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Visualizing Cardiac Function: Advances in Modern Imaging Diagnostics
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Visualizing Cardiac Function: Advances in Modern Imaging Diagnostics

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

Deadline for manuscript submissions: 10 July 2026 | Viewed by 1763

Special Issue Editors

Dr. Dafni Charisopoulou

E-Mail Website
Guest Editor
2nd Department of Paediatrics, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Interests: cardiology; cardiac imaging; echocardiography; coronary artery disease; heart failure; valvular heart disease; exercise hemodynamics; stress echocardiography
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Michael Henein

E-Mail Website
Guest Editor
1. Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
2. National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
Interests: cardiac imaging; echocardiography; coronary artery disease; valve disease; heart failure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Understanding and quantifying cardiac function is fundamental to diagnosing and managing cardiovascular disease. In recent years, advances in noninvasive imaging have revolutionized the way we visualize the beating heart—allowing for more detailed assessment of anatomy, mechanics, and flow.

This Special Issue focuses on recent innovations in echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT), as well as emerging techniques such as 3D and 4D imaging, myocardial strain analysis, and artificial intelligence–driven image interpretation.

We invite original research and review articles that explore how these modalities contribute to the evaluation of ventricular and atrial performance, myocardial deformation, valvular dynamics, and tissue characterization. Contributions addressing novel imaging biomarkers for heart failure, congenital and valvular heart disease, cardiomyopathies, and ischemic heart disease are particularly welcome.

By gathering current evidence and forward-looking perspectives, this Special Issue aims to showcase how modern imaging is reshaping the understanding of cardiac function—bridging technology and clinical insight to advance precision cardiology.

Dr. Dafni Charisopoulou
Prof. Dr. Michael Henein
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 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-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
  • coronary artery disease
  • valve disease
  • heart failure

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Published Papers (3 papers)

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12 pages, 923 KB  
Article
Epicardial Fat Thickness as a Marker of Coronary Artery Disease Severity and Ischemic Burden: A Prospective Echocardiographic Study
by Dafni Charisopoulou, Sotiria Iliopoulou, George Koulaouzidis, Nikolaos Antoniou, Kyriakos Tsantekidis, Aggeliki D. Mavrogianni, Michael Y. Henein and John Zarifis
J. Clin. Med. 2026, 15(2), 657; https://doi.org/10.3390/jcm15020657 - 14 Jan 2026
Viewed by 432
Abstract
Background/Objectives: Epicardial fat thickness (EFT) is an echocardiographic marker of epicardial adipose tissue that has been linked to coronary atherosclerosis, but its relationship with both coronary artery disease (CAD) severity and myocardial ischemia remains incompletely assessed. This study evaluated the association between [...] Read more.
Background/Objectives: Epicardial fat thickness (EFT) is an echocardiographic marker of epicardial adipose tissue that has been linked to coronary atherosclerosis, but its relationship with both coronary artery disease (CAD) severity and myocardial ischemia remains incompletely assessed. This study evaluated the association between EFT, angiographic CAD severity, and stress-induced myocardial ischemia. Methods: In a prospective study, 125 consecutive patients with suspected stable angina underwent transthoracic echocardiography with EFT measurement, dobutamine stress echocardiography, and coronary angiography. EFT was measured at end-systole in the parasternal long-axis view. Significant CAD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Myocardial ischemia was assessed using peak-stress wall motion score index (WMSI). Results: Significant CAD was present in 56% of patients. Mean EFT was significantly higher in patients with significant CAD compared with those without (7.8 ± 2.0 mm vs. 5.5 ± 1.5 mm; p < 0.001). EFT increased progressively with angiographic CAD severity (non-significant CAD: 5.5 ± 1.5 mm; one-vessel disease: 6.5 ± 1.8 mm; two-vessel disease: 7.5 ± 2.0 mm; three-vessel disease: 8.5 ± 1.9 mm; p < 0.001). Patients with EFT > 5 mm had a significantly higher prevalence of significant CAD (68.8% vs. 33.3%; p < 0.001) and were older, with higher body mass index and a greater prevalence of hypertension and obesity. Additionally, peak-stress WMSI was significantly higher in patients with elevated EFT (1.08 ± 0.07 vs. 1.04 ± 0.05; p = 0.005), indicating a greater ischemic burden. Conclusions: EFT is associated with both the anatomical severity of CAD and the extent of stress-induced myocardial ischemia, supporting its potential role in non-invasive risk stratification of patients with suspected CAD. Full article
(This article belongs to the Special Issue Visualizing Cardiac Function: Advances in Modern Imaging Diagnostics)
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27 pages, 2553 KB  
Systematic Review
Echocardiographic Assessment of Right Ventricular–Pulmonary Arterial Coupling in Heart Failure: Prognostic Insights from a Systematic Review
by Andrea Sonaglioni, Michele Lombardo, Giulio Francesco Gramaglia, Gian Luigi Nicolosi, Alessandro Lucidi, Massimo Baravelli and Sergio Harari
J. Clin. Med. 2026, 15(6), 2334; https://doi.org/10.3390/jcm15062334 - 18 Mar 2026
Viewed by 369
Abstract
Background: Prognostic heterogeneity in heart failure (HF) is substantial and not fully captured by conventional left-sided echocardiographic parameters. Growing evidence highlights the importance of right ventricular–pulmonary arterial (RV–PA) interaction in HF pathophysiology and outcomes. The echocardiographic tricuspid annular plane systolic excursion-to-systolic pulmonary [...] Read more.
Background: Prognostic heterogeneity in heart failure (HF) is substantial and not fully captured by conventional left-sided echocardiographic parameters. Growing evidence highlights the importance of right ventricular–pulmonary arterial (RV–PA) interaction in HF pathophysiology and outcomes. The echocardiographic tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio has been proposed as a simple noninvasive surrogate of RV–PA coupling, yet its prognostic value across the HF spectrum remains incompletely defined. Methods: This systematic review followed PRISMA guidelines and was registered in INPLASY. PubMed, Scopus, and EMBASE were searched from inception through January 2026 for observational studies evaluating the prognostic value of TAPSE/sPAP in adult patients with HF. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Owing to substantial heterogeneity, a qualitative synthesis with weighted pooled descriptive statistics was performed. Results: Fifteen observational studies including 5389 patients were analyzed, with a median follow-up of approximately 1.9 years, ranging from in-hospital outcomes to long-term follow-up of up to 15 years. Study populations encompassed a wide range of HF phenotypes and clinical settings, including acute and chronic HF, preserved and reduced ejection fraction, valvular heart disease, infiltrative cardiomyopathies, and advanced HF. Across studies, reduced TAPSE/sPAP was generally associated with adverse outcomes, including all-cause mortality and HF-related events, with reported hazard ratios ranging from approximately two- to five-fold. Prognostically relevant TAPSE/sPAP cut-off values tended to cluster within a relatively narrow range, with most thresholds between 0.36 and 0.40 and a weighted median of approximately 0.36. When reported, TAPSE/sPAP showed favorable discriminative performance for adverse outcomes. Overall methodological quality was predominantly fair. Conclusions: Across heterogeneous HF populations, impaired TAPSE/sPAP appears to be a consistent marker of adverse prognosis. These findings support TAPSE/sPAP as a practical, noninvasive indicator of RV–PA uncoupling that may contribute to risk stratification and phenotyping in heart failure. Prospective studies focusing on specific HF phenotypes are needed to clarify its role in longitudinal monitoring and therapeutic decision-making. Full article
(This article belongs to the Special Issue Visualizing Cardiac Function: Advances in Modern Imaging Diagnostics)
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24 pages, 1818 KB  
Systematic Review
Ethnic Variation in Left Ventricular Size and Mechanics During Healthy Pregnancy: A Systematic Review of Asian and Western Cohorts
by Andrea Sonaglioni, Giovanna Margola, Gian Luigi Nicolosi, Stefano Bianchi, Michele Lombardo and Massimo Baravelli
J. Clin. Med. 2025, 14(24), 8745; https://doi.org/10.3390/jcm14248745 - 10 Dec 2025
Cited by 2 | Viewed by 703
Abstract
Background: Pregnancy induces substantial cardiovascular remodeling, yet whether maternal cardiac adaptation differs across ethnic groups remains unclear. Body size, ventricular geometry, and thoracoabdominal configuration may modulate key functional indices such as left ventricular ejection fraction (LVEF) and global longitudinal strain (LV-GLS). This [...] Read more.
Background: Pregnancy induces substantial cardiovascular remodeling, yet whether maternal cardiac adaptation differs across ethnic groups remains unclear. Body size, ventricular geometry, and thoracoabdominal configuration may modulate key functional indices such as left ventricular ejection fraction (LVEF) and global longitudinal strain (LV-GLS). This systematic review compared echocardiographic characteristics between Asian and Western healthy pregnant women in late gestation and explored physiological mechanisms underlying observed differences. Methods: A comprehensive search of PubMed, Scopus, and EMBASE identified studies reporting transthoracic echocardiography in healthy singleton third-trimester pregnancies across Asian and Western populations. Extracted variables included anthropometry, ventricular dimensions and volumes, LVEF, and LV-GLS. Pooled estimates were calculated using inverse-variance weighting, with heterogeneity quantified using the I2 statistic. Study quality was assessed with the NIH Case–Control Quality Assessment Tool. Comparative forest plots visualized population differences. Results: Twenty studies involving 1431 participants (578 Asian and 853 Western women) met inclusion criteria. Asian women consistently exhibited smaller ventricular chambers, higher LVEF, and more favorable LV-GLS. Importantly, these differences persisted after indexing LV-GLS to BSA, indicating that body-size normalization attenuates—but does not eliminate—population differences in myocardial deformation. Western women demonstrated slightly attenuated GLS despite preserved LVEF, plausibly attributable to larger cardiac size, higher wall stress, greater diaphragmatic elevation, and increased extrinsic thoracic compression. Between-study heterogeneity was substantial (I2 > 95%) due to variation in imaging platforms, strain software, and population characteristics. Methodological quality was fair, with frequent lack of sample-size justification and incomplete confounder adjustment. Conclusions: Healthy Asian pregnant women display a hyperdynamic systolic phenotype, whereas Western women show a physiologically appropriate, load-related attenuation of LV-GLS with preserved LVEF. These findings highlight the need for ethnicity-associated and anatomy-aware echocardiographic reference values and support incorporating thoracic geometric indices, such as the modified Haller Index, into strain interpretation during pregnancy. Full article
(This article belongs to the Special Issue Visualizing Cardiac Function: Advances in Modern Imaging Diagnostics)
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