PhD defence T.C.F. (Dorine) Rijlaarsdam - Hermsen

Dissertation in short:

Angina pectoris is chest pain caused by an insufficient oxygen-rich blood supply to the heart muscle. The GP commonly refers patients to the cardiologist if angina pectoris is suspected. However, in most of these patients, no cardiac cause is present. Therefore, better patient selection might result in fewer referrals and less unnecessary diagnostic testing. 
In patients without symptoms, the presence of coronary calcium and the height of the calcium score is a significant predictor of future cardiovascular events and is more accurate than traditional risk factors. In patients with chest pain, the diagnostic and prognostic worth of the calcium score is unknown.

This thesis shows that the combination of the type of chest pain and the height of the calcium score predicts the presence of obstructive coronary artery disease. Also, the calcium score can help identify patients at high risk for future cardiovascular events. Adding the calcium score to existing guidelines improves the patient selection for additional testing. Based on these outcomes, we give recommendations for the use of the calcium score by the GP. In addition, this thesis describes the diagnostic and prognostic worth of the adenosine 'stress-only' MRI in patients with chest pain and a calcium score above zero. We conclude that adenosine 'stress-only' MRI has high diagnostic accuracy and efficiently guides coronary angiography. In conclusion, this thesis gives insight into the possible role of the calcium score and adenosine 'stress-only' MRI in the diagnostic workup of patients with non-acute chest pain.