Extended Reality and Its Applications in Cardiovascular Medicine

1. Introduction

Medical imaging is central to the diagnosis of cardiovascular disease. Cardiac computed tomography (CT), magnetic resonance imaging (MRI), and echocardiography remain the most widely used modalities in clinical practice. These techniques provide two-dimensional (2D) and three-dimensional (3D) visualizations that meet most clinical needs for diagnosis, surgical planning, and patient follow-up. However, given the complexity of cardiovascular anatomy and anomaly, conventional 2D and 3D reconstructions are limited in that they present only flat images rather than realistic 3D representations of the spatial relationship between anatomical structures and disease. This limitation has driven growing interest in innovative 3D technologies to aid in diagnosis and patient management, with 3D printing and extended reality (XR) emerging as particularly promising tools.

Three-dimensional printing has seen increasing adoption in cardiovascular medicine, with numerous studies demonstrating its clear advantages for medical education, presurgical planning, simulation of cardiac procedures, and patient communication [1,2,3,4,5,6,7,8,9,10]. Personalized 3D-printed models accurately replicate anatomy and pathology while offering a tactile, hands-on experience that traditional teaching or learning methods cannot provide, thereby contributing significantly to improved diagnosis and patient care. Another rapidly developing 3D visualization technology is XR, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR). VR offers a fully immersive 3D environment, AR overlays virtual objects onto the physical world, and MR integrates elements of both (Figure 1) [11,12,13].

Among XR technologies, VR is currently the most widely applied in medicine, including cardiovascular care, whereas AR and MR remain emerging tools with relatively few studies. Until recently, no detailed review had examined XR applications specifically in cardiology, a gap addressed by a recent systematic review [14]. This review provides the most comprehensive analysis of XR in cardiovascular disease to date.

Kanschik et al. conducted a systematic search of PubMed and Web of Science for studies published up to 31 July 2024 that reported XR applications in cardiovascular medicine [14]. Eligible publications included randomized controlled trials (RCTs), prospective and retrospective observational studies, case series, and case reports. Articles in English and German were considered, and two reviewers extracted data on the use of VR, AR, or MR across cardiology domains—including education, surgical planning, training, and patient care in both adults and children. In total, 164 studies met the inclusion criteria (Figure 2). Nearly 50% (78 studies) of the studies evaluated XR for preprocedural planning, while 36 and 31 studies focused on training and education, respectively. A further 19 studies explored XR in cardiac rehabilitation. The following section summarizes the key findings of this systematic review, with emphasis on both its strengths and limitations.

2. Review of the Key Findings of the Systematic Review

Three key observations from the review by Kanschik et al. merit discussion. First, this review is the most comprehensive assessment of XR in cardiology or cardiovascular medicine to date. While three earlier systematic reviews or meta-analyses addressed XR in cardiovascular surgery or patient care, they analyzed only 22, 21, and 50 studies, respectively, each with a narrower focus [15,16,17]. In contrast, Kanschik et al. reviewed 164 studies spanning diverse cardiovascular domains (Figure 2). Their synthesis of the latest evidence makes an important contribution to the literature and serves as a valuable reference for understanding the current status of XR in cardiovascular medicine.

Second, the authors categorized XR applications into eight areas: valvular heart disease (23 studies), non-valvular structural heart disease (12 studies), congenital heart disease (28 studies), cardiac catheterization (35 studies), general training, patient education and heart failure (19 studies), electrophysiology (19 studies), cardiac resynchronization and devices (9 studies), and cardiac rehabilitation (19 studies). They highlighted the key findings related to the use of XR, focusing on results across different cardiology categories based on RCTs, observational studies, and case reports. Furthermore, the authors identified limitations and suggested directions for future research in these areas. A lack of robust study design remains a concern—particularly in the planning and performance of cardiovascular surgical procedures—as nearly half of the studies (46%) were case reports or case series (Figure 2).

Finally, although comprehensive, the review could have emphasized more strongly that most current XR applications rely on VR, with relatively few studies using AR or MR. As XR encompasses VR, AR, and MR, this imbalance may obscure the limited evidence base for AR- and MR-guided interventions. Recent reports suggest promising applications of AR and MR in cardiovascular surgery [18,19,20,21], but larger studies with longer follow-up are needed to establish their clinical value.

3. Summary and Concluding Remarks

This Editorial summarizes the findings of a systematic review examining the role of extended reality in cardiovascular care, drawing on 164 published studies. The analysis underscores the considerable potential of XR technologies to transform cardiology— enhancing patient care, advancing medical education and training, and supporting preprocedural planning and simulation of complex interventions. With further technological advances and robust evidence from larger clinical trials, XR is poised to play an increasingly important role in cardiovascular medicine, ultimately benefiting patents worldwide.