Advanced computed tomography for cardiac applications : from cardiovascular diagnosis to clinical management

Abstract

The primary objective of this dissertation is to determine the diagnostic performance of 320-row CTA for cardiac applications, particularly in the assessment of significant coronary stenosis in patients with known or suspected CAD. It was shown that 320-row CTA allows accurate, non-invasive assessment of significant CAD and global left ventricular function in patients with suspected CAD, as well as in patients with a history of revascularization. Furthermore, the prognostic value of CTA and its role in clinical management of patients with suspected CAD were investigated. The potential of CTA to serve as a gatekeeper prior to CTA was explored. It was shown that CTA has the potential to serve as a gatekeeper for invasive coronary angiography in patients with a low-to-intermediate pre-test likelihood of obstructive CAD. Subsequently, it was shown that the assessment of left ventricular function analysis on CTA may further enhance risk stratification beyond the assessment of degree of stenosis. Finally, in patients with type 2 diabetes mellitus, the combined presence of increased waist circumference and elevated plasma triglyceride levels was shown to translate into an increased likelihood of CAD on CTA and may therefore serve as a practical clinical biomarker to improve risk stratification.