Age in years (mean ± SD∗) Male gender (%) Known coronary artery disease (%) Hypertension (%) Hyperlipidemia (%) Diabetes mellitus (%) Smoking (%) Previous chest/mediastinal radiation (%) Hematologic malignancy (%) ∗SD: standard deviation. CCTA∗ indications Left ventricular dysfunction Chest pain/dyspnea Abnormal stress test Abnormal cardiac biomarkers Miscellaneous† Table 2: Indications for cardiac computed tomographic angiogra- phy. 2 Table 1: Baseline cardiac CT angiogram population characteristics. Population characteristics Cardiology Research and Practice Table 3: Relative contraindications for invasive coronary angiogra- phy. ∗CCTA: cardiac computed tomographic angiography. †Miscellaneous indications included suspected tumor and/or thrombus (7 patients) and suspected pulmonary embolism (6 patients). Indications were not mutually exclusive. of a normal scan is very high [7]. We sought to investigate the impact of CCTA ﬁndings on cancer treatment decisions. 2. Methods This retrospective data review study was approved by the Institutional Review Board (IRB). The clinical presentation and baseline characteristics of patients who underwent CCTA between January and December 2008 at the University of Texas MD Anderson Cancer Center (MDACC) were reviewed. The indications for CCTA were collected, as well as contraindications to invasive angiography, when explicitly documented. The downstream impact of CCTA results on patient care decision-making was ascertained for both car- diac and cancer treatment by review of the medical records. Speciﬁc diagnostic or therapeutic steps were considered to be based on CTA results only when medical records explicitly referenced the CTA results and directly linked those decisions with these ﬁndings. All statistical analysis was performed using NCSS2001 (Kaysville, Utah). Prior to CCTA, patients with heart rates above 65 beats per minute on breath holding received beta-blockers (metoprolol, up to 100 mg orally and/or up to 20 mg intravenously). Patients needing heart rate control, but with contraindications to beta-blockers were managed with oral calcium-channel blockers. When blood pressure allowed, patients were also given sublingual nitroglycerin spray 0.4 mg immediately prior to undergoing scan. All studies were performed using a 64-detector scanner (Lightspeed VCT, 58.8 ± 12.8 45 (56.3) 7 (8.8) 38 (47.5) 29 (36.3) 10 (12.5) 5 (6.3) 11 (13.8) 36 (45.0) N (%) 33 (41.3) 32 (40.0) 16 (20.0) 8 (10.0) 13 (16.3) N (%) 49 (61.3) 15 (19.2) 20 (25.0) 72 (90) N (%) 21 (26.3) 37 (46.2) 22 (27.5) Invasive angiography contraindications Low to moderate probability for CAD∗ Leucopenia/thrombocytopenia Concomitant chemotherapy or radiation ≥1 above contraindication ∗CAD: coronary artery disease. Contraindications are not mutually exclusive. Table 4: Coronary ﬁndings of cardiac computed tomographic angiography. CCTA∗ results Normal coronary arteries Mild to moderate CAD† Severe‡ CAD ∗CCTA: cardiac computed tomographic angiography. †CAD: coronary artery disease. ‡Severe CAD deﬁned as luminal narrowing estimated to be greater than 70% in at least one vessel or more than 50% left main coronary stenosis. General Electric Healthcare (GEHC), Milwaukee, WI). A calcium scoring scan was performed using 2.5 mm collima- tion and 25 cm display ﬁeld of view with prospective cardiac triggering without intravenous contrast material. 150 mL of 320 mgI/mL contrast material (iodixanol, Visipaque 320, GEHC) was administered at 5 mL/sec, followed by 50 mL of normal saline at 5 mL/sec. A ﬁxed scan delay of 30 seconds was used. Cardiac scanning was performed with 0.625 mm collimation using retrospective cardiac gating and electrocardiographic (ECG) dose modulation. In patients with signiﬁcant beat to beat heart rate variability or frequent ectopic beats, ECG dose modulation was not used. Data was reconstructed at 0.625 mm slice thickness and 0.4 mm interval at 70%, 75%, and 80% of the R-R interval for coronary analysis and a second series at 1.25 mm slice thickness and 1.25 mm interval with 10 cardiac phases from 5% to 95% of the R-R interval for functional analysis. Additional coronary analysis phases were reconstructed as needed to address motion artifacts on the standard phases. Examinations were interpreted by a thoracic radiologist (GG) with 5 years experience in cardiac CT in conjunction with a cardiologist (ID). Interpretation and postprocessing were performed using an Advantage workstation (GEHC) or an iNtuition workstation (TeraRecon, Inc., San Mateo, CA). Severe CAD was deﬁned as luminal diameter narrowing estimated to be greater than 70% in at least one vessel or more than 50% left main coronary stenosis. Coro- nary stenosis that did not meet the deﬁned criteria for severe was termed mild to moderate CAD. A diagnosis of chemotherapy-induced cardiomyopathy was established by LV dysfunction with prior cardiotoxic chemotherapy expo- sure and absence of signiﬁcant obstructive CAD. Thrombo- cytopenia was deﬁned as platelet count less than 50,000 per μL, and leucopenia as white blood cell count below 4,000 per μL.