Table 4.

Cardiac computed tomography in COVID-19.

Potential role	Scenarios	Comment
Coronary assessment (epicardial)	Differential myocardial injury vs. obstructive coronary disease	CMR has a clear role here; cardiac CT might permit sufficient coronary assessment before a patient is able to undergo CMR for myocardial assessment
	First assessment of non-ST elevation acute coronary syndromes	Instead of ICA first
	Prior to non-coronary cardiac surgery	Already being used in some patients and centres prior to COVID-19
	Prior to structural heart interventions: LAA occlusion, TMVR, TAVI	May reduce need for ICA, especially in patients with fewer coronary risk factors
Left atrial appendage thrombus assessment	In patients requiring DC cardioversion of atrial arrhythmia, or prior to atrial fibrillation/flutter ablation, where sufficient anticoagulation has not been present, or there is higher than average thrombus risk	Reduces need for TOE An early and delayed image phase helps distinguish contrast stasis from thrombus. Further data on sensitivity and specificity vs. TOE will be important here
Myocarditis	Potential role through use of delayed contrast imaging to distinguish myocardial infarction with unobstructed coronaries from myocarditis	CMR is the gold standard in assessment of myocarditis by non-invasive imaging and has a larger evidence base. Further data will be needed
Structural cardiology interventions	Established role in pre-procedural planning in LAA, TMVR, and TAVI	May further reduce need for TOE where this is used

COVID-19, coronavirus disease 2019; CMR, cardiac magnetic resonance; ICA, invasive coronary angiography; LAA, left atrial appendage; TMVR, transcutaneous mitral valve intervention; TAVI, transcutaneous aortic valve intervention; TOE, transoesophageal echocardiography.