Utility of FFRCT in Patients with Chest Pain.

PURPOSE OF REVIEW: The goal of this article is to review the data supporting the use of fractional flow reserve derived from coronary computed tomography angiography (FFRCT) in patients with chest pain. REVIEW FINDINGS: Numerous clinical trials have demonstrated that the diagnostic accuracy of coronary computed tomography angiography (CCTA) can be improved with the use of FFRCT, primarily due to its superior specificity when compared to CCTA alone. This promising development may help reduce the need for invasive angiography in patients presenting with chest pain. Furthermore, some studies have indicated that incorporating FFRCT into decision-making is safe, with an FFRCT value of ≥ 0.8 being associated with favorable outcomes. While FFRCT has been shown to be feasible in patients with acute chest pain, further large-scale studies are warranted to confirm its utility. The emergence of FFRCT as a tool for the management of patients with chest pain is promising. However, potential limitations require the interpretation of FFRCT in conjunction with clinical context.

Radiomics applications in cardiac imaging: a comprehensive review.

Radiomics is a new emerging field that includes extraction of metrics and quantification of so-called radiomic features from medical images. The growing importance of radiomics applied to oncology in improving diagnosis, cancer staging and grading, and improved personalized treatment, has been well established; yet, this new analysis technique has still few applications in cardiovascular imaging. Several studies have shown promising results describing how radiomics principles could improve the diagnostic accuracy of coronary computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) in diagnosis, risk stratification, and follow-up of patients with coronary heart disease (CAD), ischemic heart disease (IHD), hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD), and many other cardiovascular diseases. Such quantitative approach could be useful to overcome the main limitations of CCTA and MRI in the evaluation of cardiovascular diseases, such as readers' subjectiveness and lack of repeatability. Moreover, this new discipline could potentially overcome some technical problems, namely the need of contrast administration or invasive examinations. Despite such advantages, radiomics is still not applied in clinical routine, due to lack of standardized parameters acquisition, inconsistent radiomic methods, lack of external validation, and different knowledge and experience among the readers. The purpose of this manuscript is to provide a recent update on the status of radiomics clinical applications in cardiovascular imaging.

Investigations on coronary artery plaque detection and subclassification using machine learning classifier.

Coronary artery diseases are one of the high-risk diseases, which occur due to the insufficient blood supply to the heart. The different types of plaques formed inside the artery leads to the blockage of the blood stream. Understanding the type of plaques along with the detection and classification of plaques supports in reducing the mortality of patients. The objective of this study is to present a novel clustering method of plaque segmentation followed by wavelet transform based feature extraction. The extracted features of all different kinds of calcified and sub calcified plaques are applied to first train and test three machine learning classifiers including support vector machine, random forest and decision tree classifiers. The bootstrap ensemble classifier then decides the best classification result through a voting method of three classifiers. A training dataset including 64 normal CTA images and 73 abnormal CTA images is used, while a testing dataset consists of 111 normal CTA images and 103 abnormal CTA images. The evaluation metrics shows better classification rate and accuracy of 97.7%. The Sensitivity and Specificity rates are 97.8% and 97.5%, respectively. As a result, our study results demonstrate the feasibility and advantages of developing and applying this new image processing and machine learning scheme to assist coronary artery plaque detection and classification.

Correcting motion artifacts in coronary computed tomography angiography images using a dual-zone cycle generative adversarial network.

BACKGROUND: Coronary computed tomography angiography (CCTA) is a noninvasive imaging modality to detect and diagnose coronary artery disease. Due to the limitations of equipment and the patient's physiological condition, some CCTA images collected by 64-slice spiral computed tomography (CT) have motion artifacts in the right coronary artery, left circumflex coronary artery and other positions. OBJECTIVE: To perform coronary artery motion artifact correction on clinical CCTA images collected by Siemens 64-slice spiral CT and evaluate the artifact correction method. METHODS: We propose a novel method based on the generative adversarial network (GAN) to correct artifacts of CCTA clinical images. We use CCTA clinical images collected by 64-slice spiral CT as the original dataset. Pairs of regions of interest (ROIs) cropped from original dataset or images with and without motion artifacts are used to train the dual-zone GAN. When predicting the CCTA images, the network inputs only the clinical images with motion artifacts. RESULTS: Experiments show that this network effectively corrects CCTA motion artifacts. Regardless of ROIs or images, the peak signal to noise ratio (PSNR), structural similarity (SSIM), mean square error (MSE) and mean absolute error (MAE) of the generated images are greatly improved compared to those of the input data. In addition, based on scores from physicians, the average score for the coronary artery artifact correction of the output images is higher. CONCLUSIONS: This study demonstrates that the dual-zone GAN has the excellent ability to correct motion artifacts in the coronary arteries and maintain the overall characteristics of CCTA clinical images.

Cardiac-CT and cardiac-MR cost-effectiveness: a literature review.

Cardiovascular diseases are still among the first causes of death worldwide with a huge impact on healthcare systems. Within these conditions, the correct diagnosis of coronary artery disease with the most appropriate imaging-based evaluations is of utmost importance. The sustainability of the healthcare systems, considering the high economic burden of modern cardiac imaging equipments, makes cost-effective analysis an important tool, currently used for weighing different costs and health outcomes, when policy makers have to allocate funds and to prioritize interventions, getting the most out of their financial resources. This review aims at evaluating cost-effective analysis in the more recent literature, focused on the role of Calcium Score, coronary computed tomography angiography and cardiac magnetic resonance.

Prevalence and morphologic features of dual left anterior descending artery subtypes in coronary CT angiography.

OBJECTIVES: The purpose of this study was to identify the prevalence of dual left anterior descending artery and define the morphological features using coronary computed tomography angiography in order to raise awareness of dual left anterior descending artery among radiologists. MATERIALS AND METHODS: The radiologic reports of 1912 patients who underwent coronary computed tomography angiography at our institution were searched retrospectively for the presence of dual left anterior descending artery. Computed tomography images of patients with dual left anterior descending artery were then reviewed, and the morphological features of dual left anterior descending artery were evaluated. RESULTS: Dual left anterior descending artery was identified in 1.3% of the patients in this study population. Type 1 dual left anterior descending artery was the most common subtype (76%). Four additional cases that were not classified before were also detected. CONCLUSION: Dual left anterior descending artery has a variety of subtypes reported mostly as odd cases, and gaining diagnostic awareness of dual left anterior descending artery is more critical, rather than listing and counting the subtypes. With the widespread use of coronary computed tomography angiography, it has become essential for radiologists to have knowledge about dual left anterior descending artery, as it is vital, especially for surgical planning.

Correlation of Arterial Stiffness With Left Atrial Volume Index and Left Ventricular Mass Index in Young Adults: Evaluation by Coronary Computed Tomography Angiography.

BACKGROUND: Increased arterial stiffness is reportedly associated with cardiac remodelling, including the left atrium and left ventricle, in middle-aged and older adults. However, little is known about this association in young adults. METHODS: In total, 73 patients (44 (60%) men) aged 25 to 45 years with suspected coronary artery disease were included in the analysis. The left atrial volume index (LAVI), left ventricular volume index (LVVI), and left ventricular mass index (LVMI) were measured using coronary computed tomography angiography (CCTA). Arterial stiffness was assessed with the cardio-ankle vascular index (CAVI). An abnormally high CAVI was defined as that above the age- and sex-specific cut-off points of the CAVI. RESULTS: Compared with patients with a normal CAVI, those with an abnormally high CAVI were older and had a greater prevalence of diabetes mellitus, higher diastolic blood pressure, greater coronary artery calcification score, and a greater LAVI (33.5±10.3 vs. 43.0±10.3mL/m2, p <0.01). In contrast, there were no significant differences in the LVVI or LVMI between the subgroups with a normal CAVI and an abnormally high CAVI. Multivariate linear regression analysis showed that the LAVI was significantly associated with an abnormally high CAVI (standardised regression coefficient=0.283, p=0.03). CONCLUSIONS: The present study demonstrated that increased arterial stiffness is associated with the LAVI, which reflects the early stages of cardiac remodelling, independent of various comorbidity factors in young adults with suspected coronary artery disease.

[Coronary Computed Tomography Angiography for Patients with Atrial Fibrillation: Feasibility of Prospective Electrocardiography-gated Diastolic Acquisition with a Manual Exposure-termination Technique].

Coronary computed tomography angiography (CCTA) was performed in 283 patients with atrial fibrillation (Af) using a prospective electocardiogeaphic gated scanning with a manual exposure-termination technique. When preparatory 5-beat scanning contained at least one RR interval longer than 800 ms, 5-beat diastolic scanning (R+800 ms protocol) was selected. When no RR interval longer than 800 ms was observed, 2-beat scanning starting at end-systolic phase (R+210 ms to R protocol) was chosen. In R+800 ms protocol, we manually terminated scanning when motion free real-time reconstruction image was confirmed. R+800 ms protocol was applied in 95% of the cases and required an average of 2 cardiac cycles, providing motion-free images in 91% of the patients. The mean exposure dose was less than that with R+210 ms to R protocol. Using the protocols above, 90% of the all patients with Af provided motion free images and 99% of them were evaluable.

Non-diagnostic coronary artery calcification and stenosis: a correlation of coronary computed tomography angiography and invasive coronary angiography.

Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50-69% (82.4% [28/34]), 70-99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.

No psychological distress in sportsmen aged 45 years and older after cardiovascular screening, including cardiac CT: The Measuring Athlete's Risk of Cardiovascular events (MARC) study.

BACKGROUND: Psychological distress caused by cardiovascular pre-participation screening (PPS) may be a reason not to implement a PPS program. We assessed the psychological impact of PPS, including cardiac computed tomography (CT), in 318 asymptomatic sportsmen aged ≥45 years. METHODS: Coronary artery disease (CAD) was defined as a coronary artery calcium score ≥100 Agatson units and/or ≥50% luminal stenosis on contrast-enhanced cardiac CT. Psychological impact was measured with the Impact of Event Scale (IES) (seven items) on a six-point scale (grade 0-5). A sum score ≥19 indicates clinically relevant psychological distress. A Likert scale was used to assess overall experiences and impact on sports and lifestyle. RESULTS: A total of 275 participants (86.5% response rate, 95% CI 83-90%) with a mean age of 54.5 ± 6.4 years completed the questionnaires, 48 (17.5%, 95% CI 13-22%) of whom had CAD. The median IES score was 1 (IQR 0-2, [0-23]). IES was slightly higher in those with CAD (mean rank 175 vs. 130, p < 0.001). One participant (with CAD) experienced clinically relevant psychological distress (IES = 23). Participants reported numerous benefits, including feeling safer exercising (58.6%, 95% CI 53-65%) and positive lifestyle changes, especially in those with CAD (17.2 vs. 52.1%, p < 0.001). The majority were satisfied with their participation (93.8%, 95% CI 91-97%). CONCLUSION: Cardiovascular PPS, including cardiac CT, causes no relevant psychological distress in older sportsmen. Psychological distress should not be a reason to forego screening in sportsmen.

The effect of arm positioning on timing and enhancement of intravenous contrast media at coronary computed tomography angiography.

BACKGROUND: Adequate intravenous contrast media (CM) enhancement is crucial for evaluation of the coronary arteries. PURPOSE: To compare the timing and enhancement of intravenous CM at coronary computed tomography angiography (CCTA) when positioning the arms in the traditional superior direction with that of positioning them in the ventral direction during the CM injection. MATERIAL AND METHODS: One hundred patients were randomized into two groups. Group A (n = 50) had their arms positioned in the superior direction, resting on a head and arm support. Group B (n = 50) held their arms resting on the front panel of the computer tomography (CT) scanner. Scanning delay time was defined by test bolus technique. A total of 60 mL iodixanol, 320 mg/mL, was followed by a 50 mL saline flush at 6 mL/s. Cardiac output (CO) and heart rate (HR) were obtained before scanning. The attenuation was calculated by placing regions of interest (ROI) in ascending aorta, left atrium, and inferior vena cava. RESULTS: More patients in group A compared with group B (26 versus 14) showed a higher attenuation of the left atrium in comparison to the ascending aorta (P < 0.05). Body weight (BW) and CO were significantly related to the attenuation of ascending aorta (P < 0.01). CONCLUSION: By placing the arms in a ventral, instead of superior position the frequency of too early imaging at CCTA can be reduced.

Cholesterol efflux capacity in humans with psoriasis is inversely related to non-calcified burden of coronary atherosclerosis.

AIMS: Cholesterol efflux capacity (CEC) was recently shown to predict future cardiovascular (CV) events. Psoriasis both increases CV risk and impairs CEC. However, whether having poor CEC is associated with coronary plaque burden is currently unknown. We aimed to assess the cross-sectional relationship between coronary plaque burden assessed by quantitative coronary computed tomography angiography (CCTA) with CEC in a well-phenotyped psoriasis cohort. METHODS AND RESULTS: Total burden and non-calcified burden (NCB) plaque indices were assessed in 101 consecutive psoriasis patients using quantitative software. Cholesterol efflux capacity was quantified using a cell-based ex vivo assay measuring the ability of apoB-depleted plasma to mobilize cholesterol from lipid-loaded macrophages. Cholesterol efflux capacity was inversely correlated with NCB (unadjusted ß-coefficient -0.33; P < 0.001), and this relationship persisted after adjustment for CV risk factors (ß -0.24; P < 0.001), HDL-C levels (ß -0.22; P < 0.001), and apoA1 levels (ß -0.19; P < 0.001). Finally, we observed a significant gender interaction (P < 0.001) whereby women with low CEC had higher NCB compared to men with low CEC. CONCLUSIONS: We show that CEC is inversely associated with prevalent coronary plaque burden measured by quantitative CCTA. Low CEC may therefore be an important biomarker for subclinical coronary atherosclerosis in psoriasis. CLINICALTRIALSGOV: NCT01778569.

320-row coronary computed tomography angiography (CCTA) with automatic exposure control (AEC): effect of 100 kV versus 120 kV on image quality and dose exposure.

PURPOSE: To compare the impact of a 100 kV tube voltage protocol to 120 kV in terms of image quality and radiation dose by a 320 row coronary computed tomography angiography (CCTA) with automatic exposure control (AEC). MATERIALS AND METHODS: Using a propensity matched analysis we compared a group of 135 patients scanned using a 100 kV tube voltage protocol with a group of 135 subjects scanned employing a 120 kV tube voltage setting. In all subjects the heart rate (HR) was <65 bpm and all CT scans were acquired using a prospective ECG gating and AEC strategy. Mean effective radiation dose and subjective and objective (Noise or N, signal to noise ratio or SNR, contrast to noise ratio or CNR) image quality, were evaluated. Subjective quality was assessed by two experienced radiologists using a 5-point scale (0: non diagnostic-4: excellent) using the 15-segment American Heart Association (AHA) coronary artery classification. RESULTS: Mean effective dose and noise were non significantly different between the two groups: mean effective dose was 2.89 ± 0.7 mSv in the 100 kV group and 2.80 ± 0.57 mSv in the 120 kV group (p = 0.25) while noise was 28.9 ± 3.3 in the 120 kV group and 29.05 ± 3.6 in the 100 kV group (p = 0.72). Both SNR and CNR were significantly higher in the 100 kV group than in the 120 kV group. This data agrees with the evidence that subjective quality was significantly higher in the 100 kV group in the middle and distal segmental classes. CONCLUSION: Our study shows that, in using a 320 row CCTA with AEC strategy it is better to employ a 100 kV tube voltage protocol because compared to 120 kV tube voltage setting, it appears to significantly improve both subjective and objective image quality without decreasing the mean effective radiation dose.

Enhancing cardiovascular risk stratification: Radiomics of coronary plaque and perivascular adipose tissue - Current insights and future perspectives.

Radiomics, the quantitative extraction and mining of features from radiological images, has recently emerged as a promising source of non-invasive image-based cardiovascular biomarkers, potentially revolutionizing diagnostics and risk assessment. This review explores its application within coronary plaques and pericoronary adipose tissue, particularly focusing on plaque characterization and cardiac events prediction. By shedding light on the current state-of-the-art, achievements, and prospective avenues, this review contributes to a deeper understanding of the evolving landscape of radiomics in the context of coronary arteries. Finally, open challenges and existing gaps are emphasized to underscore the need for future efforts aimed at ensuring the robustness and reliability of radiomics studies, facilitating their clinical translation.

Pulmonary Vein in a Pinch.

The pulmonary veins normally drain into the left atrium, with the superior pulmonary veins typically situated anterior and inferior to the right pulmonary arteries. However, anomalies can happen. We encountered an exceedingly rare pulmonary vascular anomaly for a patient presenting with atypical chest pain, where the right superior pulmonary vein aberrantly ran posterior to the right pulmonary artery (RPA) and became compressed between the RPA and the right main bronchus. Coronary computed tomography angiography identified this specific pulmonary vein anomaly but revealed unremarkable coronary arteries.

Performance of artificial intelligence in detecting the chronic total occlusive lesions of coronary artery based on coronary computed tomographic angiography.

Background: Coronary chronic total occlusion (CTO) increases the risk of developing major adverse cardiovascular events (MACE) and cardiogenic shock. Coronary computed tomography angiography (CCTA) is a safe, noninvasive method to diagnose CTO lesions. With the development of artificial intelligence (AI), AI has been broadly applied in cardiovascular images, but AI-based detection of CTO lesions from CCTA images is difficult. We aim to evaluate the performance of AI in detecting the CTO lesions of coronary arteries based on CCTA images. Methods: We retrospectively and consecutively enrolled patients with 50% stenosis, 50-99% stenosis, and CTO lesions who received CCTA scans between June 2021 and June 2022 in Beijing Anzhen Hospital. Four-fifths of them were randomly assigned to the training dataset, while the rest (1/5) were randomly assigned to the testing dataset. Performance of the AI-assisted CCTA (CCTA-AI) in detecting the CTO lesions was evaluated through sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and receiver operating characteristic analysis. With invasive coronary angiography as the reference, the diagnostic performance of AI method and manual method was compared. Results: A total of 537 patients with 1,569 stenotic lesions (including 672 lesions with <50% stenosis, 493 lesions with 50-99% stenosis, and 404 CTO lesions) were enrolled in our study. CCTA-AI saved 75% of the time in post-processing and interpreting the CCTA images when compared to the manual method (116±15 vs. 472±45 seconds). In the testing dataset, the accuracy of CCTA-AI in detecting CTO lesions was 86.2% (79.0%, 90.3%), with the area under the curve of 0.874. No significant difference was found in detecting CTO lesions between AI and manual methods (P=0.53). Conclusions: AI can automatically detect CTO lesions based on CCTA images, with high diagnostic accuracy and efficiency.

Quantification of subclinical plaque characteristics and perivascular fat using coronary computed tomography angiography (CCTA) among individuals with human immunodeficiency virus (HIV).

Background: People infected with human immunodeficiency virus (PIWH) have a higher risk of cardiovascular events. This study was designed to compare the differences in plaque characteristics and perivascular fat between subclinical coronary atherosclerosis in PIWH and healthy controls (HC) by coronary computed tomography angiography (CCTA). We also assessed the associations between human immunodeficiency virus (HIV) infection, antiretroviral therapy (ART), and coronary artery disease (CAD). Methods: This cross-sectional study included a total of 158 PIWH and 79 controls. CCTA was used to evaluate coronary artery plaque prevalence, coronary stenosis severity, plaque composition, plaque volume, and perivascular fat attenuation index (FAI). Logistic regression analyses were used to assess the associations between the prevalence of coronary artery plaque and HIV-related clinical indicators. Results: There was no difference in total coronary artery plaque prevalence between PIWH and controls (44.3% vs. 32.9%; P=0.09), but the prevalence of noncalcified plaque was significantly higher in PIWH compared with the controls (33.5% vs. 16.5%; P=0.006). After adjustment for age, sex, statin use, and family history of cardiovascular disease (CVD), the prevalence of noncalcified plaque remained 2 times higher in PIWH [odds ratio (OR), 2.082; 95% confidence interval (CI): 1.007-4.304; P=0.048]. The perivascular FAI measured around the left anterior descending artery (LAD) was higher in PIWH (-71.4±5.7 vs. -73.5±7.0; P=0.03) compared with that of the controls. The intra-group analyses of PIWH suggested that the decrease in nadir CD4+ T-cell count was associated with the increased prevalence of noncalcified plaque (OR, 4.139; 95% CI: 1.312-13.060; P=0.02). Conclusions: PIWH have a higher risk of developing noncalcified plaque and greater perivascular fat. In addition, the increased noncalcified plaque prevalence in PIWH may be associated with the immunodeficiency caused by HIV.

Pericoronary adipose tissue attenuation in patients with acute aortic dissection based on coronary computed tomography angiography.

Background: Periaortic fat is associated with coronary disease. Thus, it was hypothesized that the inflammation associated with acute aortic dissection (AAD) spreads to pericoronary adipose tissue (PCAT) via thoracic periaortic fat. Pericoronary adipose tissue attenuation (PCATa) serves as a marker for inflammation of perivascular adipose tissue (PVAT). This study sought to examine PCATa in individuals diagnosed with AAD. Methods: Consecutive patients with chest pain from May 2020 to September 2022 were prospectively enrolled in this study and underwent coronary computed tomography angiography (CCTA) and/or aorta computed tomography angiography (CTA). Based on the results of the CTA, the patients were divided into the following two groups: (I) the AAD group; and (II) the non-AAD group. PCATa of the right coronary angiography (RCA), left anterior descending (LAD), and left circumflex (LCx) was quantified for each patient using semi-automated software. The PCATa values were compared between the AAD and non-AAD patients according to the atherosclerosis of the coronary arteries. Similarly, the PCATa values of the AAD patients were compared between the preoperative and postoperative steady states. Results: A total of 136 patients (42 female, 94 male; mean age: 63.3±11.9 years) were divided into the two groups according to the presence of aortic dissection on CTA. The RCAPCATa, LADPCATa, and LCxPCATa values were significantly higher in the AAD subjects than the non-AAD subjects, regardless of the presence or absence of atherosclerosis in the coronary arteries [-85.1±9.3 vs. -92.9±10.0 Hounsfield unit (HU); -83.2±7.4 vs. -89.9±9.1 HU; -77.5±8.4 vs. -85.6±7.9 HU, all P<0.001). The preoperative RCAPCATa, LADPCATa, and LCxPCATa values were higher in the AAD patients than the postoperative steady-state patients (-82.9±8.7 vs. -97.6±8.8 HU; -79.8±7.6 vs. -92.8±6.8 HU; -74.6±7.1 vs. -87.7±6.9 HU, all P<0.001). According to the multivariable logistic regression analysis, high RCAPCATa and LADPCATa values were associated with AAD regardless of the degree of stenosis [odds ratio (OR) =0.014; 95% confidence interval (CI): 0.001-0.177; P=0.001 and OR =0.010; 95% CI: 0.001-0.189; P=0.002]. Conclusions: PCATa on computed tomography was increased in patients with AAD regardless of the presence or absence of coronary artery disease (CAD). This suggests that vascular inflammation is present in AAD independent of CAD. Further research should be conducted to investigate the potential of this imaging biomarker to predict AAD and monitor patients' responses to therapies for AAD.

Casting Light on The Hidden Prevalence: A Novel Perspective on Hypoplastic Coronary Artery Disease.

Background and Objectives: Coronary artery anomalies (CAAs) represent a group of rare cardiac abnormalities with an incidence of up to 1.2%. The aim of this retrospective study was to conduct a comprehensive epidemiological assessment of the prevalence of hypoplastic coronary arteries using coronary computed tomography angiography (CCTA) in patients with diagnosed CAAs and individuals presenting with cardiovascular manifestations in the north-eastern region of Romania. This study was motivated by the limited investigation of the CAAs conducted in this area. Methods: We analyzed data collected from 12,758 coronary computed tomography angiography (CCTA) records available at the "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, spanning the years 2012 to 2022. Results: Among 350 individuals with CAAs (2.7% of the total cohort), 71 patients (20.3% of the anomaly presenting group and 0.5% of the entire CCTA cohort) exhibited at least one hypoplastic coronary artery. The mean age of individuals diagnosed with hypoplastic coronary artery disease (HCAD) was 61 years, while the age distribution among them ranged from 22 to 84 years. Nearly equal cases of right and left dominance (33 and 31, respectively) were observed, with only 7 cases of co-dominance. Conclusions: HCAD may be considered underexplored in current published research, despite its potentially significant implications ranging to an increased risk of sudden cardiac arrest. The specific prevalence of HCAD among CAAs might be higher than previously reported, possibly reflecting better diagnostic accuracy of CCTA over classic coronary imaging. The absence of standard diagnostic and therapeutic protocols for HCAD underscores the necessity of a personalized approach for such cases.