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Cardiac Imaging: Current Applications and Future Perspectives

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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 (15 July 2025) | Viewed by 9308

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Dr. Anna Baritussio

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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

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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

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Keywords

cardiac imaging
echocardiography
cardiac CT
cardiac MRI
nuclear imaging
artificial intelligence

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Published Papers (9 papers)

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Research

Jump to: Review

11 pages, 722 KB

Open AccessArticle

Preprocedural Substrate Visualization and Image Integration Based on Late Enhancement Computed Tomography for Ventricular Tachycardia Ablation in Non-Ischemic Cardiomyopathy

by Jan-Hendrik van den Bruck, Jan-Hendrik Schipper, Katharina Seuthe, Sebastian Dittrich, Theodoros Maximidou, Arian Sultan, Jana Ackmann, Jonas Wörmann, Cornelia Scheurlen, Jakob Lüker and Daniel Steven

J. Clin. Med. 2025, 14(16), 5801; https://doi.org/10.3390/jcm14165801 - 16 Aug 2025

Viewed by 318

Abstract

Background/Objectives: Catheter ablation is an established therapy for ventricular tachycardia (VT), though outcomes remain limited in patients with non-ischemic dilated cardiomyopathy (NIDCM) due to complex arrhythmogenic substrates. Late iodine enhancement computed tomography (LIE-CT) offers a promising alternative to cardiac MRI for preprocedural substrate visualization. This study evaluated procedural characteristics and outcomes of LIE-CT-supported VT ablation versus conventional mapping (CM) in NIDCM patients. Methods: NIDCM patients undergoing VT ablation between January 2022 and August 2024 were retrospectively analyzed. LIE-CT data were processed using inHEART software. Patients were matched 1:1 by propensity score based on baseline characteristics, electrical storm, and prior ablations. Results: A total of 46 patients (mean age 59 ± 16.4 years, 74% male) were included (23 LIE-CT, 23 CM). Procedure durations were comparable (231.5 ± 74.2 vs. 220.2 ± 70.2 min, p = 0.5), but mapping time (35.9 ± 15.3 vs. 54 ± 5 min, p < 0.001) and fluoroscopy time (14.7 ± 5.1 vs. 21.3 ± 10.6 min, p = 0.02) were significantly shorter with LIE-CT. Epicardial access was more frequent (52% vs. 26%, p < 0.001), and bipolar ablation for intramural scar was performed in 17% of LIE-CT cases. There were no significant differences in acute kidney injury or 30-day mortality. At a median follow-up of 367 days, VT-free survival was 57% with LIE-CT and 52% with CM (p = 0.8). Conclusions: LIE-CT-supported VT ablation and substrate visualization was safe, without additional risk of acute kidney injury, and enabled more efficient and targeted VT ablation. Prospective studies are warranted to assess its impact on long-term outcomes in NIDCM patients. Full article

(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)

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17 pages, 2352 KB

Open AccessArticle

Comparative Study of Automated Real-Time Left Atrial Appendage Sizing Using Patient-Specific 3D Heart Models Versus Transesophageal Echocardiography and Multidetector Computed Tomography in Patients with Nonvalvular Atrial Fibrillation: Implications for Device Selection

by Dominika Kanschik, Amin Polzin, Houtan Heidari, Lisa Dannenberg, Raphael Phinicarides, Kathrin Klein, Nikos Werner, Malte Kelm, Christian Jung, Tobias Zeus and Shazia Afzal

J. Clin. Med. 2025, 14(16), 5696; https://doi.org/10.3390/jcm14165696 - 12 Aug 2025

Viewed by 272

Abstract

Background: An accurate device sizing for percutaneous left atrial appendage closure (LAAC) can be challenging. Intraprocedural automated LAA evaluation by transoesophageal echocardiography (TEE) based on an artificial intelligence-assisted 3D model may facilitate sizing and prediction of C-arm angulation for device implantation in a one-stop-shop procedure. This study aimed to evaluate the feasibility and accuracy of automated echocardiographic LAA sizing based on a patient-specific 3D heart model prototype in real-time. Methods: A prospective monocentric study was conducted in 66 patients who underwent LAAC with the Amulet device. All major LAA morphologies were represented. Preprocedural multidetector computed tomography (MSCT) measurements and intraprocedural TEE and angiography measurements of the ostium, landing zone, and C-arm angulation were compared with the 3D heart model measurements. Results: The procedure achieved a 100% success rate. The measurements for the maximum diameter of the ostium in the 3D heart model were not significantly different from those obtained via angiography, TEE, and MSCT. Specifically, the maximum diameter of the landing zone did not differ significantly compared to TEE and angiographic measurements (20.90 ± 3.42 mm vs. 20.96 ± 4.81 mm, p = 0.563; compared to 21.20 ± 3.90 mm, p = 0.291). However, these measurements were significantly smaller than the average MSCT measurements (18.30 ± 2.68 mm vs. 21.03 ± 4.34 mm, p < 0.001). Additionally, the predicted implantation angles showed no significant differences between the 3D heart model and MSCT. Conclusions: The intraprocedural application of this prototype is both safe and feasible. The measurements obtained from the 3D heart model were consistent with those from TEE and angiography, although discrepancies were noted when compared to MSCT measurements. Notably, the predicted implantation angles demonstrated strong agreement with MSCT, further supporting the prototype’s efficacy in clinical settings. Full article

(This article belongs to the Special Issue Cardiac Imaging: Current Applications and Future Perspectives)

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14 pages, 4912 KB

Open AccessArticle

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 682

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 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 KB

Open AccessArticle

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 832

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 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 KB

Open AccessArticle

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 869

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. 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 KB

Open AccessArticle

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 1270

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 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, P_a, 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] P_a 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 P_a 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 KB

Open AccessArticle

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 1418

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 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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16 pages, 4154 KB

Open AccessArticle

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 1617

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 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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22 pages, 4640 KB

Open AccessFeature PaperReview

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 994

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 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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