- Author
-
T.P. van de Hoef
- Title
- Novel insights into the complexity of ischaemic heart disease derived from combined coronary pressure and flow velocity measurements
- Supervisors
- Co-supervisors
- Award date
- 2 July 2015
- Number of pages
- 359
- ISBN
- 9789461696816
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
This thesis concerns the complexity of ischaemic heart disease, and the crucial role of the coronary microcirculation in its diagnosis and prognosis. After five decades of a stenosis-centered approach towards both its diagnosis and treatment, it is increasingly acknowledged that ischaemic heart disease is a complex disease that involves multiple levels of the coronary circulation, including both the epicardial and microvascular domains of the coronary circulation, as well as the myocardium. This multi-level origin of ischaemic heart disease has important implications for routine physiology-guided strategies applied in contemporary clinical practice, as is discussed in Part A of this thesis.
Despite a well-documented benefit of physiology-guided coronary revascularization compared with angiographic guidance, its application in clinical practice remains limited. This has governed attempts to optimize the applicability of coronary physiology techniques in clinical practice by circumventing part of the practical ambiguities associated with physiological testing. One of such approaches, circumventing the need for pharmacological vasodilation, is discussed in Part B of this thesis.
Finally, the acknowledgement of the coronary microcirculation as an important prognostic component in ischaemic heart disease has governed attempts to identify the magnitude of its prognostic value, as well as to design novel therapeutic strategies that specifically address the coronary microcirculation, which is discussed in Part C of this thesis. - Note
- Research conducted at: Universiteit van Amsterdam
- Persistent Identifier
- https://hdl.handle.net/11245/1.478331
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: Coronary pressure-flow relations as basis for the understanding of coronary physiology
Chapter 3: Fractional flow reserve as a surrogate for inducible myocardial ischaemia
Chapter 4: Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity
Chapter 5: Impact of hyperaemic microvascular resistance on fractional flow reserve measurements in patients with stable coronary artery disease: insights from combined stenosis and microvascular resistance assessment
Chapter 6: Impact of age on intracoronary physiological indices of stenosis severity and microcirculatory function
Chapter 7: Coronary flow capacity: a cross-modality concept to enhance the diagnosis and risk-stratification of ischaemic heart disease
Chapter 8: Diagnostic accuracy of combined intracoronary pressure and flow velocity information during baseline conditions: adenosine-free assessment of functional coronary lesion severity
Chapter 9: Head-to-head comparison of basal stenosis resistance index, instantaneous wave-free ratio, and fractional flow reserve: diagnostic accuracy for stenosis-specific myocardial ischemia
Chapter 10: Basal stenosis resistance derived from simultaneous pressure and flow velocity measurements
Chapter 11: Impaired coronary autoregulation is associated with long-term fatal events in patients with stable coronary artery disease
Chapter 12: Impact of coronary microvascular function on long-term cardiac mortality in patients with acute ST-segment elevation myocardial infarction
Chapter 13: Intracoronary hemodynamic effects of pressure-controlled intermittent coronary sinus occlusion (PICSO): results from the first-in-man Prepare PICSO study
Chapter 14: Pressure-controlled intermittent coronary sinus occlusion (PICSO) in acute ST-segment elevation myocardial infarction: Results of the Prepare RAMSES study
Chapter 15: Fundamentals in clinical coronary physiology: why coronary flow is more important than coronary pressure
Chapter 16: Summary of the thesis and future perspectives / Samenvatting van het proefschrift
Appendices
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