PhD defence F.M.A. (Fay) Nous

Dissertation in short:

The aim of this thesis is to investigate the evaluation of coronary artery disease (CAD) by contemporary CT technology in challenging, previously often excluded patient populations, and to assess the applicability and utility of new cardiac CT applications for the functional interpretation of CAD. In the first part, we describe our clinical experience with coronary CT angiography (CCTA) as first-line screening imaging modality for the clinical surveillance of cardiac allograft vasculopathy in heart transplantation (HTx) patients. Furthermore, we investigated the prevalence of CAD by CCTA in patients with atrial fibrillation (AF) and without known or suspected CAD and compared clinical management and outcome in AF patients with and without obstructive CAD on CCTA. In the second part, we performed a subanalysis on the CRESCENT I and II trials and investigated the potential impact of CT- derived fractional flow reserve (CT-FFR) on the diagnostic efficiency and effectiveness of CCTA in patients with CAD. Additionally, we investigated the temporal changes in the use and utility of CT-FFR within the ADVANCE registry. Furthermore, we assessed the diagnostic performance of an CT-FFR application in patients with and without diabetes mellitus with suspected CAD. Moreover, we describe the results of CCTA with CT-FFR in a cohort of HTx patients for routine annual screening for CAV. Finally, the prospective international multicenter SPECIFIC study evaluated the diagnostic performance of dynamic CT myocardial perfusion imaging on top of CCTA as compared to clinically indicated coronary angiography and invasive FFR.