Surgical Treatment of Functional regurgitation
J. (Jerry) Braun
Promotores: Prof.dr. R.J.M. Klautz, Prof.dr. J.J. Bax
7 november 2012
In this thesis, studies on the clinical and echo- cardiographic outcomes of a structured approach to functional mitral regurgitation are combined. Functional mitral regurgitation results from left ventricular wall motion abnormalities. As such, treatment should be directed at the mitral valve (by means of an undersized annuloplasty), but also at the level of the left ventricle. The structured approach to patients with heart failure by the Leiden Heart Team, a collaboration between cardiologists and cardiothoracic surgeons, has led to good outcomes and has received international recognition.
Viral vector-mediated gene transfer in fundamental andapplied cardiovascular research
J. (Jim) Swildens
Promotores: Prof .dr. M.J. Schalij, Prof.dr. A van der Laarse
11 oktober 2012
Novel insights into Cardiac Imaging in Cardiovascular Disease
J.M.J. (Mark) Boogers
Promotores: Prof.dr. J.W. Jukema, Prof.dr. J.J. Bax
14 juni 2012
The purpose of the thesis was to explore the role of novel insights from cardiac imaging for diagnosis (Part I), therapeutic options (Part II) and risk stratification (Part III) of patients with cardiovascular disease. Rapid developments in cardiac imaging techniques have already contributed significantly in the evaluation of patients with a broad spectrum of cardiovascular disease, including coronary artery disease and chronic heart failure.
New insights in cardiac imaging and post-processing technologies can further refine the currently applied diagnostic, therapeutic and prognostic algorithms for patients with cardiovascular disease. Moreover, further developments in cardiac imaging can help to generate a more patient-tailored health care system, which in turn should result in an improved cost-effective health care system as patients are more appropriately selected for diagnostic procedures and therapeutic interventions, such as (percutaneous) coronary intervention procedures and dedicated cardiac device therapies.
Cardiac Resynchronization Therapy
Determinants of patient outcome and emerging indications
Rutger J.van Bommel
Promotores: Prof. Dr. J.J. Bax, Prof. dr. M.J. Schalij
31 mei 2012
In this thesis, a comprehensive analysis was performed on the long-term effects of cardiac resynchronization therapy (CRT) in selected patients with heart failure. CRT has evolved as a successful treatment strategy in selected patients with drug refractory heart failure. Evidence of large clinical trials established the beneficial effects of CRT in addition to optimal medical treatment on both morbidity and mortality. Nonetheless, about 30% of patients do not demonstrate response to CRT. This thesis demonstrated that several patient characteristics have a strong influence on both response at 6 months follow-up and prognosis during long-term follow-up. In addition to these patient characteristics, the position of the LV pacing lead in relation to the site of latest activation and potential scar tissue may have a great influence on outcome. Integration of patient characteristics, LV lead position with information on LV dyssynchrony and scar tissue may help to improve patient selection and response to CRT.
Furthermore, it is not unlikely that the favorable effects of CRT will be extended to other patient groups in the coming years. These groups include asymptomatic (NYHA class I) patients, patients with a narrow QRS complex (<120 ms) or patients with heart failure but preserved LVEF (â‰¥45%). Data from this thesis showed that CRT also seems to improve other conditions frequently observed in patients with heart failure. The improved LV systolic function induced by CRT increases cerebral blood flow and also results in stabilization of renal function. Finally, patients with severe functional MR and high operative risk also derive benefit from CRT. Perhaps CRT may one day be used as an effective treatment strategy in these patient groups.
Substrate of Ventricular Tachycardia
Adrianus P. Wijnmaalen
Promotores: Prof.dr. M.J. Schalij, Dr. K. Zeppenfeld
22 maart 2012
The research was focused on the substrate and catheter ablation of ventricular arrhythmias. Catheter ablation is of increasing importance in the treatment of patients with ventricular arrhythmias. This thesis evaluates risk factors, substrate characteristics and outcome in different patient populations undergoing catheter ablation. Furthermore it is shown that the use of new mapping criteria and integration of electroanatomical mapping with imaging like MRI and CT can enhance the efficacy of ablation.
Imaging of Coronary Atherosclerosis and Vulnerable Plaque
From mechanism to management
Joëlla .E. van Velzen
Promotores: Prof. Dr. E.E. van der Wall, Prof. Dr. J.J. Bax
16 februari 2012
The aim of this thesis was to evaluate the role of imaging in the assessment and characterization of atherosclerosis and vulnerable plaque in the coronary arteries. Non-invasive computed tomography coronary angiography (CTA) is a relatively new technique for the evaluation of coronary atherosclerosis. Therefore, the performance of CTA in characterizing coronary atherosclerosis was assessed and was compared to invasive imaging techniques, in addition to determining the impact on clinical management.
In Part 1, the current advances of coronary CTA in characterizing atherosclerosis and vulnerable plaque were explored and in Part 2, the relation between characterization of atherosclerosis on CTA and the effect on clinical management was evaluated.
Advanced Computed Tomography for Cardiac Applications:
From Cardiovascular Diagnosis to Clinical Management
Fleur R. de Graaf
Promotores: Prof.dr. J.J. Bax, Prof.dr. E.E. van der Wall
2 februari 2012
The primary objective of this dissertation is to determine the diagnostic performance of 320-row computed tomography angiography (CTA) for cardiac applications, particularly in the assessment of significant coronary stenosis in patients with known or suspected coronary artery disease. It was shown that 320-row CTA allows accurate, non-invasive assessment of significant coronary artery disease and global left ventricular function in patients with suspected atherosclerosis, as well as in patients with a history revascularization. Importantly, all diagnostic of accuracy studies demonstrated that 320-row CTA has particularly high negative predictive value, which makes this modality particularly suitable for the exclusion of CAD. The second objective was to investigate the prognostic value of CTA and its role in clinical management of patients with suspected coronary artery disease. In addition the potential of CTA to serve as a gatekeeper to invasive coronary angiography was explored.