Abstract
Despite ongoing advances in prevention, diagnostic strategies and treatment options, coronary artery disease (CAD) remains a leading cause of death worldwide and has an unfavourable impact on quality of life. The use of upfront computed tomography coronary angiography (CTCA) has shown potential to reduce fatal and nonfatal myocardial infarction in patients with stable CAD. Furthermore, it is a less invasive option compared to standard coronary angiography. In this thesis we examined the impact and challenges of implementing CTCA in the Netherlands and we investigated methods to improve image acquisition. In the third part of this thesis, we evaluated the extended use of CTCA, both for the detection of CAD in the work-up for transcatheter aortic valve implantation (TAVI) and to predict the occurrence of chronic silent brain infarctions following this procedure.
Considering implementation, we found that there already is high coverage of CTCA-services in the Netherlands. However, a substantial increase in CTCA capacity is necessary to fully implement CTCA in cardiologic care. Furthermore, we found that implementation of CTCA will result in a substantial reduction in costly and invasive CAG. Considering improved methods of image acquisition, we found that patient tailored contrast delivery protocols for CTCA, adjusting the contrast delivery to body weight and CT-scanner kV settings, improved attenuation values in the coronary arteries and therefore may result in improved diagnostic qualities of CTCA. In the third part of this thesis, we found that CTCA has high diagnostic accuracy to detect CAD in the work-up TAVI and could be used to reduce CAG in these fragile patients by up to 70%. These same pre-TAVI CTCA scans may be used for additional purposes other than the evaluation of CAD. We found that the degree of aortic valve calcifications, measured on these pre-TAVI CTCA scans, was associated with a larger increase in the white matter hyperintensity volume, and therefore shows potential to predict chronic silent brain infarctions.
Considering implementation, we found that there already is high coverage of CTCA-services in the Netherlands. However, a substantial increase in CTCA capacity is necessary to fully implement CTCA in cardiologic care. Furthermore, we found that implementation of CTCA will result in a substantial reduction in costly and invasive CAG. Considering improved methods of image acquisition, we found that patient tailored contrast delivery protocols for CTCA, adjusting the contrast delivery to body weight and CT-scanner kV settings, improved attenuation values in the coronary arteries and therefore may result in improved diagnostic qualities of CTCA. In the third part of this thesis, we found that CTCA has high diagnostic accuracy to detect CAD in the work-up TAVI and could be used to reduce CAG in these fragile patients by up to 70%. These same pre-TAVI CTCA scans may be used for additional purposes other than the evaluation of CAD. We found that the degree of aortic valve calcifications, measured on these pre-TAVI CTCA scans, was associated with a larger increase in the white matter hyperintensity volume, and therefore shows potential to predict chronic silent brain infarctions.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Supervisors/Advisors |
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| Award date | 10 Sept 2021 |
| Print ISBNs | 9789464214390 |
| Publication status | Published - 2021 |
