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Cardiac Imaging: Current Applications and Future Perspectives
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Cardiac Imaging: Current Applications and Future Perspectives

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

Deadline for manuscript submissions: closed (15 July 2025) | Viewed by 8057

Special Issue Editors

Dr. Anna Baritussio

E-Mail Website
Guest Editor
Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, 35128 Padua, Italy
Interests: cardiac imaging; electrocardiography; myocarditis; heart failure
Dr. Isabella Leo

E-Mail Website
Guest Editor
1. CMR Unit, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
2. Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
Interests: echocardiography; congenital heart disease; cardiac imaging; cardiology; cardiovascular magnetic resonance

Special Issue Information

Dear Colleagues,

The field of cardiac imaging has seen remarkable advancements, drastically transforming the landscape of both diagnosis and management of cardiovascular conditions. Contemporary imaging modalities, including advanced echocardiography, cardiac magnetic resonance, computed tomography, and nuclear imaging, have revolutionized our approach to cardiac care. This Special Issue, entitled “Cardiac Imaging: Current Applications and Future Perspectives”, aims to collect these developments and provide novel insights into their clinical applications. Authors are invited to contribute both original research articles and in-depth reviews that shed light on the multifaceted aspects of cardiac imaging, including emerging technological advances and their impact on diagnostic precision, patient outcomes, and optimized clinical workflows. We hope that this Special Issue will represent a useful resource for clinicians, researchers, and healthcare professionals dedicated to cardiac healthcare innovation.

Dr. Anna Baritussio
Dr. Isabella Leo
Guest Editors

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

  • cardiac imaging
  • echocardiography
  • cardiac CT
  • cardiac MRI
  • nuclear imaging
  • artificial intelligence

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Published Papers (7 papers)

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Research

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14 pages, 4912 KiB  
Article
AI-Augmented Point of Care Ultrasound in Intensive Care Unit Patients: Can Novices Perform a “Basic Echo” to Estimate Left Ventricular Ejection Fraction in This Acute-Care Setting?
by Cassandra Gallant, Lori Bernard, Cherise Kwok, Stephanie Wichuk, Michelle Noga, Kumaradevan Punithakumar, Abhilash Hareendranathan, Harald Becher, Brian Buchanan and Jacob L. Jaremko
J. Clin. Med. 2025, 14(9), 2899; https://doi.org/10.3390/jcm14092899 - 23 Apr 2025
Viewed by 581
Abstract
Background: Echocardiography is crucial to understanding cardiac function in the Intensive Care Unit (ICU), often by measuring the left ventricular ejection fraction (LVEF). Traditionally, measures of LVEF are completed as part of a comprehensive examination by an expert sonographer or cardiologist, but front-line [...] Read more.
Background: Echocardiography is crucial to understanding cardiac function in the Intensive Care Unit (ICU), often by measuring the left ventricular ejection fraction (LVEF). Traditionally, measures of LVEF are completed as part of a comprehensive examination by an expert sonographer or cardiologist, but front-line practitioners increasingly perform focused point-of-care estimates of LVEF while managing life-threatening illness. The two main echocardiographic windows used to grossly estimate LVEF are parasternal and apical windows. Artificial intelligence (AI) algorithms have recently been developed to assist non-experts in obtaining and interpreting point-of-care ultrasound (POCUS) echo images. We tested the feasibility, accuracy and reliability of novice users estimating LVEF using POCUS-AI echo. Methods: A total of 30 novice users (most never holding an ultrasound probe before) received 2 h of instruction, then scanned ICU patients (10 patients, 80 scans) using the Exo Iris POCUS probe with AI guidance tool. They were permitted up to 5 min to attempt parasternal long axis (PLAX) and apical 4 chamber (A4C) views. AI-reported LVEF results from these scans were compared to gold-standard LVEF obtained by an expert echo sonographer. To further assess accuracy, this sonographer also scanned another 65 patients using Exo Iris POCUS-AI vs. conventional protocol. Results: Novices obtained images sufficient to estimate LVEF in 96% of patients in <5 min. Novices obtained PLAX views significantly faster than A4C (1.5 min vs. 2.3 min). Inter-rater reliability of LVEF estimation was very high (ICC 0.88–0.94) whether images were obtained by novices or experts. In n = 65 patients, POCUS-AI LVEF was highly specific for a decreased LVEF ≤ 40% (SP = 90% for PLAX) but only moderately sensitive (SN = 56–70%). Conclusions: Estimating cardiac LVEF from AI-enhanced POCUS is highly feasible even for novices in ICU settings, particularly using the PLAX view. POCUS-AI LVEF results were highly consistent whether performed by novice or expert. When AI detected a decreased LVEF, it was highly accurate, although a normal LVEF reported by POCUS-AI was not necessarily reassuring. This POCUS-AI tool could be clinically useful to rapidly confirm a suspected low LVEF in an ICU patient. Further improvements to sensitivity for low LVEF are needed. Full article
(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)
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14 pages, 741 KiB  
Article
Modest NT-proBNP Elevation in Septuagenarians Without Heart Failure Is Not Associated with Cardiac Alterations or Cardiovascular Outcomes
by Cristina Oliveira da Silva, Camilla Hage, Jonas Johnson, Magnus Bäck, Anikó I. Nagy, Emma Svennberg, Larissa Bastos, Johan Engdahl, Faris Al-Khalili, Lars Lund and Aristomenis Manouras
J. Clin. Med. 2025, 14(7), 2407; https://doi.org/10.3390/jcm14072407 - 1 Apr 2025
Viewed by 713
Abstract
Background/Objectives: To assess the association between moderate N-terminal natriuretic peptide (NT-proBNP) and cardiac alterations and prognosis in septuagenarians without heart failure (HF). Methods: From the STROKESTOP II screening study, 230 individuals aged 75/76 years with NT-proBNP < 900 ng/L were randomly selected. Subjects [...] Read more.
Background/Objectives: To assess the association between moderate N-terminal natriuretic peptide (NT-proBNP) and cardiac alterations and prognosis in septuagenarians without heart failure (HF). Methods: From the STROKESTOP II screening study, 230 individuals aged 75/76 years with NT-proBNP < 900 ng/L were randomly selected. Subjects with persistent atrial fibrillation (AF), more than mild valvular disease, or HF were excluded. Echocardiography was performed. NT-proBNP ≥ 125 ng/L and paroxysmal AF (pAF) on thumb ECG were used as grouping variables. Participants were followed up during a median of 5 years for cardiovascular mortality, HF, AF, and cerebrovascular events. Cox regression analysis was employed for prognostic assessment. Results: Three groups were identified: SR ≥ 125 (n = 94, no pAF and NT-proBNP ≥ 125 ng/L), pAF (n = 77, pAF and NT-proBNP ≥ 125 ng/L), and controls (n = 30, no pAF and NT-proBNP < 125 ng/L). NT-proBNP was not associated with structural (left atrial volume and left ventricular (LV) mass) or functional (E/e’, LV strain) alterations in any group (p > 0.05). Cardiovascular risk factors (HR: 4.6; CI = 1.7–12.3; p = 0.002), but not NT-proBNP (HR: 1.9; CI = 0.7–5.1; p = 0.2), entailed a prognostic value for the composite endpoint of HF, AF, and cardiovascular death. Conclusions: In septuagenarians without HF, modest NT-proBNP elevation was not associated with echocardiographic changes or prognosis Full article
(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)
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12 pages, 1484 KiB  
Article
Assessment of Left Ventricular Strain Echocardiography in Individuals with Hashimoto’s Thyroiditis and Its Association with Serum TIMP-1 Concentration
by Irfan V. Duzen, Selcen Y. Tuluce, Sadettin Ozturk, Mert D. Savcılıoglu, Huseyin Goksuluk, Gokhan Altunbas, Mehmet Kaplan, Ertan Vuruskan, Suzan Tabur, Murat Sucu and Seyithan Taysi
J. Clin. Med. 2025, 14(5), 1705; https://doi.org/10.3390/jcm14051705 - 3 Mar 2025
Viewed by 805
Abstract
Background: Hashimoto’s thyroiditis (HT), which is an autoimmune condition and the primary cause of hypothyroidism, has numerous impacts on the cardiovascular system. This research aimed to compare TIMP-1 levels and LV strain values in euthyroid HT, hypothyroid HT, and healthy control persons. [...] Read more.
Background: Hashimoto’s thyroiditis (HT), which is an autoimmune condition and the primary cause of hypothyroidism, has numerous impacts on the cardiovascular system. This research aimed to compare TIMP-1 levels and LV strain values in euthyroid HT, hypothyroid HT, and healthy control persons. Materials and Methods: This study included 40 hypothyroid HT patients, 42 HT patients who became euthyroid with thyroid hormone replacement therapy, and 40 healthy controls. All subjects had conventional echocardiography and STE. Global and segmental LV longitudinal strain values (LVGLS) were calculated. Participants’ blood was tested for TIMP-1, thyroid function, and anti-TPO. Results: Higher serum TIMP-1 levels were found in euthyroid and hypothyroid HT patients than in the control group. Additionally, patients with euthyroid and hypothyroid HT displayed lower segmental and global LV strain values than the control group. A negative correlation was observed between strain values and TIMP-1 and anti-TPO levels. No significant difference was observed in serum TIMP-1 and strain values between euthyroid and hypothyroid HT patients. Patients with hypothyroid HT exhibited impaired diastolic function and reduced ejection fraction when compared to both euthyroid HT and control groups. However, euthyroid HT patients and the controls had similar diastolic function and ejection fractions. Conclusions: Hashimoto’s thyroiditis causes impairment of LV strain, regardless of thyroid hormone levels. Additionally, the condition is associated with elevated TIMP-1 levels. The relationship between LV strain values and anti-TPO levels indicates that the autoimmune component of the disease may be responsible for the impaired LV strain. Full article
(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)
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13 pages, 3841 KiB  
Article
Cardiac CT Perfusion Imaging of Pericoronary Adipose Tissue (PCAT) Highlighting Potential Confounds in CTA Analysis
by Hao Wu, Yingnan Song, Ammar Hoori, Juhwan Lee, Sadeer G. Al-Kindi, Wei-Ming Huang, Chun-Ho Yun, Chung-Lieh Hung, Sanjay Rajagopalan and David L. Wilson
J. Clin. Med. 2025, 14(3), 769; https://doi.org/10.3390/jcm14030769 - 24 Jan 2025
Viewed by 1159
Abstract
Background: Features of pericoronary adipose tissue (PCAT) from coronary computed tomography angiography (CCTA) are associated with inflammation and cardiovascular risk. As PCAT is vascularly connected with coronary vasculature, the presence of iodine is a potential confounding factor on PCAT HU and textures [...] Read more.
Background: Features of pericoronary adipose tissue (PCAT) from coronary computed tomography angiography (CCTA) are associated with inflammation and cardiovascular risk. As PCAT is vascularly connected with coronary vasculature, the presence of iodine is a potential confounding factor on PCAT HU and textures that has not been adequately investigated. We aim to use dynamic cardiac CT perfusion (CCTP) to understand the perfusion of PCAT and determine its effects on PCAT assessment. Methods: From CCTP, we analyzed HU dynamics of territory-specific PCAT, the myocardium, and other adipose depots in patients with coronary artery disease. HU, blood flow, and radiomics were assessed over time. Changes from peak aorta time, Pa, chosen to model the acquisition time of CCTA, were obtained. Results: HU in PCAT increased more than in other adipose depots. Blood flow in PCAT was ~23% of that in the contiguous myocardium. A two-second offset [before, after] Pa resulted in [4 ± 1.1 HU, 3 ± 1.5 HU] differences in PCAT, giving a 7 HU swing. Due to changes in HU, the apparent PCAT volume reduced by ~15% from the first scan (P1) to Pa using a conventional fat window. Comparing radiomic features over time, 78% of features changed >10% relative to P1. Distal and proximal to a significant stenosis, we found less enhancement and longer time-to-peak distally in PCAT. Conclusions: CCTP elucidates blood flow in PCAT and enables the analysis of PCAT features over time. PCAT assessments (HU, apparent volume, and radiomics) are sensitive to acquisition timing and obstructive stenosis, which may confound the interpretation of PCAT in CCTA images. Data normalization may be in order. Full article
(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)
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12 pages, 1900 KiB  
Article
Predictors of Residual Right to Left Shunt in Patients Undergoing Percutaneous Transcatheter Patent Foramen Ovale Closure: A New Clue “Inferior Vena Cava-Patent Foramen Ovale Angle”
by Duygu Inan, Benay Ozbay, Ayse Irem Demırtola Mammadli, Funda Ozlem Pamuk, Sevil Tugrul Yavuz, Emir Derviş, Yeliz Guler, Duygu Genç Albayrak, Kadir Kasım Sahin and Alev Kılıcgedik
J. Clin. Med. 2024, 13(22), 6703; https://doi.org/10.3390/jcm13226703 - 7 Nov 2024
Cited by 1 | Viewed by 1374
Abstract
Background: Many different devices are currently used for percutaneous patent foramen ovale (PFO) closure (pPFOc), aiming to achieve complete occlusion to prevent recurrent embolism. We aimed to reveal the association between residual right-to-left shunt (RLS) after pPFOc and baseline structural features of the [...] Read more.
Background: Many different devices are currently used for percutaneous patent foramen ovale (PFO) closure (pPFOc), aiming to achieve complete occlusion to prevent recurrent embolism. We aimed to reveal the association between residual right-to-left shunt (RLS) after pPFOc and baseline structural features of the PFO determined using transoesophageal echocardiography (TEE) before the procedure. Methods: This is a single-center cross-sectional study. A total of 123 patients who underwent pPFOc for cryptogenic stroke (CS) were screened, consecutively. Patients were compared based on the presence of residual RLS. The association of structural features of the PFO with residual RLS was evaluated using logistic regression analysis. Results: The procedure was successfully completed in a total of 103 patients included in the study after exclusion and 21% had significant residual RLS. During a median follow-up of 18 months, one patient died at 25 months due to malignancy, recurrent CS were observed in 5 (5%) patients, and atrial fibrillation was detected in 3 (3%) patients. No significant difference was observed in the baseline clinical characteristics and laboratory parameters among the patients. In addition to atrial septal aneurysm (ASA), aortic rim, tunnel width and length; inferior vena cava (IVC)-PFO tunnel angle was associated with residual RLS with a cut-off 11.3 (AUC: 0.786, 64% sensitivity, 87% specificity, p < 0.001). In individuals with residual RLS, longer and wider tunnel size, rudimentary aortic rim, acute IVC-PFO tunnel angle, and decreased tunnel length-left disc ratio were observed. Conclusions: IVC-PFO tunnel angle is a novel parameter and provides benefit to detect significant RLS in pPFOc patients. Full article
(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)
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Graphical abstract

16 pages, 4154 KiB  
Article
Diagnostic and Prognostic Value of Right Ventricular Fat Quantification from Computed Tomography in Arrhythmogenic Right Ventricular Cardiomyopathy
by Valentina Faga, María Ruiz Cueto, David Viladés Medel, Zoraida Moreno-Weidmann, Paolo D. Dallaglio, Carles Diez Lopez, Gerard Roura, Jose M. Guerra, Rubén Leta Petracca, Joan Antoni Gomez-Hospital, Josep Comin Colet, Ignasi Anguera and Andrea Di Marco
J. Clin. Med. 2024, 13(13), 3674; https://doi.org/10.3390/jcm13133674 - 24 Jun 2024
Viewed by 1567
Abstract
Background: In arrhythmogenic right ventricular cardiomyopathy (ARVC) non-invasive scar evaluation is not included among the diagnostic criteria or the predictors of ventricular arrhythmias (VA) and sudden death (SD). Computed tomography (CT) has excellent spatial resolution and allows a clear distinction between myocardium and [...] Read more.
Background: In arrhythmogenic right ventricular cardiomyopathy (ARVC) non-invasive scar evaluation is not included among the diagnostic criteria or the predictors of ventricular arrhythmias (VA) and sudden death (SD). Computed tomography (CT) has excellent spatial resolution and allows a clear distinction between myocardium and fat; thus, it has great potential for the evaluation of myocardial scar in ARVC. Objective: The objective of this study is to evaluate the feasibility, and the diagnostic and prognostic value of semi-automated quantification of right ventricular (RV) fat replacement from CT images. Methods: An observational case–control study was carried out including 23 patients with a definite (19) or borderline (4) ARVC diagnosis and 23 age- and sex-matched controls without structural heart disease. All patients underwent contrast-enhanced cardiac CT. RV images were semi-automatically reconstructed with the ADAS-3D software (ADAS3D Medical, Barcelona, Spain). A fibrofatty scar was defined as values of Hounsfield Units (HU) <−10. Within the scar, a border zone (between −10 HU and −50 HU) and dense scar (<−50 HU) were distinguished. Results: All ARVC patients had an RV scar and all scar-related measurements were significantly higher in ARVC cases than in controls (p < 0.001). The total scar area and dense scar area showed no overlapping values between cases and controls, achieving perfect diagnostic performance (sensitivity and specificity of 100%). Among ARVC patients, 16 (70%) had experienced sustained VA or aborted SD. Among all clinical, ECG and imaging parameters, the dense scar area was the only one with a statistically significant association with VA and SD (p = 0.003). Conclusions: In ARVC, RV myocardial fat quantification from CT is feasible and may have considerable diagnostic and prognostic value. Full article
(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)
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Review

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22 pages, 4640 KiB  
Review
Feasibility and Role of Cardiac Magnetic Resonance in Intensive and Acute Cardiovascular Care
by Isabella Leo, Stefano Figliozzi, Jessica Ielapi, Federico Sicilia, Daniele Torella, Santo Dellegrottaglie, Anna Baritussio and Chiara Bucciarelli-Ducci
J. Clin. Med. 2025, 14(4), 1112; https://doi.org/10.3390/jcm14041112 - 9 Feb 2025
Viewed by 900
Abstract
Cardiac magnetic resonance (CMR) is established as a key imaging modality in a wide range of cardiovascular diseases and has an emerging diagnostic and prognostic role in selected patients presenting acutely. Recent technical advancements have improved the versatility of this imaging technique, which [...] Read more.
Cardiac magnetic resonance (CMR) is established as a key imaging modality in a wide range of cardiovascular diseases and has an emerging diagnostic and prognostic role in selected patients presenting acutely. Recent technical advancements have improved the versatility of this imaging technique, which has become quicker and more detailed in both functional and tissue characterization assessments. Information derived from this test has the potential to change clinical management, guide therapeutic decisions, and provide risk stratification. This review aims to highlight the evolving diagnostic and prognostic role of CMR in this setting, whilst also providing practical guidance on which patients can benefit the most from CMR and which information can be derived from this test that will impact clinical management. Full article
(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)
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