State of the Art of Cardiac Multimodality Imaging

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 October 2021) | Viewed by 30609

Special Issue Editors

University Hospital Vall d'Hebron, Barcelona, Spain
Interests: aortic diseases; echocardiography; marfan syndrome; genetic aortic disorders; valvular heart diseases
University Hospital Vall d'Hebron, Barcelona, Spain
Interests: cardiovascular magnetic resonance; 4d-flow CMR; cardiovascular computed tomography; echocardiography; non-ischemic cardiomyopathies; acute myocardial infarction

Special Issue Information

Dear Colleagues,

Cardiac imaging techniques have progressed significantly in recent years. Echocardiography, computed tomography, magnetic resonance imaging, and nuclear medicine with PET and SPECT play a pivotal role in the diagnosis, prognosis, and management of most cardiac diseases. Most of these techniques offer a different perspective and information around the disease, and integration of their results may significantly improve the diagnosis and status definition of the disease. Echocardiography is the most used technique in clinical practice as a consequence of its availability, rapidity, mobility and adequate anatomical and dynamic information of blood flow via the Doppler technique. Computed tomography is the imaging technique with the best spatial resolution, giving the most accurate anatomical information of the heart, aorta, and peripheral vessels. Magnetic resonance imaging by different sequences may add morphological and dynamic information, avoiding radiation, and offer tissue characterization which is crucial in several cardiac diseases. Finally, nuclear techniques may assess cellular metabolism and inflammation, being relevant in some specific diseases. However, with this large armamentarium of multimodality imaging, it is important to avoid redundant and duplicated information. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions, taking into account test accuracy, additional benefits, risks, and cost. In this Special Issue, we will examine recent innovation and advances in multimodality imaging analyzing the benefits and redundances of imaging technique information with the intention of defining the best workflow for improving the knowledge and management of several cardiac diseases.

Dr. Arturo Evangelista
Dr. Jose Rodríguez-Palomares
Guest Editors

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Keywords

  • Multimodality Cardiac Imaging
  • Echocardiography
  • Computed Tomography
  • Magnetic Resonance Imaging
  • Ischemic Hear Disease
  • Valvular Heart Diseases
  • Cardiomyopathies
  • Aortic Diseases
  • Left atrial assessment
  • Left ventricular function
  • Right ventricular function

Published Papers (10 papers)

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Editorial

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4 pages, 203 KiB  
Editorial
Special Issue: State of the Art of Cardiac Multimodality Imaging
by Arturo Evangelista and Jose Rodríguez-Palomares
J. Clin. Med. 2022, 11(13), 3793; https://doi.org/10.3390/jcm11133793 - 30 Jun 2022
Viewed by 870
Abstract
Imaging has progressed significantly in recent years and plays a pivotal role in the diagnosis, prognosis, and management of cardiac diseases [...] Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)

Research

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15 pages, 29981 KiB  
Article
Reference Ranges of Left Ventricular Hemodynamic Forces in Healthy Adults: A Speckle-Tracking Echocardiographic Study
by Francesco Ferrara, Francesco Capuano, Rosangela Cocchia, Brigida Ranieri, Carla Contaldi, Graziella Lacava, Valentina Capone, Salvatore Chianese, Salvatore Rega, Roberto Annunziata, Chiara Sepe, Andrea Salzano, Rodolfo Citro, Antonello D’Andrea, Ciro Mauro, Filippo Cademartiri, Gianni Pedrizzetti and Eduardo Bossone
J. Clin. Med. 2021, 10(24), 5937; https://doi.org/10.3390/jcm10245937 - 17 Dec 2021
Cited by 6 | Viewed by 2420
Abstract
Background: The normal limits of left ventricular (LV) hemodynamic forces (HDFs) are not exactly known. The aim of this study was to explore the full spectrum of HDF parameters in healthy subjects and determine their physiologic correlates. Methods: 269 healthy subjects were enrolled [...] Read more.
Background: The normal limits of left ventricular (LV) hemodynamic forces (HDFs) are not exactly known. The aim of this study was to explore the full spectrum of HDF parameters in healthy subjects and determine their physiologic correlates. Methods: 269 healthy subjects were enrolled (mean age: 43 ± 14 years; 123 (45.7%) men). All participants underwent an echo-Doppler examination. Tri-plane tissue tracking from apical views was used to measure 2D global endocardial longitudinal strain (GLS), circumferential strain (GCS), and LV HDFs. HDFs were normalized with LV volume and divided by specific weight. Results: LV systolic longitudinal HDFs (%) were higher in men (20.8 ± 6.5 vs. 18.9 ± 5.6, p = 0.009; 22.0 ± 6.7 vs. 19.8 ± 5.6, p = 0.004, respectively). There was a significant correlation between GCS (increased) (r = −0.240, p < 0.001) and LV longitudinal HDFs (reduced) (r = −0.155, p = 0.01) with age. In a multivariable analysis age, BSA, pulse pressure, heart rate and GCS were the only independent variables associated with LV HDFs (β coefficient = −0.232, p < 0.001; 0.149, p = 0.003; 0.186, p < 0.001; 0.396, p < 0.001; −0.328, p < 0.001; respectively). Conclusion: We report on the physiologic range of LV HDFs. Knowledge of reference values of HDFs may prompt their implementation into clinical routine and allow a more comprehensive assessment of the LV function. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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8 pages, 1665 KiB  
Article
Are Aortic Root and Ascending Aorta Diameters Measured by the Pediatric versus the Adult American Society of Echocardiography Guidelines Interchangeable?
by Maria Luz Servato, Gisela Teixidó-Turá, Anna Sabate-Rotes, Laura Galian-Gay, Laura Gutiérrez, Filipa Valente, Ruben Fernandez-Galera, Guillem Casas, Angela López-Sainz, M. Teresa González-Alujas, Augusto Sao-Aviles, Ignacio Ferreira, Jose Rodríguez-Palomares and Arturo Evangelista
J. Clin. Med. 2021, 10(22), 5290; https://doi.org/10.3390/jcm10225290 - 14 Nov 2021
Cited by 6 | Viewed by 5246
Abstract
Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root [...] Read more.
Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root and ascending aorta diameters determined by the diastolic leading edge (DLE) and the systolic inner edge (SIE) conventions in adult and pediatric patients with inherited cardiovascular diseases. Transthoracic echocardiograms were performed in 328 consecutive patients (260 adults and 68 children). Aorta diameters were measured twice at the root and ascending aorta by the DLE convention following the 2015 American Society of Echocardiography (ASE) adult guidelines and the SIE convention following the 2010 ASE pediatric guidelines. Comparison of the diameters measured by the two conventions in the overall population showed a non-significant underestimation of the diameter measured by the SIE convention at root level of 0.28 mm (CI −1.36; 1.93) and at tubular ascending aorta level of 0.17 mm (CI −1.69; 2.03). Intraobserver and interobserver variability were excellent. Maximum aorta diameter measured by the leading edge convention in end-diastole and the inner edge convention in mid-systole had similar values to a mild non-significant underestimation of the inner-to-inner method that permits them to be interchangeable when used in clinical practice. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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11 pages, 900 KiB  
Article
Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve
by Angela Lopez, Ilaria Dentamaro, Laura Galian, Francisco Calvo, Josep M. Alegret, Violeta Sanchez, Rodolfo Citro, Antonella Moreo, Fabio Chirillo, Paolo Colonna, María Celeste Carrero, Eduardo Bossone, Sergio Moral, Augusto Sao-Aviles, Laura Gutiérrez, Gisela Teixido-Tura, Jose Rodríguez-Palomares and Arturo Evangelista
J. Clin. Med. 2021, 10(22), 5264; https://doi.org/10.3390/jcm10225264 - 12 Nov 2021
Cited by 4 | Viewed by 2215
Abstract
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. [...] Read more.
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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12 pages, 1126 KiB  
Article
Predictive Value of Cardiac Magnetic Resonance Feature Tracking after Acute Myocardial Infarction: A Comparison with Dobutamine Stress Echocardiography
by Filipa X. Valente, José Gavara, Laura Gutierrez, Cesar Rios-Navarro, Pau Rello, Manel Maymi, Ruben Fernandez-Galera, José V. Monmeneu, Augusto Sao-Aviles, Maria P. Lopez-Lereu, M. Teresa Gonzalez-Alujas, David Moratal, Hug Cuellar, José Barrabés, Imanol Otaegui, Artur Evangelista, Ignacio Ferreira, Vicente Bodi and José Rodriguez-Palomares
J. Clin. Med. 2021, 10(22), 5261; https://doi.org/10.3390/jcm10225261 - 12 Nov 2021
Cited by 3 | Viewed by 1432
Abstract
In acute ST-segment elevation myocardial infarction (STEMI) late gadolinium enhancement (LGE) may underestimate segmental functional recovery. We evaluated the predictive value of cardiac magnetic resonance (CMR) feature-tracking (FT) for functional recovery and whether it incremented the value of LGE compared to low-dose dobutamine [...] Read more.
In acute ST-segment elevation myocardial infarction (STEMI) late gadolinium enhancement (LGE) may underestimate segmental functional recovery. We evaluated the predictive value of cardiac magnetic resonance (CMR) feature-tracking (FT) for functional recovery and whether it incremented the value of LGE compared to low-dose dobutamine stress echocardiography (LDDSE) and speckle-tracking echocardiography (STE). Eighty patients underwent LDDSE and CMR within 5–7 days after STEMI and segmental functional recovery was defined as improvement in wall-motion at 6-months CMR. Optimal conventional and FT parameters were analyzed and then also applied to an external validation cohort of 222 STEMI patients. Circumferential strain (CS) was the strongest CMR-FT predictor and addition to LGE increased the overall accuracy to 74% and was especially relevant in segments with 50–74% LGE (AUC 0.60 vs. 0.75, p = 0.001). LDDSE increased the overall accuracy to 71%, and in the 50–74% LGE subgroup improved the AUC from 0.60 to 0.69 (p = 0.039). LGE + CS showed similar value as LGE + LDDSE. In the validation cohort, CS was also the strongest CMR-FT predictor of recovery and addition of CS to LGE improved overall accuracy to 73% although this difference was not significant (AUC 0.69, p = 0.44). Conclusion: CS is the strongest CMR-FT predictor of segmental functional recovery after STEMI. Its incremental value to LGE is comparable to that of LDDSE whilst avoiding an inotropic stress agent. CS is especially relevant in segments with 50–74% LGE where accuracy is lower and further testing is frequently required to clarify the potential for recovery. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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Review

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18 pages, 5149 KiB  
Review
Multimodality Imaging in the Study of the Left Atrium
by Sergio Moral, Marc Abulí, Pau Vilardell, Emilce Trucco, Esther Ballesteros and Ramon Brugada
J. Clin. Med. 2022, 11(10), 2854; https://doi.org/10.3390/jcm11102854 - 18 May 2022
Cited by 3 | Viewed by 3222
Abstract
The left atrium (LA) plays a vital role in maintaining normal cardiac function. Many cardiac diseases involve the functioning of the LA directly or indirectly. For this reason, the study of the LA has become a priority for today’s imaging techniques. Assessment of [...] Read more.
The left atrium (LA) plays a vital role in maintaining normal cardiac function. Many cardiac diseases involve the functioning of the LA directly or indirectly. For this reason, the study of the LA has become a priority for today’s imaging techniques. Assessment of LA size, function and wall characteristics is routinely performed in cardiac imaging laboratories when a patient undergoes transthoracic echocardiography. However, in cases when the LA is the focus of disease management, such as in atrial fibrillation or left atrial appendage closure, the use of multimodality is critical. Knowledge of the usefulness of each cardiac imaging technique for the study of LA in these patients is crucial in order to choose the most appropriate treatment. While echocardiography is the most widely performed technique for its evaluation and the study of wall deformation analysis is increasingly becoming more reliable, multidetector computed tomography allows a detailed analysis of its anatomy to be carried out in 3D reconstructions that help in the approach to interventional treatments. In addition, the evaluation of the wall by cardiac magnetic resonance imaging or the generation of electroanatomical maps in the electrophysiology room have become essential tools in the treatment of multiple atrial pathologies. For this reason, the goal of this review article is to describe the basic anatomical and functional information of the LA as well as their study employing the main imaging techniques currently available, so that practitioners specializing in cardiac imaging techniques can use these tools in an accurate and clinically useful manner. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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30 pages, 14495 KiB  
Review
Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis
by Guillem Casas and José F. Rodríguez-Palomares
J. Clin. Med. 2022, 11(3), 578; https://doi.org/10.3390/jcm11030578 - 24 Jan 2022
Cited by 9 | Viewed by 3816
Abstract
Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis [...] Read more.
Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis should be confirmed by cardiovascular magnetic resonance, which will provide more accurate morphologic and functional information, as well as extensive tissue characterization. Multimodality cardiac imaging techniques are also essential in assessing the prognosis of patients with cardiomyopathies; left ventricular ejection fraction and late gadolinium enhancement are two of the main variables used for risk stratification, and they are incorporated into clinical practice guidelines. Finally, periodic testing with cardiac imaging techniques should also be performed due to the evolving and progressive natural history of most cardiomyopathies. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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19 pages, 33773 KiB  
Review
Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging
by Andrea Baggiano, Gianpiero Italiano, Marco Guglielmo, Laura Fusini, Andrea Igoren Guaricci, Riccardo Maragna, Carlo Maria Giacari, Saima Mushtaq, Edoardo Conte, Andrea Daniele Annoni, Alberto Formenti, Maria Elisabetta Mancini, Daniele Andreini, Mark Rabbat, Mauro Pepi and Gianluca Pontone
J. Clin. Med. 2022, 11(3), 477; https://doi.org/10.3390/jcm11030477 - 18 Jan 2022
Cited by 11 | Viewed by 2912
Abstract
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, [...] Read more.
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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16 pages, 3138 KiB  
Review
Unraveling Bicuspid Aortic Valve Enigmas by Multimodality Imaging: Clinical Implications
by Arturo Evangelista Masip, Laura Galian-Gay, Andrea Guala, Angela Lopez-Sainz, Gisela Teixido-Turà, Aroa Ruiz Muñoz, Filipa Valente, Laura Gutierrez, Ruben Fernandez-Galera, Guillem Casas, Alejandro Panaro, Alba Marigliano, Marina Huguet, Teresa González-Alujas and Jose Rodriguez-Palomares
J. Clin. Med. 2022, 11(2), 456; https://doi.org/10.3390/jcm11020456 - 17 Jan 2022
Cited by 8 | Viewed by 4328
Abstract
Multimodality imaging is the basis of the diagnosis, follow-up, and surgical management of bicuspid aortic valve (BAV) patients. Transthoracic echocardiography (TTE) is used in our clinical routine practice as a first line imaging for BAV diagnosis, valvular phenotyping and function, measurement of thoracic [...] Read more.
Multimodality imaging is the basis of the diagnosis, follow-up, and surgical management of bicuspid aortic valve (BAV) patients. Transthoracic echocardiography (TTE) is used in our clinical routine practice as a first line imaging for BAV diagnosis, valvular phenotyping and function, measurement of thoracic aorta, exclusion of other aortic malformations, and for the assessment of complications such are infective endocarditis and aortic. Nevertheless, TTE is less useful if we want to assess accurately other aortic segments such as mid-distal ascending aorta, where computed tomography (CT) and magnetic resonance (CMR) could improve the precision of aorta size measurement by multiplanar reconstructions. A major advantage of CT is its superior spatial resolution, which affords a better definition of valve morphology and calcification, accuracy, and reproducibility of ascending aorta size, and allows for coronary artery assessment. Moreover, CMR offers the opportunity of being able to evaluate aortic functional properties and blood flow patterns. In this setting, new developed sequences such as 4D-flow may provide new parameters to predict events during follow up. The integration of all multimodality information facilitates a comprehensive evaluation of morphologic and dynamic features, stratification of the risk, and therapy guidance of this cohort of patients. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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14 pages, 37643 KiB  
Review
Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management
by Ali Alenazy, Abdalla Eltayeb, Muteb K. Alotaibi, Muhammah Kashif Anwar, Norah Mulafikh, Mohammed Aladmawi and Olga Vriz
J. Clin. Med. 2022, 11(2), 455; https://doi.org/10.3390/jcm11020455 - 17 Jan 2022
Cited by 12 | Viewed by 3250
Abstract
Mitral valve prolapse (MVP) is the most common valvular disease with a prevalence of 2%. It has generally a benign course; however, recent findings suggested an association between MVP and complex arrhythmias and eventually cardiac arrest and for this reason, it is also [...] Read more.
Mitral valve prolapse (MVP) is the most common valvular disease with a prevalence of 2%. It has generally a benign course; however, recent findings suggested an association between MVP and complex arrhythmias and eventually cardiac arrest and for this reason, it is also called arrhythmogenic MVP. Subjects who experience this complication are in general young women, with thickened mitral leaflets or bileaflet prolapse not necessarily associated with severe mitral regurgitation (MR). The nature of the relation between MVP and cardiac arrest is not clearly understood. Actually, the challenging task is to find the cluster of prognostic factors including T-wave inversion, polymorphic premature ventricular contractions, bileaflet prolapse, MR severity, but most importantly, those parameters of hypercontractility, mitral annulus disjunction (MAD), and myocardial fibrosis using a multimodality approach. Transthoracic echocardiography is the first-line imaging modality for the diagnosis of MVP, but also for detecting MAD and hypercontractility, followed by cardiac magnetic resonance for tissue characterization and detection of myocardial and papillary muscle fibrosis, using either late gadolinium enhancement (at the basal segment of the inferolateral wall and papillary muscles) (macro-fibrosis), or diffuse fibrosis by T1 mapping (native and post contrast T1). Moreover, there are also preliminary data on positron emission tomography utilizing 18F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation. The objective of this review article is to provide the clinician with an overview and a practical clinical approach to MVP for risk stratification and treatment guidance. Full article
(This article belongs to the Special Issue State of the Art of Cardiac Multimodality Imaging)
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