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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 17683

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Dr. Andreas A. Kammerlander

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Guest Editor

1. Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
2. The Division of Cardiology, Medical University of Vienna, Wien, Austria
Interests: amyloidosis; aortic valve; cardiac imaging techniques; coronary artery disease; fibrosis; heart failure; magnetic resonance imaging; metabolic health; mitral valve; multidetector computed tomography; myocardial infarction; tricuspid valve
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Special Issue Information

Dear Colleagues,

The field of cardiovascular imaging is evolving at an unprecedented pace. Over the last few years, we have seen significant advances across echocardiography, magnetic resonance imaging, computed tomography, and nuclear imaging. Much effort has been put into increasing safety for the patient, diagnostic accuracy, and decreasing the work burden for clinicians.

With an increasing financial burden caused by multimodality imaging and further downstream testing, cost-effectiveness for health care systems is becoming more and more important in the field of cardiovascular imaging.

It is my honour and pleasure to invite you to contribute to this Special Issue on “Recent Advances in Cardiovascular Imaging”. The Journal invites submissions on all imaging modalities that focus on diagnostic accuracy, risk prediction, cost-effectiveness and change of clinical practice based on cardiovascular imaging. Papers in the field of machine learning may be eligible for submission only if they have a dedicated clinical focus.

Please note that since 2019, we no longer accept preclinical studies using animal models and case reports unless specifically invited by the Editorial Office.

We look forward to receiving your submissions.

Dr. Andreas A. Kammerlander
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Cardiovascular imaging
Echocardiography
Magnetic resonance imaging
Computed tomography
Heart failure
Coronary artery disease
Cost effectiveness
Multimodality imaging
Inflammation
Vascular biology
Fibrosis
Fractional flow reserve
Parametric mapping
T1 mapping
T2 mapping
Myocarditis
Plaque
Coronary artery calcification
Outcomes
Angiography

Published Papers (8 papers)

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Research

11 pages, 1092 KiB

Open AccessArticle

Heart Rate-Dependent Degree of Motion Artifacts in Coronary CT Angiography Acquired by a Novel Purpose-Built Cardiac CT Scanner

by Milán Vecsey-Nagy, Ádám Levente Jermendy, Márton Kolossváry, Borbála Vattay, Melinda Boussoussou, Ferenc Imre Suhai, Alexisz Panajotu, Judit Csőre, Sarolta Borzsák, Daniele Mariastefano Fontanini, Csaba Csobay-Novák, Béla Merkely, Pál Maurovich-Horvat and Bálint Szilveszter

J. Clin. Med. 2022, 11(15), 4336; https://doi.org/10.3390/jcm11154336 - 26 Jul 2022

Cited by 3 | Viewed by 2459

Abstract

Although reaching target heart rate (HR) before coronary CT angiography (CCTA) is still of importance, adequate HR control remains a challenge for many patients. Purpose-built cardiac scanners may provide optimal image quality at higher HRs by further improving temporal resolution. We aimed to compare the amount of motion artifacts on CCTA acquired using a dedicated cardiac CT (DCCT) compared to a conventional multidetector CT (MDCT) scanner. We compared 80 DCCT images to 80 MDCT scans matched by sex, age, HR, and coronary dominance. Image quality was graded on a per-patient, per-vessel and per-segment basis. Motion artifacts were assessed using Likert scores (1: non-diagnostic, 2: severe artifacts, 3: mild artifacts, 4: no artifacts). Patients were stratified into four groups according to HR (<60/min, 60–65/min, 66–70/min and >70/min). Overall, 2328 coronary segments were evaluated. DCCT demonstrated superior overall image quality compared to MDCT (3.7 ± 0.4 vs. 3.3 ± 0.7, p < 0.001). DCCT images yielded higher Likert scores in all HR ranges, which was statistically significant in the 60–65/min, 66–70/min and >70/min ranges (3.9 ± 0.2 vs. 3.7 ± 0.2, p = 0.008; 3.5 ± 0.5 vs. 3.1 ± 0.6, p = 0.048 and 3.5 ± 0.4 vs. 2.7 ± 0.7, p < 0.001, respectively). Using a dedicated cardiac scanner results in fewer motion artifacts, which may allow optimal image quality even in cases of high HRs. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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10 pages, 1109 KiB

Open AccessArticle

Global and Regional Myocardial Work in Female Adolescents with Weight Disorders

by Justine Paysal, Etienne Merlin, Emmanuelle Rochette, Daniel Terral and Stéphane Nottin

J. Clin. Med. 2021, 10(20), 4671; https://doi.org/10.3390/jcm10204671 - 12 Oct 2021

Cited by 1 | Viewed by 1485

Abstract

Background: Anorexia nervosa (AN) and obesity (OB) lead to changes in SBP (i.e., loading conditions) that may affect left ventricular (LV) myocardial work (MW). The novel concept of LV pressure-strain loops allows non-invasive estimation of MW, this latter being correlated with cardiac energy metabolism. In addition, the study of regional MW can detect subtle alterations in cardiac function by highlighting an abnormal distribution of MW. Objective: The aim of this study was to assess the cardiac function of AN and OB patients by evaluating global and regional LV strains and MW. Methods: Eighty-seven female adolescents, comprising 26 with AN (14.6 ± 1.9 yrs. old), 28 with OB (13.2 ± 1.4 yrs. old), and 33 controls (14.0 ± 2.0 yrs. old) underwent speckle-tracking echography to assess global and regional LV strains and MW. Results: SBP was higher in adolescents with obesity than in AN patients or controls. Global MW was similar between groups. In AN patients and controls, longitudinal strains were higher at the apex than at the base of the LV, whereas they were similar in obesity patients, owing to a decrease in their apical longitudinal strain. Consequently, their MW was higher at the basal level than either of the other two groups (1854 ± 272 vs. 1501 ± 280 vs. 1575 ± 295 mmHg% in OB patients, AN patients, and controls, respectively. Conclusion: Despite altered SBP, the global MW of adolescents with weight disorders was unaffected. However, in adolescents with obesity, the distribution of their regional LV MW was altered, which might reflect specific regional remodeling. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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13 pages, 882 KiB

Open AccessArticle

Prognostic Value of Computed Tomographic Coronary Angiography for Long-Term Major Adverse Cardiac Events after Liver Transplantation

by Doo-Hwan Kim, Young-Kug Kim, Tae-Yong Ha, Shin Hwang, Wooil Kim, Hyun-Jung Koo, Dong-Hyun Yang, Joon-Won Kang and Sung-Gyu Lee

J. Clin. Med. 2021, 10(14), 3132; https://doi.org/10.3390/jcm10143132 - 15 Jul 2021

Cited by 3 | Viewed by 1731

Abstract

Computed tomographic coronary angiography (CTCA) has prognostic value for early major adverse cardiac events (MACEs) after liver transplantation. However, the association between CTCA and long-term MACEs in liver transplant (LT) recipients remains unknown. We evaluated the association between CTCA and long-term MACEs within 5 years after living donor liver transplantation (LDLT). A total of 628 LDLT recipients who underwent CTCA were analyzed between 2010 and 2012. MACEs were investigated within 5 years after LDLT. The factors associated with long-term MACEs in transplant recipients were evaluated. Only 48 (7.6%) patients developed MACEs. In the Fine and Gray competing risk regression, a coronary artery calcium score (CACS) of >400 combined with obstructive coronary artery disease (CAD) (subdistribution hazard ratio: 5.01, 95% confidence interval: 2.37–10.58, p < 0.001), age (1.05, 1.01–1.10, p = 0.018), diabetes mellitus (2.43, 1.37–4.29, p = 0.002), dyslipidemia (2.45, 1.23–4.70, p = 0.023), and creatinine (1.19, 1.08–1.30, p < 0.001) were independently associated with long-term MACEs. CACS (>400) combined with obstructive CAD may be associated with MACEs within 5 years after LDLT, suggesting the importance of preoperative noninvasive CTCA in LT recipients. The evaluation of coronary artery stenosis on CTCA combined with CACS may have a prognostic value for long-term MACEs in LT recipients. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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11 pages, 4220 KiB

Open AccessArticle

Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

by Matthias Schneider, Varius Dannenberg, Andreas König, Welf Geller, Thomas Binder, Christian Hengstenberg and Georg Goliasch

J. Clin. Med. 2021, 10(11), 2266; https://doi.org/10.3390/jcm10112266 - 24 May 2021

Cited by 4 | Viewed by 1585

Abstract

Background: Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF. Methods: A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested. Results: The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52–79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15–22) and median FAC was 42% (30–52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396–1.421, p = 0.38) and 0.845 (95%CI 0.383–1.867, p = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296–0.886, p = 0.017) and 1.631 (95%CI 1.101–2.416, p = 0.015), respectively. Conclusions: This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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14 pages, 18185 KiB

Open AccessArticle

The Holistic Coronary Physiology Display: Calculation of the Flow Separation Index in Vessel-Specific Individual Flow Range during Fractional Flow Reserve Measurement Using 3D Coronary Reconstruction

by Gábor Tamás Szabó, Áron Üveges, Balázs Tar, András Ágoston, Azzaya Dorj, Csaba Jenei, Rudolf Kolozsvári, Benjamin Csippa, Dániel Czuriga and Zsolt Kőszegi

J. Clin. Med. 2021, 10(9), 1910; https://doi.org/10.3390/jcm10091910 - 28 Apr 2021

Cited by 7 | Viewed by 2380

Abstract

In order to make optimal decisions on the treatment of atherosclerotic coronary heart disease (CHD), appropriate evaluation is necessary, including both the anatomical and physiological assessment of the coronary arteries. According to current guidelines, a fractional flow reserve (FFR)–based clinical decision is recommended, but coronary flow reserve (CFR) measurements and microvascular evaluation should also be considered in special cases for a detailed exploration of the coronary disease state. We aimed to generate an extended physiological evaluation during routine FFR measurement and define a new pathological flow–related prognostic factor. Fluid dynamic equations were applied to calculate CFR on the basis of the three-dimensional (3D) reconstruction of the invasively acquired coronary angiogram and the measured intracoronary pressure data. A new, potentially robust prognostic parameter of a coronary lesion called the “flow separation index” (FS_i), which is thought to detect the pathological flow amount through a stenosis was introduced in a vessel-specific flow range. Correlations between FS_i and the clinically established physiological indices (CFR and FFR) were determined. The FS_i was calculated in 19 vessels of 16 patients, including data from the pre- and post-stent revascularization treatment of 3 patients. There was no significant correlation between the FS_i and the CFR (r = −0.23, p = 0.34); however, there was significant negative correlation between the FS_i and the FFR (r = −0.66, p = 0.002). An even stronger correlation was found between the FS_i and the ratio of the resting pressure ratio and the FFR (r = 0.92, p < 0.0001). The diagnostic power of the FS_i for predicting the FFR value of <0.80, as a gold standard prognostic factor, was tested by receiver operating characteristic analysis. FS_i > 0.022 proved to be the cutoff value of the prediction of a pathologically low FFR with a 0.856 area under the curve (95% confidence interval: 0.620 to 0.972). The present flow–pressure–velocity display provides a comprehensive summary of patient-specific pathophysiology in CHD. The consequences of epicardial stenoses can be evaluated together with their complex relations to microvascular conditions. Based on these values, clinical decision-making concerning both pharmacological therapy and percutaneous or surgical revascularization may be more precisely guided. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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11 pages, 919 KiB

Open AccessArticle

Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings

by Jorge Rodríguez-Capitán, Andrés Sánchez-Pérez, Sara Ballesteros-Pradas, Mercedes Millán-Gómez, Rosa Cardenal-Piris, Manuel Oneto-Fernández, Lola Gutiérrez-Alonso, Ricardo Rivera-López, Agustín Guisado-Rasco, Macarena Cano-García, Mario Gutiérrez-Bedmar and Manuel Jiménez-Navarro

J. Clin. Med. 2021, 10(9), 1863; https://doi.org/10.3390/jcm10091863 - 25 Apr 2021

Cited by 4 | Viewed by 2201

Abstract

The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20–50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23–2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40–3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10–2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25–3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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14 pages, 1031 KiB

Open AccessArticle

Sex Differences in Left Ventricular Remodeling and Outcomes in Chronic Aortic Regurgitation

by Andreas A. Kammerlander, Carolina Donà, Christian Nitsche, Matthias Koschutnik, Amna Zafar, Parastou Eslami, Franz Duca, Stefan Aschauer, Robert Schönbauer, Dietrich Beitzke, Christian Loewe, Udo Hoffmann, Cathérine Gebhard, Christian Hengstenberg and Julia Mascherbauer

J. Clin. Med. 2020, 9(12), 4100; https://doi.org/10.3390/jcm9124100 - 18 Dec 2020

Cited by 9 | Viewed by 2231

Abstract

Background: Left ventricular (LV) dilatation is a key compensatory feature in patients with chronic aortic regurgitation (AR). However, sex-differences in LV remodeling and outcomes in chronic AR have been poorly investigated so far. Methods: We performed cardiovascular magnetic resonance imaging (CMR) including phase-contrast velocity-encoded imaging for the measurement of regurgitant fraction (RegF) at the sinotubular junction, in consecutive patients with at least mild AR on echocardiography. We assessed LV size (end-diastolic volume indexed to body surface area, LVEDV/BSA) and investigated sex differences between LV remodeling and increasing degrees of AR severity. Cox-regression models were used to test differences in outcomes between men and women using a composite of heart failure hospitalization, unscheduled AR intervention, and cardiovascular death. Results: 270 consecutive patients (59.6% male, 59.8 ± 20.8 y/o, 59.6% with at least moderate AR on echocardiography) were included. On CMR, mean RegF was 18.1 ± 17.9% and a total of 65 (24.1%) had a RegF ≥ 30%. LVEDV/BSA was markedly closer related with AR severity (RegF) in men compared to women. Each 1-SD increase in LVEDV/BSA (mL/m²) was associated with a 9.7% increase in RegF in men and 5.9% in women, respectively (p-value for sex-interaction < 0.001). Based on previously published reference values, women—in contrast to men—frequently had a normal LV size despite severe AR (e.g., for LVEDV/BSA on CMR: 35.3% versus 8.7%, p < 0.001). In a Cox-regression model adjusted for age, LVEDV/BSA and RegF, women were at significantly higher risk for the composite endpoint when compared to men (adj. HR 1.81 (95%CI 1.09–3.03), p = 0.022). Conclusion: In patients with chronic AR, LV remodeling is a hallmark feature in men but not in women. Severity of AR may be underdiagnosed in female patients in the absence of LV dilatation. Future studies need to address the dismal prognosis in female patients with chronic AR. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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14 pages, 1327 KiB

Open AccessArticle

Guideline-Based Statin Eligibility, Coronary Artery Stenosis and Cardiovascular Events in Patients with Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial

by Amit Pursnani, Jana Taron, Thomas Mayrhofer, Michael T. Lu, Maros Ferencik, Joseph A. Ladapo, Pamela S. Douglas and Udo Hoffmann

J. Clin. Med. 2020, 9(10), 3076; https://doi.org/10.3390/jcm9103076 - 24 Sep 2020

Cited by 2 | Viewed by 2499

Abstract

Background: Recommendations for preventive statin treatment in patients with stable chest pain may be difficult as symptoms can be unspecific. It is unclear if coronary CT angiography (CTA)-detected coronary artery disease (CAD) can optimize statin prescription. Methods: In stable chest pain patients randomized to CTA in the PROMISE trial, statin eligibility was defined per 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Primary outcome was a composite of death, myocardial infarction or unstable angina over 26 months median follow-up. Hazard ratios (HR) of non-obstructive (1–69% stenosis) and obstructive (≥70% stenosis) CAD for events were determined using Cox proportional hazard models. Calculated HR were then incorporated into the ACC/AHA pooled cohort equation (PCE) to revised ASCVD risk and assess re-classification of statin eligibility. Results: Among 3986 patients (60.5 ± 8.2 years; 51% female), 72.9% (2904/3986) were statin eligible. Event rates in statin-eligible vs. ineligible patients were 3.3% vs. 2.3% (HR = 1.4 (95% CI 0.9–2.2), p = 0.142). Although the proportion of statin-eligible patients increased with CAD severity, 54% without CAD were statin eligible. Incorporating information on CAD into PCE reclassified 12.7% of patients (1.3% towards statin, 11.4% towards no statin). Similar results were found in stratified analysis of statin naïve patients (reclassification of 13.9%, 1.0% towards statin, and 12.9% towards no statin). As a result, revised ASCVD risk improved model discrimination in all patients (c-statistic: 0.59 (95 %CI 0.55–0.62) vs. 0.52 (95 %CI 0.49–0.56); p 0.001), while reducing statin use by 10.1% (62.7% vs. 72.9% statin eligible, p 0.001). Conclusion: In stable chest pain patients, integration of CAD into guideline recommendations was associated with greater accuracy to reclassify those at increased risk for incident events and a more efficient use of statins. Full article

(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging)

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