Background: Although there have been recent advances, cardiovascular disease remains the commonest cause of premature death in the United Kingdom. There is a need to develop safe non-invasive techniques to aid the diagnosis and treatment of patients with cardiovascular disease.
Objectives: The aims of this thesis are: (i) to establish whether coronary artery calcification can be measured reproducibly by helical computed tomography; (ii) to establish the effect of lipid lowering therapy on the progression of coronary calcification; (iii) to determine whether multidetector computed tomography can predict graft patency in patients who have undergone coronary artery bypass grafting; and (iv), to investigate the role of magnetic resonance imaging to assess plaque characteristics following acute carotid plaque rupture.
Methods: In 16 patients, coronary artery calcification was assessed twice within 4 weeks by helical computed tomography. As part of a randomised controlled trial, patients received atorvastatin 80 mg daily or matching placebo, and had coronary calcification assessed annually. Fifty patients with previous coronary artery bypass surgery who were listed for diagnostic coronary angiography underwent contrast enhanced computed tomography angiography using a 16-slice multidetector computed tomography scanner. Finally, 15 patients with recent symptoms and signs of an acute transient ischaemic attack, amaurosis fugax or stroke underwent magnetic resonance angiography of the carotid arteries using dedicated surface coils. Plaque volume, regional plaque densities and neovascularisation were determined before and after gadolinium enhancement.
Results: Quantification of coronary artery calcification demonstrated good reproducibility in patients with scores > 100 AU. Despite reducing systemic inflammation and halving serum low-density lipoprotein cholesterol concentrations, atorvastatin therapy did not affect the rate of progression of coronary artery calcification. Computed tomography angiography was found to be highly specific for the detection of graft patency. Assessment of plaque characteristics by magnetic resonance scanning in patients with recent acute carotid plaque was feasible and reproducible.
Conclusions: Coronary artery calcium scores can be determined in a reproducible manner. Although they correlate well with the presence of atherosclerosis and predict future coronary risk. there is little role for monitoring progression of coronary artery calcification in order to assess the response to lipid lowering therapy. Computed tomography can be used reliably to predict graft patency in patients who have undergone coronary artery bypass grafting, and is an acceptable non-invasive alternative to invasive coronary angiography. Magnetic resonance imaging techniques ' can be employed in a feasible, timely and reproducible manner to detect plaque characteristics associated with acute atherothrombotic disease.