In this thesis, the role of multi-modality imaging in ischemic heart disease, arrhythmias and cardiac mechanics is investigated. Computed tomography (CT) is utilized to evaluate the role of sex on... Show moreIn this thesis, the role of multi-modality imaging in ischemic heart disease, arrhythmias and cardiac mechanics is investigated. Computed tomography (CT) is utilized to evaluate the role of sex on progression of coronary artery disease (CAD) and the relationship between anatomical and functional markers of CAD. Reference values for a novel technique, non-invasive myocardial work, are presented for different cardiac pathologies and its relation with the extent of infarct transmurality following ST-segment elevation myocardial infarction is evaluated. The prognostic value of left ventricular (LV) global longitudinal strain (GLS) on 2-dimensional speckle tracking echocardiography and heart-to-mediastinum ratio on 123I-MIBG scintigraphy on appropriate Implantable Cardioverter Defibrillator (ICD) therapy is evaluated. Furthermore, the predictive value of posterior left atrial adipose tissue attenuation on CT for atrial fibrillation recurrence following ablation is investigated. Show less
Rosendael, A.R. van; Smit, J.M.; El'Mahdiui, M.; Rosendael, P.J. van; Leung, M.; Delgado, V.; Bax, J.J. 2022
Aims: Left atrial (LA) volume and LA epicardial fat are both substrates for atrial fibrillation (AF), but may relate with AF at different (early vs. late) stages in the AF disease process. We... Show moreAims: Left atrial (LA) volume and LA epicardial fat are both substrates for atrial fibrillation (AF), but may relate with AF at different (early vs. late) stages in the AF disease process. We evaluated associations between LA epicardial fat and LA volume in patients with sinus rhythm (SR), paroxysmal AF (PAF), and persistent/permanent AF. Methods and results: In total, 300 patients (100 with SR, 100 with PAF, and 100 with persistent/permanent AF) who underwent cardiac computed tomography angiography (CTA) were included. The epicardial fat mass posterior to the LA and the LA volume were quantified from CTA and compared between patients with SR, PAF, and persistent/permanent AF. Furthermore, four groups were created by classifying LA epicardial fat and LA volume into large or small according to their median. The mean age of the population was 58.9 +/- 10.5 years and 69.7% was male. Left atrial epicardial fat mass was larger in patients with PAF compared with SR, but did not further increase from PAF to persistent/permanent AF. Left atrial volume increased significantly from SR to PAF and to persistent/permanent AF. Left atrial epicardial fat and LA volume were both concordantly large or small in 184 (61%) patients, and discordant in 116 (39%). When both were small, 65.2% of the patients had SR, 23.9% PAF, and 10.9% persistent/permanent AF. When the LA epicardial fat mass was large and the LA volume small (compared with both being small), patients were significantly more often in PAF (55.2 vs. 23.9, P < 0.05), less frequently in SR (32.8% vs. 65.2%, P < 0.05) but showed comparable rates of persistent/permanent AF (12.0% vs. 10.9%, P < 0.05). When the LA volume was large, most patients had persistent/permanent AF. Conclusion: Left atrial epicardial fat mass was larger in PAF vs. SR, possibly indicating a marker of early disease, while large LA volumes were associated with a high prevalence of persistent/permanent AF. Elevated LA epicardial fat mass without large LA volume may reflect the early AF disease process. Show less
Purpose of Review The present article reviews the pathophysiology of cardiac sympathetic denervation, the principles of positron emission tomography (PET) imaging of the sympathetic innervation of... Show morePurpose of Review The present article reviews the pathophysiology of cardiac sympathetic denervation, the principles of positron emission tomography (PET) imaging of the sympathetic innervation of the heart and its potential clinical role, based on current and expected future evidence. Recent Findings Imaging of cardiac sympathetic denervation can be performed with radiolabeled noradrenaline analogues, e.g., C-11-hydroxyephedrine. A greater burden of sympathetic denervation carries prognostic significance, e.g., in patients with ischemic cardiomyopathy and a left ventricular ejection fraction <= 35%, who are more likely to experience sudden cardiac death. Abnormalities of sympathetic cardiac innervation have been demonstrated in hypertrophic, dilated, and arrhythmic right ventricular cardiomyopathies, and may be helpful in better phenotyping patients who will benefit from device therapy, e.g., cardiac resynchronization and implantable cardioverter-defibrillator implantation. The results of future trials, e.g., the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) II study, are awaited to inform on the role of PET cardiac sympathetic imaging in the selection of device therapy. PET cardiac sympathetic innervation imaging allows visualization and quantification of autonomic denervation secondary to various cardiac diseases, and has significant potential to influence clinical decision-making, e.g., the titration of pharmacotherapy and more directed selection of candidates for device implantation. Show less
In this thesis, i) the role of echocardiography in predicting outcome after cardiac resynchronization therapy (CRT) is investigated, as well as ii) the role of multimodality imaging in the risk... Show moreIn this thesis, i) the role of echocardiography in predicting outcome after cardiac resynchronization therapy (CRT) is investigated, as well as ii) the role of multimodality imaging in the risk-stratification of cardiac disease.The relationship between baseline QRS duration and the presence of a left bundle branch block, and the degree of reverse left ventricular (LV) remodeling and improvement of LV ejection fraction (EF), is discussed in CRT recipients. Results are presented for the interaction of two key determinants of outcome after CRT, namely LV global longitudinal strain and LV reverse remodeling, as well as their impact on survival. The benefits of improved mechanical dyssynchrony (quantified with mechanical dispersion) after CRT are examined, as well as a novel, non-invasive technique for assessing myocardial work in CRT. The prognostic impact of functional mitral regurgitation (FMR) in CRT, and the impact of atrial fibrillation on FMR improvement, are discussed.The role of cardiac imaging in the risk-stratification of genetic dilated cardiomyopathy is discussed, especially when associated with neuromuscular disorders. Specifically, the use of speckle tracking echocardiography in risk-stratification of genetic dilated cardiomyopathy was investigated. Show less
Sudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e... Show moreSudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e.g. myocardial scar, dilated cardiomyopathy). Multimodality imaging (echocardiographic, cardiac magnetic resonance and nuclear techniques) can potentially visualize many predisposing substrates and triggers. Implantable cardioverter-defibrillator (ICD) is the most effective approach to primary prevention of SCD, and current guidelines regarding ICD implantation are based on a left ventricular ejection fraction (LVEF) <= 35%. This practice is limited by a low sensitivity and specificity, and has limited value when applied to different etiologies. In this review, the role of multimodality imaging in SCD risk-stratification and the limitations of an LVEF-based approach, are discussed. Additional randomized, prospective data are eagerly awaited to inform on the role of imaging in SCD risk stratification, and ongoing/planned trials are subsequently discussed. (C) 2019 The Authors. Published by Elsevier Inc. Show less
The general introduction of this thesis outlines the epidemiology and the impact of aortic valve disease in the western world. The thesis further discusses the current and future role of advanced... Show moreThe general introduction of this thesis outlines the epidemiology and the impact of aortic valve disease in the western world. The thesis further discusses the current and future role of advanced cardiac imaging modalities, using 3D echocardiography and speckle tracking echocardiography strain imaging in the diagnostic and clinical management of patients with aortic regurgitation. In addition, the clinical applications of multimodality cardiac imaging in (transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis will be discussed: from pre-procedural patient evaluation, to the understanding of complications post-TAVI such as paravalvular regurgitation, and the assessment and monitoring of patients after TAVI. Show less
Coronary artery disease(CAD) is one of the leading causes of mortality and morbidity worldwide. Clinically, it refers to atherosclerotic changes in the coronary arteries and is usually assessed... Show moreCoronary artery disease(CAD) is one of the leading causes of mortality and morbidity worldwide. Clinically, it refers to atherosclerotic changes in the coronary arteries and is usually assessed with a stress electrocardiogram and conventional coronary angiography(CCA). CCA, however, is an invasive technique and carries a small risk of complications. Non-invasive techniques such as coronary angiography with CT(CTCA), and myocardial perfusion imaging (MPI) with SPECT and MR are therefore used as gatekeeper tests before CCA. These techniques provide valuable information on both the coronary stenoses and their hemodynamic impact on the myocardial function. However, each of these techniques presents only one aspect of CAD. To achieve a higher level of accuracy and precision in CAD assessment, integration of information from different cardiac imaging modalities is essential. The goal of this thesis was therefore to develop techniques to realize this multimodal diagnostic image integration to enhance CAD diagnosis. To this end, we developed novel algorithms for near automated analysis of magnetic resonance based myocardial perfusion images. In addition, we developed and evaluated a new integration framework that allows comprehensive visualization of physiologic information from myocardial perfusion imaging -either with MR or SPECT and anatomical information from CTCA Show less
Graaf, F.R. de; Velzen, J.E. van; Boer, S.M. de; Werkhoven, J.M. van; Kroft, L.J.; Roos, A. de; ... ; Wall, E.E. van der 2013
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... Show moreThe 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. Show less
The objectives of this thesis were to investigate the role of novel cardiac imaging technologies in the current clinical daily practice with the advent of novel therapies. In Part I, the role of... Show moreThe objectives of this thesis were to investigate the role of novel cardiac imaging technologies in the current clinical daily practice with the advent of novel therapies. In Part I, the role of novel imaging modalities to assess left ventricular mechanics will be discussed, focusing on 1) the incremental value of novel myocardial deformation indices over conventional echocardiographic parameters to characterize left ventricular performance in several cardiac conditions (Part IA); 2) the relationship between left ventricular synchronicity and mechanics (Part IB); and the effect of different therapies on left ventricular mechanics (Part IC). The value of twodimensional speckle tracking imaging to characterize all these left ventricular electromechanical aspects will be thoroughly described and the additional value of integrated backscatter imaging and the study of left ventricular vortex formation will be introduced. The evaluation of left atrial myocardial tissue properties in patients with atrial fibrillation undergoing radiofrequency catheter ablation procedure will be the focus of Part II. Integrated backscatter imaging was used to evaluate the fibrosis content of the left atrial wall and related to atrial fibrillation recurrence rate after radiofrequency catheter ablation (Chapter 18). As previously discussed, the fibrosis content of the left atrial wall may determine the deformation properties of the myocardium and the reverse remodeling of the left atrium after ablation (Chapter 19). Therefore, tissue Doppler derived strain may predict the occurrence of left atrial reverse remodeling after radiofrequency catheter ablation. In addition, tissue Doppler imaging may be useful to evaluate the electromechanical properties of the left atrial wall, in close relation with the occurrence of new atrial fibrillation onset and perpetuation of the arrhythmia (Chapter 20). Finally, the role of novel cardiac imaging modalities in the emerging transcatheter valve therapies will be discussed in Part III. Part IIIA will outline the prevalence of valvular heart disease in relation to several clinical conditions (post-Streptococcal reactive arthritis and use of dopamine agonist therapy) and ageing. Particularly, in elderly patients who show an increased operative morbidity and mortality, the advent of transcatheter valve repair/replacement techniques has provided alternative therapies to surgery. Part IIIB will discuss the role of 3-dimensional imaging techniques (real-time 3-dimensional echocardiography and multi-detector row computed tomography) in the pre-procedural screening and to guide the procedure. Show less
