Cardiovascular assessment with multi-detector computed tomography

• Main Author: Nicol, Edward David
• Published: Imperial College London 2008
• Subjects: 615.84
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486334

In essence this thesis examined cardiovascular assessment with 64-MDCT. Cardiac MDCT estimates of disease has been 1) validated against conventional invasive ang,iography (ICA) for determination of coronary artery disease (CAD) and its severity, 2) correlated against myocardial perfusion scintigraphy (MPS) to assess functional severity of atheroma, 3) validated against cardiovascular magnetic resonance (CMR) and correlated against MPS for assessment of left (' ventricular regional and global function, 4) validate~ against CMR for the assessment of right ventricular function and 5) assessed for intra- and interobserver reproducibility across all investig ations. The investigations have confirmed the following: first, observer agreement for visual quantification of both extent and severity of CAD was good. Second, the severity of disease on MDCT correlates well with findings on ICA. Third, a 70% visual stenosis on MDCT correlated well with functionally significant disease on MPS. Third, biventricular volumes and function on MDCT is highly reproducible and correlates well with CMR. Fourth, there is an increase in certain pharmacological treatment with the use of CTA when compared with MPS. Fifth, there is an increase in subsequent investigation, especially invasive coronary angiography in patients undergoing CTA when compared with MPS. Sixth, a cost analysis demonstrates using CTA in the investigation of patients with low to intermediate likelihood of CAD is likely to be more costly than using MPS. Seventh, cardiac MDCT is able to perform a complete cardiopulmonary assessment in a single combined gated CTPAICTA study. Eighth, MDCT is able to assess both' coronary anatomy and cardiac morphology in patients with adult congenital heart disease. Finally, in patients under investigation for coronary artery disease, MDCT demonstrates a high negative predictive value but limited positive predictive value for the detection of significant coronary artery disease and is therefore most useful in patients with low to intermediate coronary artery disease.