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Diagnostics
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Advances in Non-Invasive Diagnostic Technologies for Heart Diseases
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Advances in Non-Invasive Diagnostic Technologies for Heart Diseases

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

Deadline for manuscript submissions: 31 December 2026 | Viewed by 5909

Editor

Dr. Dentamaro Ilaria

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Guest Editor
Cardiology Division, Miulli Hospital, 70021 Acquaviva delle Fonti, Italy
Interests: multimodal cardiac imaging; echocardiography; cardiac magnetic resonance
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues，

The use of non-invasive imaging techniques is undeniably one of the aspects that best characterize modern cardiology. With the implementation of percutaneous interventional procedures in the treatment of structural heart disease, and current advances in the management of chronic ischemic heart disease, metabolic storage diseases, and heart failure in clinical practice, imaging methods are required to provide increasingly sophisticated evaluation parameters, in order to adopt adequate therapeutic strategies and identify the patients best suited to undergo certain procedures. Therefore, clinicians in cardiac patient management cannot ignore the power of the complete and precise information provided by non-invasive diagnostic methods such as echocardiography, cardiac magnetic resonance imaging, cardiac CT, and nuclear cardiology, which can greatly facilitate correct diagnosis and adequate prognostic stratification.

With the expansion of imaging options and the paradigmatic shift to multimodality imaging, this Special Issue will explore and expand current research, to help identify areas of cardiovascular medicine where imaging can add value in improving diagnosis and the prediction of therapeutic benefits.

Dr. Dentamaro Ilaria
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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics 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

  • transthoracic echocardiography
  • cardiac magnetic resonance
  • multimodality cardiovascular imaging
  • cardiac CT
  • transesophageal echocardiography
  • cardiovascular disease

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Published Papers (5 papers)

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Research

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15 pages, 1490 KB  
Article
Epicardial Adipose Tissue CT Radiomics Improves Acute Coronary Syndrome Prediction Beyond Coronary Artery Calcium Score
by Eric Po-Yu Huang, Yi-Chun Chen, Ming-Ting Wu and Jyh-Cheng Chen
Diagnostics 2026, 16(9), 1270; https://doi.org/10.3390/diagnostics16091270 - 23 Apr 2026
Cited by 1 | Viewed by 566
Abstract
Objectives: To determine if global epicardial adipose tissue (EAT) radiomics, derived from non-contrast coronary artery calcium (CAC) scans, improves acute coronary syndrome (ACS) prediction beyond traditional risk factors (TRFs) and Agatston score (AS) in individuals without angina. Methods: We retrospectively analyzed 2020 [...] Read more.
Objectives: To determine if global epicardial adipose tissue (EAT) radiomics, derived from non-contrast coronary artery calcium (CAC) scans, improves acute coronary syndrome (ACS) prediction beyond traditional risk factors (TRFs) and Agatston score (AS) in individuals without angina. Methods: We retrospectively analyzed 2020 subjects without angina who underwent CAC scans from 2016 to 2019, among whom 76 patients developed acute coronary syndrome (ACS) during a follow-up period until December 2023. One-to-one propensity score matching (PSM) based on TRFs (age, sex, BMI, smoking, diabetes, hypertension, dyslipidemia) and Agatston score ranks (ASR) created 76 ACS and 76 matched non-ACS subjects. A radiomics model was built using 5-fold cross-validation on the matched cohort and tested on the entire unmatched cohort. Statistical tests included AUC comparison. Results: PSM effectively mitigated disparities of TRFs and ASR. The radiomics model achieved AUCs of 0.91 ± 0.01 and 0.89 ± 0.03 for the training and matched test sets, respectively, and 0.89 ± 0.03 on the unmatched cohort. The radiomics score significantly improved ACS prediction over TRF and CAC models (p < 0.001) in both matched and unmatched cohorts. Conclusions: Global EAT radiomic phenotypes from conventional CAC scan improve ACS risk stratification beyond TRFs and AS in individuals without angina. In contrast to PCAT on CCTA, our simple approach appears to be suitable for large-scale applications using preventative CAC scans. Full article
(This article belongs to the Special Issue Advances in Non-Invasive Diagnostic Technologies for Heart Diseases)
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Review

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30 pages, 2852 KB  
Review
Myocardial Function Assessment After Cardioversion in Persistent Atrial Fibrillation: Current Evidence and Future Directions
by Emma Sokolova, Ainārs Rudzītis and Oskars Kalējs
Diagnostics 2026, 16(16), 2548; https://doi.org/10.3390/diagnostics16162548 - 12 Aug 2026
Abstract
Background/Objectives: Persistent atrial fibrillation (AF) is associated with complex structural, electrical, and functional myocardial remodeling that contributes to impaired cardiac performance, symptom burden, and adverse cardiovascular outcomes. Although restoration of sinus rhythm through electrical cardioversion remains a cornerstone of rhythm-control therapy, treatment [...] Read more.
Background/Objectives: Persistent atrial fibrillation (AF) is associated with complex structural, electrical, and functional myocardial remodeling that contributes to impaired cardiac performance, symptom burden, and adverse cardiovascular outcomes. Although restoration of sinus rhythm through electrical cardioversion remains a cornerstone of rhythm-control therapy, treatment success is traditionally defined by rhythm maintenance and recurrence rates, while myocardial functional recovery receives substantially less attention. This review aims to summarize current evidence regarding myocardial dysfunction in persistent AF, evaluate available approaches for assessing myocardial recovery after cardioversion, and explore future directions for function-guided rhythm-control strategies. Methods: A narrative review of contemporary literature was performed, focusing on studies published in major cardiovascular journals and current international guidelines. Evidence regarding myocardial remodeling, reverse remodeling after restoration of sinus rhythm, echocardiographic assessment, myocardial strain imaging, biomarker dynamics, and post-cardioversion management strategies was synthesized and critically evaluated. Results: Persistent AF induces multidimensional myocardial dysfunction through tachycardia-mediated injury, structural remodeling, neurohormonal activation, inflammation, and fibrosis. Emerging evidence suggests that restoration of sinus rhythm may initiate a process of reverse remodeling characterized by improvements in left ventricular systolic function, global longitudinal strain, atrial mechanical performance, and biomarker profiles. Advanced echocardiographic techniques and serial biomarker assessment provide valuable opportunities to quantify myocardial recovery beyond conventional rhythm-based endpoints. However, current clinical practice and guideline-directed management remain predominantly focused on rhythm outcomes, while functional recovery is not routinely incorporated into therapeutic decision-making. Based on available evidence, a conceptual framework termed the “Post-Cardioversion Functional Window” is proposed to describe a period of potentially enhanced myocardial recovery during which systematic functional assessment may facilitate individualized management and future risk stratification. Conclusions: Myocardial recovery after restoration of sinus rhythm represents an underrecognized component of contemporary AF management. Integration of echocardiographic, biomarker-based, and clinical functional assessment may improve understanding of post-cardioversion remodeling and support the development of personalized rhythm-control strategies. Future prospective studies are needed to validate myocardial recovery endpoints and determine their role in guiding therapeutic decisions after cardioversion. Full article
(This article belongs to the Special Issue Advances in Non-Invasive Diagnostic Technologies for Heart Diseases)
21 pages, 2156 KB  
Review
Unmasking the Apex: Multimodality Imaging for the Evaluation of Left Ventricular Apical Obliteration
by Ilaria Dentamaro, Marco Maria Dicorato, Paolo Basile, Maria Cristina Carella, Francesco Mangini, Rita Musci, Roberta Ruggieri, Eduardo Urgesi, Laura Piscitelli, Sergio Dentamaro, Gianluca Pontone, Cinzia Forleo, Marco Matteo Ciccone and Andrea Igoren Guaricci
Diagnostics 2026, 16(2), 184; https://doi.org/10.3390/diagnostics16020184 - 7 Jan 2026
Cited by 1 | Viewed by 1452
Abstract
Left ventricular (LV) apical obliteration represents a convergent imaging phenotype arising from diverse cardiac conditions, including thrombotic, hypertrophic, infiltrative, congenital, and neoplastic diseases. These conditions, despite sharing overlapping morphological features, require profoundly different management strategies. In this context, an accurate characterization of the [...] Read more.
Left ventricular (LV) apical obliteration represents a convergent imaging phenotype arising from diverse cardiac conditions, including thrombotic, hypertrophic, infiltrative, congenital, and neoplastic diseases. These conditions, despite sharing overlapping morphological features, require profoundly different management strategies. In this context, an accurate characterization of the LV apex is a cornerstone point, and can be performed through various techniques. Advances in multimodality imaging have substantially improved diagnostic precision, allowing clinicians to differentiate true obliteration from mimicking conditions such as hypertrabeculation, apical hypertrophy, or subendocardial fibrosis. This review provides a comprehensive overview of the anatomical variability of the LV apex and its implications for imaging interpretation. We appraise the role of echocardiography, including contrast-enhanced and speckle-tracking studies—alongside cardiac magnetic resonance (CMR), computed tomography (CT), and selective nuclear imaging in the evaluation of apical pathology. For each principal cause of apical obliteration—LV thrombus, apical hypertrophic cardiomyopathy, left ventricular non-compaction, endomyocardial fibrosis, cardiac amyloidosis, and intracardiac tumors—we outline key diagnostic clues, imaging red flags, and distinguishing tissue characteristics. Special emphasis is given to the incremental value of CMR for tissue characterization, thrombus detection, and fibrosis mapping, as well as to the interpretative challenges posed by apical foreshortening, near-field artefacts, and suboptimal acoustic windows. A practical, stepwise imaging framework is proposed to guide clinicians through the differential diagnosis of apical obliteration using an integrated multimodality approach. Future directions include the incorporation of 4D flow, advanced mapping techniques, and artificial intelligence-powered analysis to refine apical phenotyping and identify early disease signatures. Recognizing the full spectrum of apical pathology and its imaging manifestations is essential to prevent misdiagnosis, enable timely therapeutic decisions, and improve risk stratification. Full article
(This article belongs to the Special Issue Advances in Non-Invasive Diagnostic Technologies for Heart Diseases)
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16 pages, 3803 KB  
Review
Multimodality Cardiovascular Imaging in Patients After Coronary Artery Bypass Grafting: Diagnosis and Risk Stratification
by Lucia La Mura, Annalisa Pasquini, Adriana D′Antonio, Eirini Beneki, Irfan Ullah, Ashot Avagimyan, Mahmoud Abdelnabi, Ramzi Ibrahim, Vikash Jaiswal and Francesco Perone
Diagnostics 2025, 15(24), 3224; https://doi.org/10.3390/diagnostics15243224 - 17 Dec 2025
Viewed by 1447
Abstract
Coronary artery bypass grafting (CABG) remains a cornerstone of treatment for patients with advanced or complex coronary artery disease, yet long-term success is influenced by graft patency, progression of native disease, and ventricular remodeling. Optimizing the follow-up of these patients requires a structured [...] Read more.
Coronary artery bypass grafting (CABG) remains a cornerstone of treatment for patients with advanced or complex coronary artery disease, yet long-term success is influenced by graft patency, progression of native disease, and ventricular remodeling. Optimizing the follow-up of these patients requires a structured approach in which multimodality cardiovascular imaging plays a central role. Echocardiography remains the first-line modality, providing readily available assessment of ventricular function, valvular competence, and wall motion, while advanced techniques, such as strain imaging and myocardial work, enhance sensitivity for subclinical dysfunction. Coronary computed tomography angiography (CCTA) offers excellent diagnostic accuracy for graft patency and native coronary anatomy, with emerging applications of CT perfusion and fractional flow reserve derived from CT (FFR-CT) expanding its ability to assess lesion-specific ischemia. Cardiovascular magnetic resonance (CMR) provides comprehensive tissue characterization, quantifying scar burden, viability, and inducible ischemia, and stress CMR protocols have demonstrated both safety and independent prognostic value in post-CABG cohorts. Nuclear imaging with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) remains essential for quantifying perfusion, viability, and absolute myocardial blood flow, with hybrid PET/CT approaches offering further refinement in patients with recurrent symptoms. In patients after CABG, multimodality imaging is tailored to the patient’s characteristics, symptoms, and pre-test probability of disease progression. In asymptomatic patients, imaging focuses on surveillance, risk stratification, and the early detection of subclinical abnormalities, whereas in symptomatic individuals, it focuses on establishing the diagnosis, defining prognosis, and guiding therapeutic interventions. Therefore, the aim of our review is to propose updated and comprehensive guidance on the crucial role of multimodality cardiovascular imaging in the evaluation and management of post-CABG patients and to provide a practical, evidence-based framework for optimizing outcomes. Full article
(This article belongs to the Special Issue Advances in Non-Invasive Diagnostic Technologies for Heart Diseases)
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24 pages, 13910 KB  
Review
Multimodality Imaging in Apical Hypertrophic Cardiomyopathy: Can Echocardiography Learn from Cardiac Magnetic Resonance?
by Francesco Mangini, Massimo Grimaldi, Francesco Spinelli, Santo Dellegrottaglie, Antonio Di Monaco, Simona Quarta, Grazia Casavecchia, Matteo Gravina, Vincenzo Bellomo, Luca Sgarra, Sergio Suma, Gaetano Citarelli, Enrica Filograna, Robert W. W. Biederman and Roberto Calbi
Diagnostics 2025, 15(23), 3013; https://doi.org/10.3390/diagnostics15233013 - 26 Nov 2025
Viewed by 1596
Abstract
Apical hypertrophic cardiomyopathy is a distinctive and often under-recognized variant of hypertrophic cardiomyopathy, characterized by predominant thickening of the apical segments of the left ventricle. Echocardiography and cardiac magnetic resonance imaging represent the two principal modalities for diagnosis and morphological assessment. While transthoracic [...] Read more.
Apical hypertrophic cardiomyopathy is a distinctive and often under-recognized variant of hypertrophic cardiomyopathy, characterized by predominant thickening of the apical segments of the left ventricle. Echocardiography and cardiac magnetic resonance imaging represent the two principal modalities for diagnosis and morphological assessment. While transthoracic echocardiography remains the first-line imaging technique, it may underestimate apical involvement, particularly when image foreshortening or poor endocardial/epicardial delineation occurs. Cardiac magnetic resonance has become the reference standard for defining apical morphology, quantifying hypertrophy, and characterizing myocardial tissue and perfusion. Beyond its diagnostic role, magnetic resonance serves as a research platform for the identification of new apical-centric criteria which, after appropriate validation, may be translated into echocardiographic practice. Echocardiography, however, retains unique strengths through its real-time evaluation of cardiac dynamics, ready-to-use approach to diastolic function assessment, and its ability to identify subtle apical or para-apical obstructive gradients that may raise the initial diagnostic suspicion. This review underscores the complementary roles of the two modalities and the multiple domains in which transthoracic echocardiography can derive substantial methodological and conceptual benefit from cardiac magnetic resonance imaging, both in imaging methodology and in the refinement of diagnostic evaluation. Full article
(This article belongs to the Special Issue Advances in Non-Invasive Diagnostic Technologies for Heart Diseases)
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