Advances in cardiac computed tomography angiography and characterization of cardiac disease

Abstract

This thesis investigated novel parameters on coronary computed tomography angiography for the characterization of coronary artery disease (CAD) and explored left ventricular (reverse) remodeling in patients with severe aortic stenosis (AS). Precursors of culprit lesions of patients who developed an acute coronary syndrome had a higher pericoronary adipose tissue attenuation as compared to non-culprit lesions in these patients and compared to lesions of patients with stable CAD. In addition, we observed that overall plaque burden was associated with increased risk of adverse events in patients with stable CAD. The relative fractions of the various plaque components of total plaque volume lacked additional prognostic value. Furthermore, patient with diabetes mellitus had a lower coronary volume to left ventricular mass ratio. Next, sex differences in left ventricular (LV) remodeling in patients with severe AS who underwent transcatheter aortic valve implantation (TAVI) were evaluated. No sex differences in LV (reverse) remodeling were observed and this was not associated with sex differences in outcome after TAVI. Moreover, LV reverse remodeling after TAVI was not impaired by subclinical leaflet thrombosis. LV ejection fraction (LVEF) improved significantly after TAVI, and patients with reduced baseline LVEF revealed the greatest improvement in LVEF.