Computed Tomography Coronary Angiography (CTCA) beyond the assessment of the coronary arteries : LV geometric remodeling, epicardial adipose tissue, and myocardial attenuation as additional diagnostic and prognostic information
Computed Tomography Coronary Angiography (CTCA) is a relatively new imaging modality to diagnose coronary atherosclerotic disease (CAD). The common theme of the presented research can be summarized as follows: "Can supplemental diagnostic and prognostic information beyond the coronary arteries be extracted from the standard CTCA study? `` This dissertation consists of four parts. Part 1 explains the basic principles of assessing left ventricular (LV) remodeling and how CTCA-acquired EAT volume, psoas muscle area, and psoas muscle attenuation variables are determined. The technical aspects of CTCA data acquisition and imaging protocol that influence the obtained measurements (e.g., tube current voltage and slice thickness) are briefly discussed. An overview of the current stage of medical knowledge on CT-measured epicardial adipose tissue (EAT) volume, psoas muscle volume, and psoas muscle attenuation as new biomarkers for clinical outcomes is presented. Part 2 provides normal reference values for CT-measured LV mid-diastolic wall thickness (LVMD-WT) and right ventricular (RV) mid-diastolic volume. Three studies examining the feasibility of depicting early LV remodeling patterns from CTCA images in patients with diabetes mellitus, hypertension, overweight/obesity, and CAD are presented. Parts 3 and 4 present studies examining if CT-acquired EAT indexed to body mass index (EATBMI), normalized subendocardial and psoas muscle CT attenuation contains prognostic information. Overall, these study results show that: (1) CTCA images can depict early LV geometric changes before `overt LV remodeling' occurs in patients with HTN, DM, overweight/obesity, and CAD. (2) EATBMI is an independent predictor of major adverse cardiac events (MACE) 30 days after elective non-cardiac surgery. (3) Normalized subendocardial attenuation is an independent and incremental predictor of major adverse cardiac events (MACE) 30 days after elective non-cardiac surgery. (4) CT attenuation of the psoas muscle is an independent predictor of all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR). (5) In a multivariable model, including classical risk assessment, cytokine serum levels, and psoas muscle attenuation, adiponectin, and TNFα serum levels are independent predictors of all-cause 5-years and 500-day mortality in patients undergoing TAVR, respectively.
Antwerpen : Universiteit Antwerpen, Faculteit Geneeskunde en Gezondheidswetenschappen , 2023
386 p.
Supervisor: Heidbüchel, H. [Supervisor]
Supervisor: van Herck, P. [Supervisor]
Supervisor: Van De Heyning, C.M. [Supervisor]
Supervisor: Bosmans, J. [Supervisor]
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The publisher created published version Available from 29.11.2025
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Creation 20.11.2023
Last edited 20.12.2023
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