Novel imaging aspects in the management of patients with acute coronary syndromes

Wouter Wieringa

Novel imaging aspects in the management of patients with acute coronary syndromes

Vertaalde titel van de bijdrage: Nieuwe aspecten van beeldvormende technieken in de behandeling van patienten met acute coronaire syndromen

Wouter Wieringa

Onderzoeksoutput: Thesis fully internal (DIV)

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Samenvatting

De behandeling van hartinfarcten is de laatste decennia sterk verbeterd. Echter, een groot deel van de patiënten zal opnieuw klachten krijgen. Vroegtijdige identificatie van deze patiënten kan helpen om behandeling en klinische resultaten verder te optimaliseren. Hartinfarcten zijn veelal het gevolg van atherosclerose. Atherosclerose is een langzaam ziekteproces dat in een laat stadium tot hartinfarcten leidt, hetgeen mogelijkheden biedt om kwetsbare atherosclerotische plekken in het kransvat vroegtijdig op te sporen. Verscheidene beeldvormende technieken kunnen daarbij helpen.
In dit proefschrift zijn ‘beeldvormings-markers’ onderzocht om deze patiënten op te sporen. Myocard perfusie (hartspier doorbloeding) geeft belangrijke prognostische informatie en kan worden gemeten tijdens een dotterprocedure. Een dotterprocedure binnen de eerste 5 uren na ontstaan van klachten geeft betere myocard perfusie en klinische uitkomsten. Patiënten met een slechte myocard perfusie, die klachten krijgen in de vroege ochtenduren hebben tevens een betere prognose. Dit duidt op een 24-uurs patroon in de relatie tussen myocard perfusie, hartinfarct grootte en klinische uitkomsten.
Computer tomografie (CT) angiografie kan atherosclerose en haar morfologie afbeelden. Bij patiënten met een hartinfarct zonder zichtbare vernauwing van het kransvat bij bloedvatcatheterisatie, was meestal ook bij CT-angiografie geen atherosclerose waarneembaar. Aanvullende diagnostiek om andere oorzaken van de klachten te vinden valt daarom te overwegen. Er werden correlaties gevonden tussen morfologische eigenschappen van atherosclerose en immuun-inflammatoire bloedwaarden. Deze markers zijn potentieel nuttig in de risico-evaluatie van patiënten met atherosclerose. Normale bevindingen op CT-angiografie correleerden met vroeg stadium atherosclerotische afwijkingen. Identificatie van laat stadium atherosclerose met behulp van CT-angiografie bleek in de klinische praktijk lastig.

Vertaalde titel van de bijdrage	Nieuwe aspecten van beeldvormende technieken in de behandeling van patienten met acute coronaire syndromen
Originele taal-2	English
Kwalificatie	Doctor of Philosophy
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	van Gilst, Wiek, Supervisor Pundziute-Do Prado, Gabija, Co-supervisor Lipsic, Erik, Co-supervisor
Datum van toekenning	2-jun.-2014
Plaats van publicatie	[S.l.]
Uitgever	s.n.
Gedrukte ISBN's	978-90-367-6979-2
Elektronische ISBN's	978-90-367-6978-5
Status	Published - 2014

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Title and contentsFinal publisher's version, 266 KB
Chapter 1Final publisher's version, 238 KB
Chapter 2Final publisher's version, 428 KB
Chapter 3Final publisher's version, 736 KB
Chapter 4Final publisher's version, 1,59 MB
Chapter 5Final publisher's version, 389 KB
Chapter 6Final publisher's version, 323 KB
Chapter 7Final publisher's version, 475 KB
Chapter 8Final publisher's version, 230 KB
Chapter 9Final publisher's version, 202 KB
Complete dissertationFinal publisher's version, 3,04 MB
PropositionsFinal publisher's version, 34,1 KB

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title = "Novel imaging aspects in the management of patients with acute coronary syndromes",

abstract = "Advances in treatment of patients with acute coronary syndrome have markedly improved cardiovascular outcomes over the last decades. Although revascularisation and pharmacological therapy provide benefit in terms of morbidity and mortality, still a large number of patients with coronary artery disease (CAD) will experience progression of the disease and/or occurrence of a coronary event. The ability to identify these patients may help to optimize the therapy and hence, clinical outcomes. Our research focuses on imaging techniques that may assist the identification of patients with CAD at higher risk for recurrent cardiovascular events. Measurement of myocardial perfusion is of prognostic importance. Patients treated by percutaneous coronary intervention within the first 5 hours after the onset of symptoms of myocardial infarction have better clinical outcomes. Patients with decreased myocardial perfusion, who have onset of complaints in the early morning hours also have better prognosis. This implicates a 24-hour relationship between myocardial perfusion, myocardial infarct size and clinical outcomes.Computer tomography (CT) angiography has the ability to identify atherosclerosis and its morphology. In patients with myocardial infarction, but without visible atherosclerosis on coronary angiography, CT showed no atherosclerosis in most cases either. It would be reasonable to extend the diagnostic evaluations in these patients. We found correlations between morphological characteristics of atherosclerosis and immune-inflammatory bloodmarkers. These markers are potentially useful in the risk assessment and monitoring of patients with CAD. Normal findings on CT angiography related to early lesions on invasive imaging. Nevertheless, differentiation of advanced plaque may proof difficult in clinical practice.",

author = "Wouter Wieringa",

year = "2014",

language = "English",

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N2 - Advances in treatment of patients with acute coronary syndrome have markedly improved cardiovascular outcomes over the last decades. Although revascularisation and pharmacological therapy provide benefit in terms of morbidity and mortality, still a large number of patients with coronary artery disease (CAD) will experience progression of the disease and/or occurrence of a coronary event. The ability to identify these patients may help to optimize the therapy and hence, clinical outcomes. Our research focuses on imaging techniques that may assist the identification of patients with CAD at higher risk for recurrent cardiovascular events. Measurement of myocardial perfusion is of prognostic importance. Patients treated by percutaneous coronary intervention within the first 5 hours after the onset of symptoms of myocardial infarction have better clinical outcomes. Patients with decreased myocardial perfusion, who have onset of complaints in the early morning hours also have better prognosis. This implicates a 24-hour relationship between myocardial perfusion, myocardial infarct size and clinical outcomes.Computer tomography (CT) angiography has the ability to identify atherosclerosis and its morphology. In patients with myocardial infarction, but without visible atherosclerosis on coronary angiography, CT showed no atherosclerosis in most cases either. It would be reasonable to extend the diagnostic evaluations in these patients. We found correlations between morphological characteristics of atherosclerosis and immune-inflammatory bloodmarkers. These markers are potentially useful in the risk assessment and monitoring of patients with CAD. Normal findings on CT angiography related to early lesions on invasive imaging. Nevertheless, differentiation of advanced plaque may proof difficult in clinical practice.

AB - Advances in treatment of patients with acute coronary syndrome have markedly improved cardiovascular outcomes over the last decades. Although revascularisation and pharmacological therapy provide benefit in terms of morbidity and mortality, still a large number of patients with coronary artery disease (CAD) will experience progression of the disease and/or occurrence of a coronary event. The ability to identify these patients may help to optimize the therapy and hence, clinical outcomes. Our research focuses on imaging techniques that may assist the identification of patients with CAD at higher risk for recurrent cardiovascular events. Measurement of myocardial perfusion is of prognostic importance. Patients treated by percutaneous coronary intervention within the first 5 hours after the onset of symptoms of myocardial infarction have better clinical outcomes. Patients with decreased myocardial perfusion, who have onset of complaints in the early morning hours also have better prognosis. This implicates a 24-hour relationship between myocardial perfusion, myocardial infarct size and clinical outcomes.Computer tomography (CT) angiography has the ability to identify atherosclerosis and its morphology. In patients with myocardial infarction, but without visible atherosclerosis on coronary angiography, CT showed no atherosclerosis in most cases either. It would be reasonable to extend the diagnostic evaluations in these patients. We found correlations between morphological characteristics of atherosclerosis and immune-inflammatory bloodmarkers. These markers are potentially useful in the risk assessment and monitoring of patients with CAD. Normal findings on CT angiography related to early lesions on invasive imaging. Nevertheless, differentiation of advanced plaque may proof difficult in clinical practice.

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