New Trends and Advances in Cardiac Imaging

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 September 2024) | Viewed by 8438

Special Issue Editor


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Guest Editor
Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Zagreb, Croatia
Interests: cardiovascular and thoracic radiology

Special Issue Information

Dear Colleagues,

In recent years, we have witnessed rapid improvements in computed tomography (CT) and magnetic resonance imaging (MRI) technology that have enabled the comprehensive morphologic and functional assessment of cardiovascular structures. Multimodality imaging is playing an increasingly important role in the management of patients with cardiovascular disease, improving their diagnosis, treatment, and outcomes. In patients with suspected coronary artery disease, CT allows the detection and assessment of the severity of stenoses and atherosclerotic plaques, including the detection of high-risk plaque features, with an increasing role for functional assessment using CT stress perfusion imaging and/or CT fractional flow reserves. Cardiovascular MRI encompasses a variety of imaging modalities that provide the accurate and reproducible measurement of ventricular volume, function, and myocardial mass; the quantification of valvular disease and shunts; the excellent characterization of myocardial tissue and ischemia; and the visualization of vascular abnormalities.The goal of this Special Issue is to depict new technological advances in cardiovascular CT and MRI, the state-of-the-art performance of these techniques, as well as their application for the multimodality imaging assessment of patients with different cardiovascular diseases including coronary artery disease, cardiomyopathies, inflammatory and pericardial diseases, cardiac arrhythmias and masses, and congenital heart disease. In addition to being noninvasive and accurate diagnostic modalities, these techniques are also important for the selection of optimal treatment strategies and risk stratification. In this Special Issue, we would also like to show the increasing role of artificial intelligence, hybrid imaging techniques, and multidisciplinary approaches leading to improved and personalized patient management.

Dr. Maja Hrabak-Paar
Guest Editor

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Keywords

  • cardiovascular computed tomography
  • cardiovascular magnetic resonance
  • coronary artery disease
  • cardiomyopathies
  • pericardial diseases
  • congenital heart disease
  • myocarditis
  • cardiac arrhythmias
  • cardiac masses

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Published Papers (8 papers)

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Research

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11 pages, 1631 KiB  
Article
Visceral Obesity and Its Association with Severe Coronary Artery Calcification in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease
by Min Kyu Kang, Jeung Eun Song, Young Oh Kweon, Won Young Tak, Soo Young Park, Yu Rim Lee and Jung Gil Park
Diagnostics 2024, 14(20), 2305; https://doi.org/10.3390/diagnostics14202305 - 17 Oct 2024
Viewed by 440
Abstract
Background/Objectives: The role of body composition parameters in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) with presence and severity of coronary artery calcification (CAC) is still not fully elucidated. We aimed to evaluate the impact of computed tomography (CT)-based body composition [...] Read more.
Background/Objectives: The role of body composition parameters in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) with presence and severity of coronary artery calcification (CAC) is still not fully elucidated. We aimed to evaluate the impact of computed tomography (CT)-based body composition parameters in patients with MASLD with CAC severity. Methods: In this multicenter study, 1870 individuals underwent cardiac CT for the detection of CAC as well as ultrasonography for the diagnosis of hepatic steatosis. The presence of CAC was defined by a CAC score threshold of >0, while severe CAC was defined by a threshold of >300. Using the abdominal cross-sectional CT images at the L3 vertebra level, we analyzed the skeletal muscle index, visceral to subcutaneous adipose tissue ratio, and muscle density using the Hounsfield unit. Results: Of 648 patients with MASLD, the proportions of presence of CAC and severe CAC were 45.2% and 9.9%, respectively. Visceral obesity was not associated with the presence of CAC after adjustment for age, sex, smoking, statin therapy, type 2 diabetes, and advanced fibrosis (adjusted odds ratio (aOR), 1.38; 95% confidence interval (CI), 0.86–2.23; p = 0.180). However, visceral obesity was independently associated with severe CAC after adjustment for several metabolic risk factors (aOR, 3.54; 95% CI, 1.25–14.90; p = 0.039), and adjustment for atherosclerotic cardiovascular disease risk scores (aOR, 3.74; 95% CI, 1.31–15.79; p = 0.032). Conclusions: Visceral obesity may serve as a novel prognostic CT-based radiological biomarker for patients with MASLD with severe CAC. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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15 pages, 1957 KiB  
Article
Distal Transradial Access Optimization: A Prospective Trial of Ultrasound-Guided Radial Artery Characterization for the Anatomical Snuffbox
by Łukasz Koziński, Zbigniew Orzałkiewicz, Paweł Zagożdżon and Alicja Dąbrowska-Kugacka
Diagnostics 2024, 14(18), 2081; https://doi.org/10.3390/diagnostics14182081 - 20 Sep 2024
Viewed by 963
Abstract
Background/Objectives: The distal transradial approach (dTRA) is increasingly used in interventional cardiology. Doppler Ultrasound (DUS) effectively assesses radial artery (RA) characteristics. This study aims to identify specific RA DUS characteristics in patients undergoing coronary procedures via dTRA. Methods: Participants from the ANTARES [...] Read more.
Background/Objectives: The distal transradial approach (dTRA) is increasingly used in interventional cardiology. Doppler Ultrasound (DUS) effectively assesses radial artery (RA) characteristics. This study aims to identify specific RA DUS characteristics in patients undergoing coronary procedures via dTRA. Methods: Participants from the ANTARES trial who completed the intervention per-protocol and retained RA patency were included. DUS was performed at baseline, 1 day, and 60 days post-procedure. Results: Among 400 participants, 348 had either dTRA (n = 169) or conventional transradial access (cTRA) (n = 179). Distal RA lumen diameter was 12% smaller than that of the proximal RA (p < 0.001). Men had a 14% larger distal RA diameter than women (2.33 ± 0.31 mm vs. 2.04 ± 0.27 mm, p < 0.0001), similar to the proximal RA relationship. Peak flow velocities were similar between the sexes. Univariate linear regression showed that height, weight, body mass index, and body surface area (BSA) predicted arterial size, with BSA remaining significant in multivariate analysis (beta coefficient 0.62; confidence interval 0.49–0.75; p < 0.0001). Distal RA diameter correlated positively with palpable pulse at the snuffbox and wrist. The dTRA resulted in an immediate 14% and 11% increase in distal and proximal RA diameter, respectively (both p < 0.05). Sixty days after dTRA, the distal RA remained slightly dilated (p < 0.05), while the proximal RA returned to baseline. Conclusions: Distal RA diameter is significantly associated with sex, measuring smaller than the forearm segment. A strong palpable pulse correlates with larger distal RA size. The dTRA induces RA lumen expansion. A thorough understanding of distal RA anatomy is essential for optimizing patient selection and refining techniques for transradial procedures. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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13 pages, 6137 KiB  
Article
The Effect of Severe Coronary Calcification on Diagnostic Performance of Computed Tomography-Derived Fractional Flow Reserve Analyses in People with Coronary Artery Disease
by Iva Žuža, Tin Nadarević, Tomislav Jakljević, Nina Bartolović and Slavica Kovačić
Diagnostics 2024, 14(16), 1738; https://doi.org/10.3390/diagnostics14161738 - 10 Aug 2024
Viewed by 823
Abstract
Background: Negative CCTA can effectively exclude significant CAD, eliminating the need for further noninvasive or invasive testing. However, in the presence of severe CAD, the accuracy declines, thus necessitating additional testing. The aim of our study was to evaluate the diagnostic performance of [...] Read more.
Background: Negative CCTA can effectively exclude significant CAD, eliminating the need for further noninvasive or invasive testing. However, in the presence of severe CAD, the accuracy declines, thus necessitating additional testing. The aim of our study was to evaluate the diagnostic performance of noninvasive cFFR derived from CCTA, compared to ICA in detecting hemodynamically significant stenoses in participants with high CAC scores (>400). Methods: This study included 37 participants suspected of having CAD who underwent CCTA and ICA. CAC was calculated and cFFR analyses were performed using an on-site machine learning-based algorithm. Diagnostic accuracy parameters of CCTA and cFFR were calculated on a per-vessel level. Results: The median total CAC score was 870, with an IQR of 642–1370. Regarding CCTA, sensitivity and specificity for RCA were 60% and 67% with an AUC of 0.639; a LAD of 87% and 50% with an AUC of 0.688; an LCX of 33% and 90% with an AUC of 0.617, respectively. Regarding cFFR, sensitivity and specificity for RCA were 60% and 61% with an AUC of 0.606; a LAD of 75% and 54% with an AUC of 0.647; an LCX of 50% and 77% with an AUC of 0.647. No significant differences between AUCs of coronary CTA and cFFR for each vessel were found. Conclusions: Our results showed poor diagnostic accuracy of CCTA and cFFR in determining significant ischemia-related lesions in participants with high CAC scores when compared to ICA. Based on our results and study limitations we cannot exclude cFFR as a method for determining significant stenoses in people with high CAC. A key issue is accurate and detailed lumen segmentation based on good-quality CCTA images. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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Review

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23 pages, 2238 KiB  
Review
Novel Insights into Non-Invasive Diagnostic Techniques for Cardiac Amyloidosis: A Critical Review
by Marco Maria Dicorato, Paolo Basile, Giuseppe Muscogiuri, Maria Cristina Carella, Maria Ludovica Naccarati, Ilaria Dentamaro, Marco Guglielmo, Andrea Baggiano, Saima Mushtaq, Laura Fusini, Gianluca Pontone, Cinzia Forleo, Marco Matteo Ciccone and Andrea Igoren Guaricci
Diagnostics 2024, 14(19), 2249; https://doi.org/10.3390/diagnostics14192249 - 9 Oct 2024
Viewed by 913
Abstract
Cardiac amyloidosis (CA) is a cardiac storage disease caused by the progressive extracellular deposition of misfolded proteins in the myocardium. Despite the increasing interest in this pathology, it remains an underdiagnosed condition. Non-invasive diagnostic techniques play a central role in the suspicion and [...] Read more.
Cardiac amyloidosis (CA) is a cardiac storage disease caused by the progressive extracellular deposition of misfolded proteins in the myocardium. Despite the increasing interest in this pathology, it remains an underdiagnosed condition. Non-invasive diagnostic techniques play a central role in the suspicion and detection of CA, also thanks to the continuous scientific and technological advances in these tools. The 12-lead electrocardiography is an inexpensive and reproducible test with a diagnostic accuracy that, in some cases, exceeds that of imaging techniques, as recent studies have shown. Echocardiography is the first-line imaging modality, although none of its parameters are pathognomonic. According to the 2023 ESC Guidelines, a left ventricular wall thickness ≥ 12 mm is mandatory for the suspicion of CA, making this technique crucial. Cardiac magnetic resonance provides high-resolution images associated with tissue characterization. The use of contrast and non-contrast sequences enhances the diagnostic power of this imaging modality. Nuclear imaging techniques, including bone scintigraphy and positron emission tomography, allow the detection of amyloid deposition in the heart, and their role is also central in assessing the prognosis and response to therapy. The role of computed tomography was recently evaluated by several studies, above in population affected by aortic stenosis undergoing transcatheter aortic valve replacement, with promising results. Finally, machine learning and artificial intelligence-derived algorithms are gaining ground in this scenario and provide the basis for future research. Understanding the new insights into non-invasive diagnostic techniques is critical to better diagnose and manage patients with CA and improve their survival. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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22 pages, 5877 KiB  
Review
Cardiovascular Aging and Risk Assessment: How Multimodality Imaging Can Help
by Maja Hrabak Paar, Miroslav Muršić, Jens Bremerich and Tobias Heye
Diagnostics 2024, 14(17), 1947; https://doi.org/10.3390/diagnostics14171947 - 3 Sep 2024
Viewed by 632
Abstract
Aging affects the cardiovascular system, and this process may be accelerated in individuals with cardiovascular risk factors. The main vascular changes include arterial wall thickening, calcification, and stiffening, together with aortic dilatation and elongation. With aging, we can observe left ventricular hypertrophy with [...] Read more.
Aging affects the cardiovascular system, and this process may be accelerated in individuals with cardiovascular risk factors. The main vascular changes include arterial wall thickening, calcification, and stiffening, together with aortic dilatation and elongation. With aging, we can observe left ventricular hypertrophy with myocardial fibrosis and left atrial dilatation. These changes may lead to heart failure and atrial fibrillation. Using multimodality imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging, it is possible to detect these changes. Additionally, multimodality imaging, mainly via CT measurements of coronary artery calcium or ultrasound carotid intima-media thickness, enables advanced cardiovascular risk stratification and helps in decision-making about preventive strategies. The focus of this manuscript is to briefly review cardiovascular changes that occur with aging, as well as to describe how multimodality imaging may be used for the assessment of these changes and risk stratification of asymptomatic individuals. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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20 pages, 12662 KiB  
Review
Free-Running Cardiac and Respiratory Motion-Resolved Imaging: A Paradigm Shift for Managing Motion in Cardiac MRI?
by Robert J. Holtackers and Matthias Stuber
Diagnostics 2024, 14(17), 1946; https://doi.org/10.3390/diagnostics14171946 - 3 Sep 2024
Viewed by 754
Abstract
Cardiac magnetic resonance imaging (MRI) is widely used for non-invasive assessment of cardiac morphology, function, and tissue characteristics due to its exquisite soft-tissue contrast. However, it remains time-consuming and requires proficiency, making it costly and limiting its widespread use. Traditional cardiac MRI is [...] Read more.
Cardiac magnetic resonance imaging (MRI) is widely used for non-invasive assessment of cardiac morphology, function, and tissue characteristics due to its exquisite soft-tissue contrast. However, it remains time-consuming and requires proficiency, making it costly and limiting its widespread use. Traditional cardiac MRI is inefficient as signal acquisition is often limited to specific cardiac phases and requires complex view planning, parameter adjustments, and management of both respiratory and cardiac motion. Recent efforts have aimed to make cardiac MRI more efficient and accessible. Among these innovations, the free-running framework enables 5D whole-heart imaging without the need for an electrocardiogram signal, respiratory breath-holding, or complex planning. It uses a fully self-gated approach to extract cardiac and respiratory signals directly from the acquired image data, allowing for more efficient coverage in time and space without the need for electrocardiogram gating, triggering, navigators, or breath-holds. This review provides a comprehensive overview of the free-running framework, detailing its history, concepts, recent improvements, and clinical applications. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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25 pages, 1295 KiB  
Review
Computed Tomography Angiography Identified High-Risk Coronary Plaques: From Diagnosis to Prognosis and Future Management
by Kyriakos Dimitriadis, Nikolaos Pyrpyris, Panagiotis Theofilis, Emmanouil Mantzouranis, Eirini Beneki, Panagiotis Kostakis, George Koutsopoulos, Konstantinos Aznaouridis, Konstantina Aggeli and Konstantinos Tsioufis
Diagnostics 2024, 14(15), 1671; https://doi.org/10.3390/diagnostics14151671 - 1 Aug 2024
Viewed by 1052
Abstract
CT angiography has become, in recent years, a main evaluating modality for patients with coronary artery disease (CAD). Recent advancements in the field have allowed us to identity not only the presence of obstructive disease but also the characteristics of identified lesions. High-risk [...] Read more.
CT angiography has become, in recent years, a main evaluating modality for patients with coronary artery disease (CAD). Recent advancements in the field have allowed us to identity not only the presence of obstructive disease but also the characteristics of identified lesions. High-risk coronary atherosclerotic plaques are identified in CT angiographies via a number of specific characteristics and may provide prognostic and therapeutic implications, aiming to prevent future ischemic events via optimizing medical treatment or providing coronary interventions. In light of new evidence evaluating the safety and efficacy of intervening in high-risk plaques, even in non-flow-limiting disease, we aim to provide a comprehensive review of the diagnostic algorithms and implications of plaque vulnerability in CT angiography, identify any differences with invasive imaging, analyze prognostic factors and potential future therapeutic options in such patients, as well as discuss new frontiers, including intervening in non-flow-limiting stenoses and the role of CT angiography in patient stratification. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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21 pages, 5736 KiB  
Review
Imaging in Infective Endocarditis—Current Opinions and Trends in Cardiac Computed Tomography
by Ana Petkovic, Nemanja Menkovic, Olga Petrovic, Ilija Bilbija, Miodrag Nisevic, Nikola N. Radovanovic, Dejana Stanisavljevic, Svetozar Putnik, Ruzica Maksimovic and Branislava Ivanovic
Diagnostics 2024, 14(13), 1355; https://doi.org/10.3390/diagnostics14131355 - 26 Jun 2024
Cited by 1 | Viewed by 2309
Abstract
Infective endocarditis is a rare disease with an increasing incidence and an unaltered high mortality rate, despite medical development. Imaging plays an integrative part in the diagnosis of infective endocarditis, with echocardiography as the initial diagnostic test. Research data in the utility of [...] Read more.
Infective endocarditis is a rare disease with an increasing incidence and an unaltered high mortality rate, despite medical development. Imaging plays an integrative part in the diagnosis of infective endocarditis, with echocardiography as the initial diagnostic test. Research data in the utility of cardiac computed tomography (CCT) in the diagnostic algorithm of IE are rising, which indicates its importance in detection of IE-related lesion along with the exclusion of coronary artery disease. The latest 2023 European Society of Cardiology Guidelines in the management of IE classified CCT as class of recommendation I and level of evidence B in detection of both valvular and paravalvular lesions in native and prosthetic valve endocarditis. This review article provides a comprehensive and contemporary review of the role of CCT in the diagnosis of IE, the optimization of acquisition protocols, the morphology characteristics of IE-related lesions, the published data of the diagnostic performance of CCT in comparison to echocardiography as the state-of-art method, as well as the limitations and future possibilities. Full article
(This article belongs to the Special Issue New Trends and Advances in Cardiac Imaging)
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