[Tomographic visualization of coronary bypass grafts: the new diagnostic frontier in clinical cardiology].

In the 16th century, the astronomer Nicolas Coper-nicus created a new paradigm when he described the rotation of the earth on its axis and its orbit of the sun. In De Revolutionibus, he described this new concept as " A fundamental change in the way of thinking or looking at a work or concept. " 1 Revolutionary concepts do not often arise in medicine. However, they are fundamental to its progress. In 1958, Mason Sones performed the first coronary an-giogram and opened a new frontier in modern cardio-logy. 2 Soon after, coronary angiography opened the way for the development of cardiovascular surgery and, eventually, percutaneous revascularization. Nowadays, noninvasive diagnosis of coronary artery disease by computed tomography (CT) represents a new frontier. Current technological advances allow 3-dimensional image acquisition of coronary artery anatomy with a temporal resolution of 100-220 ms and a spatial resolution of 0.6 mm. Various studies to assess the efficacy of CT for detecting coronary obstructions of greater than 50% have reported a high diagnostic sensitivity (72%-95%) and specificity (85%-100%). In addition, recent studies indicate that, similar to in-travascular ultrasound, CT can offer information regarding the composition of atherosclerotic plaques. 8 Adopting this technology into clinical practice could have various significant implications. The possibility of being able to use CT to obtain information on coronary artery anatomy noninvasively and inexpensively provides us with an opportunity to assess a larger number of patients at risk from coronary artery disease. At the same time, the implementation of CT as a diagnostic technique could limit the inappropriate use of invasive catheterization and restrict its application to patients with a high probability of requiring intervention. In this issue of REVISTA ESPAÑOLA DE CARDIOLOGÍA, Trigo Bautista et al 9 evaluate the usefulness of CT in the assessment of coronary artery bypass grafts. In 38 patients who had undergone surgical revascularization, the authors demonstrate a sensitivity of 92% and a specificity of 97% for the detection of more than 50% stenosis of the bypass grafts. The results of this study are similar to other recently published results using 16-detector CT. 10 One of the advantages of the new generation of 16-detector CT scanners is the capacity to acquire images within a total time period of 25-35 seconds. This reduced acquisition time limits the number of artifacts caused by respiratory movement and improves image quality by allowing the injection rate for the contrast agent to …