this work underscores the vital and continuously evolving role of CCT in cardiovascular practice.