Non-invasive cardiac imaging modalities play a crucial role in the diagnostic process and clinical management of patients without known coronary artery disease and patients with acute myocardial... Show moreNon-invasive cardiac imaging modalities play a crucial role in the diagnostic process and clinical management of patients without known coronary artery disease and patients with acute myocardial infarction. The first part of the thesis discusses the use of non-invasive imaging modalities (including coronary artery calcium scoring, multi-slice computed tomography coronary angiography, conventional two-dimensional echocardiography and speckle-tracking echocardiography) for the diagnosis and risk stratification of patients with suspected coronary artery disease. The second part of the thesis discusses the diagnostic and prognostic value of novel echocardiographic techniques (including contrast echocardiography, myocardial deformation imaging, and three-dimensional echocardiography) in patients admitted with acute myocardial infarction. Show less
Katsanos, S.; Rosendael, P. van; Kamperidis, V.; Kley, F. van der; Regeer, M.; Amri, I. al; ... ; Delgado, V. 2015
Advanced echocardiographic techniques permit assessment of left ventricular dyssynchrony in overt heart failure patients and provide important prognostic data. These techniques may guide patients__... Show moreAdvanced echocardiographic techniques permit assessment of left ventricular dyssynchrony in overt heart failure patients and provide important prognostic data. These techniques may guide patients__ selection for cardiac resynchronization therapy and device optimization. Global left ventricular longitudinal 2-dimensional strain may help detect early stages of myocardial dysfunction in diabetic patients with preserved left ventricular ejection fraction. Novel cardiac magnetic resonance imaging sequence analysis may allow tissue characterization, quantification of diffuse fibrosis and detection of early alterations in ventriculo-arterial coupling. Advanced cardiac imaging provides invaluable information at every stage of the heart failure syndrome. It may help identify an earlier stage of the disease, help to select patients for cardiac resynchronization therapy, tailor therapies in selected individuals and offer important prognostic information. Show less
This thesis provides insights in characteristics of newly introduced echocardiographic parameters in healthy children and their use in follow-up of patients with a congenital heart defect (CHD)... Show moreThis thesis provides insights in characteristics of newly introduced echocardiographic parameters in healthy children and their use in follow-up of patients with a congenital heart defect (CHD) after surgery. In healthy children, reference values and characteristics of two echocardiographic techniques, tissue Doppler imaging (TDI) and speckle-tracking strain imaging, are described. TDI-derived velocity parameters are reproducible and feasible in children. Yet use of age or growth-dependent reference values is recommended, especially in neonates. Speckle-tracking strain-derived global peak strain parameters have a good reproducibility, are age-independent and remain unchanged during periods of significant growth, such as the neonatal period. We encourage use of these parameters. In contrast, the limited reproducibility of parameters describing intraventricular time-differences is worrying. Our follow-up studies in CHD patients undergoing corrective surgery with cardiopulmonary bypass, describe a significant decrease in biventricular performance immediately postoperatively. Subsequently, left ventricular performance recovered to control values. In contrast, right ventricular performance remained impaired in most subgroups of CHD patients up to one year postoperatively. Considering the prognostic value of right ventricular performance parameters, these studies underline the need for careful evaluation of both left and right ventricular performance postoperatively. Furthermore, a longer-lasting negative influence of cardiopulmonary bypass on ventricular performance was suggested. Show less
Klitsie, L.M.; Roest, A.A.W.; Blom, N.A.; Harkel, A.D.J. ten 2013
CRT has evolved as a successful treatment strategy in selected patients with drug refractory heart failure. Evidence of large clinical trials established the beneficial effects of CRT in addition... Show moreCRT has evolved as a successful treatment strategy in selected patients with drug refractory heart failure. Evidence of large clinical trials established the beneficial effects of CRT in addition to optimal medical treatment on both morbidity and mortality. Nonetheless, about 30% of patients do not demonstrate response to CRT. Several patient characteristics have a strong influence on both response at 6 months follow-up and prognosis during long-term follow-up. In addition to these patient characteristics, the position of the LV pacing lead in relation to the site of latest activation and potential scar tissue may have a great influence on outcome. Integration of patient characteristics, LV lead position with information on LV dyssynchrony and scar tissue may help to improve patient selection and response to CRT. It is not unlikely that the favorable effects of CRT will be extended to other patient groups in the coming years. These groups include asymptomatic (NYHA class I) patients, patients with a narrow QRS complex (<120 ms) or patients with heart failure but preserved LVEF (__45%). CRT also seems to improve other conditions frequently observed in patients with heart failure. The improved LV systolic function induced by CRT increases cerebral blood flow and also results in stabilization of renal function. Finally, patients with severe functional MR and high operative risk also derive benefit from CRT. Perhaps CRT may one day be used as an effective treatment strategy in these patient groups. Show less
The general introduction of this thesis gives an overview of the epidemiology of ST-segment elevation myocardial infarction (STEMI) and the current focus of the guidelines concerning the management... Show moreThe general introduction of this thesis gives an overview of the epidemiology of ST-segment elevation myocardial infarction (STEMI) and the current focus of the guidelines concerning the management of these patients. In the past decades changes in the treatment and outcome of STEMI patients have influenced the risk stratification of this population and the focus has been shifted to the evaluation of infarct size. Furthermore, the role of echocardiography in the risk stratification after STEMI is addressed including the evolving echocardiographic techniques. The aim of the current thesis was to evaluate the clinical characteristics of this contemporary population of STEMI patients and to assess the value of echocardiography for the improvement of the risk stratification of these patients. First, the current population of STEMI patients treated with primary percutaneous coronary intervention is described in Part I, where clinical parameters are being evaluated in relation to short- and long-term outcome. In Part II, the role of conventional and novel echocardiographic techniques is being evaluated for the assessment of left ventricular (LV) systolic function and the importance of LV diastolic function is addressed in Part III. Finally, the role of echocardiography in patients with chronic ischemic heart disease is studied in Part IV. Show less
