6 This emphasizes the need for coronary anatomic assessment in these patients. In our practice in a tertiary cancer center, most patients with exposure to potentially cardiotoxic chemotherapy who experience a decrease in LV function are considered for angiography. Prior to the use of CCTA, however, many could not undergo ICA, and a conclusive diagnosis was often lacking. As we have shown, however, signiﬁcant CAD in the setting of a cardiomyopathy could accurately be excluded, therefore conﬁrming a suspicion of CIC in a quarter of our patients (Figure 1). Noninvasive coronary artery imaging is therefore appeal- ing in many instances in this patient population, particu- larly because of its high negative predictive value. Indeed, CCTA can conclusively demonstrate a normal coronary tree, therefore alleviating the need for ICA [10]. By accurately deﬁning the coronary anatomy, CCTA in fact allowed the prioritization of cancer and cardiac care in our patients, in some cases, by excluding signiﬁcant CAD suspected either based on cardiac biomarkers, symptoms, or previous testing (Figure 2). The advantage of adequate identiﬁcation of underlying severe CAD in certain circumstances would allow stratiﬁcation of patients who need modiﬁcation of their chemotherapeutic regimen or who may beneﬁt from concur- rent treatment with cardioprotective therapeutic agents that promote positive remodeling, such as β-adrenergic blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers. In others, by identifying patients who needed their cancer care to be put on hold until more press- ing cardiac issues could be addressed, CCTA also prevented undue delays in cancer care by seamlessly integrating with the ﬂow of care. Our results in a group of cancer patients with low to intermediate pretest probability for CAD on the basis of risk factors alone suggest that it may be more prevalent than suspected. Indeed, we found that nearly a third of pts had severe CAD, and 5% of total population underwent CABG. This emphasizes the importance of coordinating cancer and cardiac care, as both can coexist with equal severity in the same patients. In fact, some cases will require the interruption of chemotherapy until the patient has undergone coronary revascularization (Figure 3). The addition of noninvasive coronary imaging therefore adds an invaluable tool in the approach to these diﬃcult cases. Our study describes a single center experience, and included patients referred for CCTA. In particular, there is no control group, and therefore no direct comparison to other noninvasive modalities (stress testing) can be drawn. Whether CCTA as a ﬁrst step would compare favorably to other noninvasive modalities needs further study, particu- larly as a cost and radiation reduction measure. Although we reported short-term outcomes in terms of cancer and cardiac care, long-term followup will be needed to show deﬁnitive improvement in overall outcomes. 5. Conclusions Cardiac computed tomographic angiography is an attrac- tive imaging modality in cancer patients with suspected Cardiology Research and Practice structural heart disease when invasive coronary angiography may be too risky or impractical and allows improved coordination of cancer and cardiac care. Abbreviations CABG: coronary artery bypass grafting CIC: chemotherapy-induced cardiomyopathy CCTA: cardiac computed tomographic angiography CAD: coronary artery disease ECG: electrocardiogram ICA: invasive coronary angiography LV: left ventricular. Conﬂicts of Interest The authors have no conﬂicts of interest to disclose. References [1] E. T. Yeh, A. T. 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