Search Results (634)

We report the case of an 80 yo female patient with cardiovascular risk factors and previous diagnosis of Tako-Tsubo syndrome, who was referred to our institution one year after a previous diagnosis, due to symptoms suggestive of acute coronary syndrome (SCA) after severe emotional stress. After ruling out suspected CAD by cardiac computed tomography (CCT) and subsequent invasive coronary angiography (ICA) confirming no significant stenosis but presence of vulnerable plaque, the patient underwent further investigation by cardiac magnetic resonance (CMR) that confirmed a clinical picture compatible with recurrence of Tako-Tsubo syndrome. Our case underlines the importance of multimodality imaging to guide diagnosis and treatment in this specific clinical scenario. Full article

Background: Stage B heart failure (SBHF) increases the risk of symptomatic HF. Current guideline criteria for SBHF lack sex and ethnic thresholding and cardiac magnetic resonance (CMR) imaging cut-offs. We aimed to assess the prevalence of SBHF in a large cohort of people with type 2 diabetes (T2D) and healthy controls and propose a refined CMR definition for SBHF. Methods: Sex- and ethnic-specific thresholds for imaging criteria were derived from 373 healthy controls, who underwent CMR cine imaging. The current definition for SBHF and refined criteria was applied to our prospectively recruited and intensively phenotyped cohort of asymptomatic people with T2D and no evidence of cardiovascular disease. The prevalence of SBHF by different definitions was calculated and patient characteristics, including exercise capacity, were compared between those classified as Stage A vs. B HF. Finally, the refined criteria were also applied to the following two historical cohorts with symptomatic cardiovascular disease: severe aortic stenosis (AS n = 70) and HF with preserved ejection fraction (HFpEF n = 136). Results: A total of 423 people with T2D and a subset of 102 healthy controls who underwent echocardiography were prospectively recruited. Current guideline criteria classified 91% of those with T2D and 69% of the healthy controls as SBHF, suggesting a lack of specificity. Applying derived sex- and ethnicity-specific thresholds, combining echo and CMR measures, the prevalence of SBHF was reduced to 30% in those with T2D. Using the refined definition, those with Stage B HF had lower exercise capacity than those with Stage A HF (percentage predicted maximal oxygen consumption 81 ± 16% vs. 91 ± 20%, p < 0.001). Applying the refined definition to symptomatic AS and HFpEF participants classified 89% and 85% with abnormal cardiac remodelling. Conclusion: Current guideline criteria for SBHF are non-specific and likely of limited value in clinical practice. Refining these criteria with sex- and ethnic-specific thresholds may improve identification of those at risk of developing symptomatic disease. Further research is required to validate these criteria. Full article

Recent advances in oncology have contributed to a steady rise in cancer survivorship. However, many cancer therapies are associated with cardiovascular adverse events, leading to increased rates of cardiovascular morbidity and mortality. As a result, cardio-oncology has emerged as a rapidly advancing discipline that relies on multidisciplinary collaboration. Cardiovascular multimodality imaging (CVMI) is an essential diagnostic and surveillance tool for cardiovascular toxicity, along with clinical evaluation and biomarkers. CVMI plays a central role in diagnosing cancer therapy-related cardiac dysfunction (CTRCD) and myocarditis, while also supporting the assessment of vascular toxicity and arrhythmias. It is essential for baseline cardiac evaluation and continuous monitoring throughout and following cancer therapy. CVMI enables early detection of cardiovascular toxicity, facilitating prompt initiation of cardioprotective therapy and allowing cancer therapy to proceed without compromising safety. Echocardiography is the primary imaging modality for screening, diagnosing, and monitoring CTRCD. Moreover, it is the first-line imaging test for cardiac structural and functional assessment in patients who develop immune checkpoint inhibitor (ICI)-related myocarditis. Advanced imaging techniques, such as cardiac magnetic resonance (CMR), nuclear imaging, and cardiac computed tomography, may help determine the cause and severity of left ventricular dysfunction, as well as assess cardiac masses and vascular toxicity. Not least, CMR is the gold standard imaging modality to diagnose myocarditis. This article is a narrative review that focuses on the various modalities of CVMI and their applications in cardio-oncology. Since the issue addressed is very extensive, this review was designed to be concise. Full article

Background/Objectives: Triglyceride (TG), Total Cholesterol (TC), HDL cholesterol (HDL-C), and LDL cholesterol (LDL-C) levels are commonly tested routine lipid profiles (RLPs) for assessing cardiovascular disease (CVD) risk. While lipid levels are typically measured by using standard clinical chemistry tests in routine practice, Nuclear Magnetic Resonance (NMR) spectroscopy has recently been explored for its ability to determine lipid levels under clinical settings. This study aims to compare RLP and NMR analysis using 17,337 fresh serum samples. Additionally, it investigates the impacts of freezing–thawing on these parameters in 9559 frozen samples. Methods: RLP was performed by employing the Siemens Dimension clinical chemistry system. Furthermore, the lipid contents of the fresh and frozen serum samples were evaluated across different concentration ranges. Results: Lipid parameters of fresh samples ascertained with RLP and NMR were strongly correlated (r ≥ 0.93). Analysis with frozen samples revealed that the correlation between lipid measurements decreased below r ≤ 0.86, except for TG (r = 0.97). Additionally, at different concentration ranges, the lower-level ranges for all lipid parameters in both fresh and frozen samples exhibited weaker correlations. Conclusions: This study demonstrates that NMR spectroscopy is a reliable, rapid, chemical-free method for lipid analysis in fresh samples. However, in frozen samples, relying on NMR to support RLP offers a less reliable approach for lipid measurement. Full article

Background: Accurate quantification of visceral (VAT) and subcutaneous adipose tissue (SAT) is critical for understanding the cardiometabolic consequences of obstructive sleep apnea (OSA) and other chronic diseases. This study validates a customization framework using pre-trained networks for the development of automated VAT/SAT segmentation models using hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) data from OSA patients. While the widespread adoption of deep learning models continues to accelerate the automation of repetitive tasks, establishing a customization framework is essential for developing models tailored to specific research questions. Methods: A UNet-ResNet50 model, pre-trained on RadImageNet, was iteratively trained on 59, 157, and 328 annotated scans within a closed-loop system on the Discovery Viewer platform. Model performance was evaluated against manual expert annotations in 10 independent test cases (with 80–100 MR slices per scan) using Dice similarity coefficients, segmentation time, intraclass correlation coefficients (ICC) for volumetric and metabolic agreement (VAT/SAT volume and standardized uptake values [SUVmean]), and Bland–Altman analysis to evaluate the bias. Results: The proposed deep learning pipeline substantially improved segmentation efficiency. Average annotation time per scan was 121.8 min (manual segmentation), 31.8 min (AI-assisted segmentation), and only 1.2 min (fully automated AI segmentation). Segmentation performance, assessed on 10 independent scans, demonstrated high Dice similarity coefficients for masks (0.98 for VAT and SAT), though lower for contours/boundary delineation (0.43 and 0.54). Agreement between AI-derived and manual volumetric and metabolic VAT/SAT measures was excellent, with all ICCs exceeding 0.98 for the best model and with minimal bias. Conclusions: This scalable and accurate pipeline enables efficient abdominal fat quantification using hybrid PET/MRI for simultaneous volumetric and metabolic fat analysis. Our framework streamlines research workflows and supports clinical studies in obesity, OSA, and cardiometabolic diseases through multi-modal imaging integration and AI-based segmentation. This facilitates the quantification of depot-specific adipose metrics that may strongly influence clinical outcomes. Full article

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

Background: Cardiovascular disease (CVD), driven primarily by atherosclerosis, is a major cause of morbidity and mortality among cancer patients. This study aims to evaluate the diagnostic value of [⁶⁸Ga]Ga-FAPI-PET as a novel molecular imaging tool for atherosclerosis, compared with established, non-specific [¹⁸F]FDG. Methods: We retrospectively analyzed twenty patients with bladder cancer who underwent [⁶⁸Ga]Ga-FAPI positron-emission tomography/magnetic resonance (PET/MR) and [¹⁸F]FDG positron emission tomography/computed tomography (PET/CT) at staging. The target-to-background ratio (TBRs) of both tracers were assessed along six arterial segments, and uptake patterns were compared between the two radiotracers. Additionally, associations between the intensity of PET-active lesions and certain CVD risk factors, as well as the intake of acetylsalicylic acid (ASA), were evaluated. Results: [⁶⁸Ga]Ga-FAPI detects significantly more active arterial PET lesions and shows significantly higher uptake than [¹⁸F]FDG in the per-lesion analysis (TBR_FAPI: 1.7 ± 0.5 vs. TBR_FDG: 1.4 ± 0.2; difference 19%; p < 0.001) and in the patient-based analysis (TBR_FAPI: 1.7 ± 0.4 vs. TBR_FDG: 1.4 ± 0.2; difference 19%; p = 0.018). Arterial hypertension (p < 0.001), dyslipidemia (p < 0.001), and particularly type 2 diabetes mellitus (p < 0.001; difference 34%), were significantly associated with elevated [⁶⁸Ga]Ga-FAPI expression compared to [¹⁸F]FDG uptake. ASA therapy was associated with a significant reduction in arterial [⁶⁸Ga]Ga-FAPI expression than [¹⁸F]FDG (p = 0.02). Conclusions: [⁶⁸Ga]Ga-FAPI-PET imaging, demonstrating superior detection of atherosclerotic activity compared to [¹⁸F]FDG, might be a promising molecular imaging marker for atherosclerosis. Full article

Cardiovascular magnetic resonance (CMR) imaging is a key component of current diagnostic pathways in subjects with acute myocarditis. The 2020 ESC Guidelines on Sports Cardiology recommend athletes with acute myocarditis to abstain from sports during the recovery phase from inflammation and to undergo comprehensive evaluation—including CMR—before safely returning to play. This retrospective study analyzed 95 non-competitive athletes presenting with acute myocarditis and evaluated by initial and repeated CMRs. CMR exams assessed myocardial inflammation, edema, and scarring as defined based on the updated Lake Louise criteria. As per 2020 ESC Guidelines, eligibility was granted by excluding extensive myocardial damage. Initial CMR showed 84% positive STIR (edema) and 79% with LGE ≥ 3 segments. After 3–6 months, STIR positivity dropped to 12%, LGE extent remained globally stable, but with some reduction in 42%. Few experienced recurrent myocarditis or LVEF decline; 24% met return-to-play criteria by repeated CMR. Our study shows that few non-competitive athletes recovering from acute myocarditis meet ESC CMR criteria to resume competitive sports at prescribed follow-up evaluation. The long-term prognostic value of CMR markers like LGE and edema remains unclear, highlighting the need for further research to refine return-to-play guidelines and ensure athlete safety. Full article

Background/Objectives: Cardiac magnetic resonance (CMR) imaging is a key tool for diagnosing cardiovascular disease, but its analysis remains time-consuming and dependent on expert interpretation, which can limit throughput and reproducibility. To address these challenges, we aim to develop an automated solution that streamlines CMR post-processing, enabling consistent, rapid, and quantitative assessment of cardiac structures and myocardial pathology. Methods: We introduce SPOT-Cardio, an AI-powered imaging analysis toolbox based on a 2D breath-held late gadolinium enhancement (LGE) imaging technology: SPOT. This acquisition combines BR- and BL-LGE images in a single scan, allowing simultaneous capture of high-contrast scar information and detailed cardiac anatomy. Using the resulting CMR images, deep learning models (based on 2D U-Net or MedFormer) were trained to segment cardiac structures and myocardial scars. The trained models and associated image-processing algorithms were then integrated into the open-source medInria platform and specifically within its cardiac-focused MUSICardio application. Results: SPOT-Cardio enables automatic segmentation of cardiac structures and myocardial scars, performs landmark-based regional localization, and extracts key biomarkers such as scar volume, extent, and transmurality. The resulting quantitative measures are presented in standardized bullseye plots accompanied by detailed clinical reports. Conclusions: With a one-click workflow and intuitive visualization, SPOT-Cardio reduces manual workload and supports more accessible and consistent cardiovascular assessment. By integrating advanced image acquisition with AI-based automation, it provides a practical and efficient solution for streamlined and quantitative CMR analysis. Full article

Background/Objectives: Unlike post-mortem histopathology, cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) enable longitudinal assessment of structural, functional, and metabolic alterations in preclinical myocardial infarction models. This study aims to describe the temporal evolution of infarct size and systolic function by CMR and glucose consumption via PET, explore their differences in non-reperfused and reperfusion infarction models, and assess their capacity to predict histology-derived infarct size and systolic function at chronic phase CMR. Methods: Two murine models of myocardial infarction were generated using permanent (non-reperfused, n = 8) or transient (reperfused, n = 9) coronary occlusion. CMR and fluorine-18 2-fluoro-2-deoxyglucose PET imaging were performed at baseline and at 1, 7, and 21 days post-infarction to quantify infarct size, systolic function, and myocardial glucose metabolism. Infarct size was also assessed using Masson’s trichrome staining. Results: At 24 h post-infarction, CMR-derived infarction together with significant reduction in systolic function and glucose metabolism were already noted in both models. At 21-day CMR, however, reperfused mice showed lower infarct size and more preserved systolic function compared to their non-reperfused counterparts, while no differences in glucose metabolism were reported. Infarct size and systolic function at 1-day CMR and the number of segments with reduced glucose consumption at 1-day PET independently predicted histology-derived infarct size and long-term systolic function. Conclusions: Combined PET/CMR imaging enables non-invasive, sequential evaluation of infarct size, systolic function, and glucose metabolism in experimental myocardial infarction. This multimodality approach is well suited for assessing the efficacy of emerging therapies in preclinical research. Full article

Pectus excavatum (PE) is the most frequent chest wall deformity, representing 65–95% of all cases, with an estimated prevalence of up to 1 in 300 births. Despite its frequency, it remains underrecognized in sports cardiology. PE results from sternal depression and narrowing of the anterior chest, which may lead to cardiac compression, impaired diastolic filling, and reduced stroke volume during exercise. Consequently, athletes with PE often present with cardiovascular symptoms such as exercise-induced dyspnoea, chest pain, palpitations, presyncope, or reduced physical fitness. Electrocardiographic changes, including right bundle branch block, axis deviation, atrial enlargement, T-wave inversion, QS complexes or Brugada phenocopies, are frequent and may mimic serious cardiovascular conditions, complicating pre-participation screening. Furthermore, PE is associated with potentially high-risk conditions including mitral valve prolapse, ventricular arrhythmias, and connective tissue disorders such as Marfan syndrome, which carry implications for sports eligibility and safety. Assessment of athletes with PE requires multimodal imaging (echocardiography, computed tomography, magnetic resonance), cardiopulmonary exercise testing, and exclusion of concomitant cardiovascular disease. Treatment strategies range from conservative approaches (physiotherapy, vacuum bell therapy) to surgical correction, most commonly with the Nuss procedure, which can improve cardiac function, exercise capacity, and quality of life. Management should involve shared decision making between clinicians, athletes, and families, weighing potential risks against athletic aspirations. Awareness of PE in sports cardiology is crucial, as it not only influences differential diagnosis and screening outcomes but also impacts career decisions and the psychological well-being of athletes. Full article

After SARS-CoV-2 infection, a subset of patients experience persistent cardiac symptoms, yet data on long-term cardiac involvement and clinical outcomes in the post-COVID-19 condition remain limited. This study aimed to investigate myocardial abnormalities using advanced cardiovascular magnetic resonance (CMR) imaging techniques in patients with ongoing cardiac symptoms for at least three months following COVID-19 diagnosis, and to assess their clinical outcomes. Between January 2021 and March 2022, 94 post-COVID-19 patients were examined at a median of 99 days (IQR 92–110) after diagnosis and compared to 100 controls. The CMR assessment included the left ventricular ejection fraction (LVEF), myocardial T2 signal, late gadolinium enhancement (LGE), and myocardial strain parameters. Follow-up for major adverse cardiac events (MACEs) was conducted at a median of 269 days (IQR 144–352). While no significant differences in LVEF were observed, post-COVID-19 patients demonstrated significantly reduced peak radial and circumferential strain values, suggesting subclinical myocardial dysfunction. Additionally, these patients exhibited a higher event rate compared to controls (0.063 vs. 0; p = 0.029). These findings indicate that patients with cardiac symptoms following COVID-19 may exhibit subtle but measurable myocardial changes and an increased risk of adverse outcomes. The observed alterations in myocardial strain most likely reflect mild, subclinical myocardial involvement within the spectrum of post-COVID-19 effects, rather than a direct cause of persistent symptoms. Further research is warranted to determine the prognostic significance of these findings. Full article

Restrictive cardiomyopathy (RCM) poses a significant challenge in diagnosis, is frequently identified in advanced stages, and has limited therapeutic options, which may lead to adverse cardiovascular outcomes. This narrative review examines the application of artificial intelligence (AI) across key diagnostic modalities and delineates priorities for translational advancement. The discussed diagnostic tools include echocardiography, cardiac magnetic resonance (CMR), electrocardiography (ECG), and electronic health records (EHR). A targeted, non-systematic search of PubMed and Scopus was performed to identify studies focused on model development, validation, or diagnostic accuracy concerning RCM and related infiltrative disorders. The findings suggest that AI can enable earlier detection, standardize imaging protocols, and enhance phenotype-driven management of RCM. Nonetheless, several challenges exist, including limited data access, the absence of external validation, variability across imaging devices and locations, and the imperative for transparent, explainable systems. Key priorities for successful implementation encompass establishing multi-center collaborations, detecting and correcting bias, clinician involvement in deployment, and integrating multimodal data, including imaging, signal data, and -omics. If effectively integrated into clinical practice, AI has the potential to redefine the management of RCM from a condition recognized primarily in its later stages to one characterized by early detection, dynamic risk assessment, and personalized treatment strategies. Full article

Magnetic Particle Imaging (MPI) is a new type of tracer-based imaging that has great spatial and temporal resolution, does not require ionizing radiation, and can see deep into tissues by directly measuring the nonlinear magnetization response of superparamagnetic iron oxide nanoparticles (SPIONs). Unlike Magnetic Resonance Imaging (MRI) or Computed Tomography (CT), MPI has very high contrast and quantitative accuracy, which makes it perfect for use in dynamic cardiovascular applications. This study presents a full picture of the most recent changes in cardiac MPI, such as the physics behind Field-Free Point (FFP) and Field-Free Line (FFL) encoding, new ideas for tracer design, and important steps in the evolution of scanner hardware. We discuss the clinical relevance of cardiac MPI in visualizing myocardial perfusion, quantifying blood flow, and guiding real-time interventions. A hybrid imaging workflow, which improves anatomical detail and functional assessment, is utilized to explore the integration of MPI with complementary modalities, particularly MRI. By consolidating recent preclinical breakthroughs and highlighting the roadmap toward human-scale implementation, this article underscores the transformative potential of MPI in cardiac diagnostics and image-guided therapy. Full article

Endurance exercise is widely recognized for its cardiovascular benefits, including improved longevity and metabolic health. However, excessive endurance training may lead to adverse cardiac adaptations, such as myocardial fibrosis, detected via late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR). This review examines the dual role of myocardial fibrosis in athletes—as a potential risk marker for life-threatening arrhythmias or a benign byproduct of physiological remodeling. While moderate exercise promotes beneficial cardiac hypertrophy, ultra-endurance athletes exhibit a 10–20% increase in ventricular size and mass, alongside elevated cardiac biomarkers post-exercise. Myocardial fibrosis, particularly in the left ventricle (LV), is associated with arrhythmias and sudden cardiac death, especially when presenting as a subepicardial/midmyocardial patchy pattern. Studies report that 22% of athletes with this pattern experienced malignant arrhythmias, underscoring its clinical significance. Conversely, fibrosis may also reflect adaptive remodeling in some cases, complicating its interpretation. The mechanisms underlying fibrosis in athletes remain unclear but may involve repeated cardiac stress, inflammation, or distinct atherosclerotic plaque dynamics. CMR is critical for detecting fibrosis, though differentiating pathological from physiological patterns requires careful clinical correlation. Risk stratification must consider LGE patterns, arrhythmia history, and symptoms. Despite concerns, elite athletes generally exhibit increased longevity, highlighting the complex interplay between exercise benefits and risks. Further research is needed to clarify fibrosis mechanisms, refine diagnostic criteria, and guide management strategies to ensure athlete safety while preserving the advantages of endurance training. Full article