"Clinical applications of cardiac computed tomography and coronary computed tomography angiography: from the pathophysiology to the bedside management". "Applicazioni cliniche della tomografia computerizzata cardiaca e dell'angiografia tomografica computerizzata coronarica: dalla fisiopatologia alla gestione del paziente".

The present research work aims to give an overview on some of the clinical applications of sophisticated and widely-used cardiac imaging techniques which are cardiac computed tomography (CT) and coronary computed tomography angiography (CCTA). The towo presented projects arise from the data reported by the World Health Organization describing ischemic heart disease and stroke among some of the biggest killers globally and the leading causes of death worldwide over the last 15 years and from the consideration that the role and the clinical applications of cardiac CT are gradually changing the diagnostic approach and the therapeutic management of many cardiac conditions - especially coronary artery disease - with extraordinarily practical clinical implications. Part I of this study focuses on the role of cardiac CT and CCTA in symptomatic patients to assess and quantify the burden of atherosclerotic disease. A special focus is put on the diabetic population based on the premise that diabetes is a rising epidemic condition and one of the major public health problems worldwide. The motivation behind this project is that optimal risk stratification through accurate detection, quantification and characterization of the atherosclerotic burden is crucial to provide the best therapeutic management and to improve cardiovascular outcomes worldwide both in the general population and in high-risk subgroups, such as the diabetic community. Part II of the present research project describes an additional research project on the application of cardiac computed tomography in the setting of vascular disease with reference to its basic pathophysiologic mechanisms. Specifically, the research focuses on the relationship between cardio-vascular ankle index and left ventricular geometry assessed by cardiovascular CT in a multi-ethnic adult population. Insights from this research work suggest that arterial stiffness is associated with lower left ventricular volume index assessed by cardiac CT. The present thesis includes a revision of the existing literature on the two main topics discussed above and two original works on some of the most relevant clinical applications of cardiac computed tomography and coronary computed tomography angiography.