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Keywords = multimodality cardiac imaging techniques

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16 pages, 1308 KiB  
Review
Multimodality Imaging in Aldosterone-Induced Cardiomyopathy: Early Detection and Prognostic Implications
by Francesca Zoccatelli, Gabriele Costa, Matteo Merlo, Francesca Pizzolo, Simonetta Friso and Luigi Marzano
Diagnostics 2025, 15(15), 1896; https://doi.org/10.3390/diagnostics15151896 - 29 Jul 2025
Viewed by 331
Abstract
Primary aldosteronism (PA), the most common cause of secondary hypertension, is increasingly recognized as an independent driver of adverse cardiac remodeling, mediated through mechanisms beyond elevated blood pressure alone. Chronic aldosterone excess leads to myocardial fibrosis, left ventricular hypertrophy, and diastolic dysfunction via [...] Read more.
Primary aldosteronism (PA), the most common cause of secondary hypertension, is increasingly recognized as an independent driver of adverse cardiac remodeling, mediated through mechanisms beyond elevated blood pressure alone. Chronic aldosterone excess leads to myocardial fibrosis, left ventricular hypertrophy, and diastolic dysfunction via mineralocorticoid receptor activation, oxidative stress, inflammation, and extracellular matrix dysregulation. These changes culminate in a distinct cardiomyopathy phenotype, often underrecognized in early stages. Multimodality cardiac imaging, led primarily by conventional and speckle-tracking echocardiography, and complemented by exploratory cardiac magnetic resonance (CMR) techniques such as T1 mapping and late gadolinium enhancement, enables non-invasive assessment of structural, functional, and tissue-level changes in aldosterone-mediated myocardial damage. While numerous studies have established the diagnostic and prognostic relevance of imaging in PA, several gaps remain. Specifically, the relative sensitivity of different modalities in detecting subclinical myocardial changes, the long-term prognostic significance of imaging biomarkers, and the differential impact of adrenalectomy versus medical therapy on cardiac reverse remodeling require further clarification. Moreover, the lack of standardized imaging-based criteria for defining and monitoring PA-related cardiomyopathy hinders widespread clinical implementation. This narrative review aims to synthesize current knowledge on the pathophysiological mechanisms of aldosterone-induced cardiac remodeling, delineate the strengths and limitations of existing imaging modalities, and critically evaluate the comparative effects of surgical and pharmacologic interventions. Emphasis is placed on early detection strategies, identification of imaging biomarkers with prognostic utility, and integration of multimodal imaging into clinical decision-making pathways. By outlining current evidence and highlighting key unmet needs, this review provides a framework for future research aimed at advancing personalized care and improving cardiovascular outcomes in patients with PA. Full article
(This article belongs to the Section Pathology and Molecular Diagnostics)
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16 pages, 279 KiB  
Review
Emerging Insights into Granulomatous and Amyloidogenic Cardiomyopathies
by Syed Bukhari, Adnan Younus and Zubair Bashir
J. Clin. Med. 2025, 14(12), 4208; https://doi.org/10.3390/jcm14124208 - 13 Jun 2025
Viewed by 506
Abstract
Background: Granulomatous and amyloidogenic cardiomyopathies are infiltrative conditions that can be fatal if left untreated. Among these, cardiac amyloidosis and cardiac sarcoidosis are significant but often underdiagnosed causes of heart failure, each serving as cardiac manifestations of broader systemic diseases. Advancements in imaging [...] Read more.
Background: Granulomatous and amyloidogenic cardiomyopathies are infiltrative conditions that can be fatal if left untreated. Among these, cardiac amyloidosis and cardiac sarcoidosis are significant but often underdiagnosed causes of heart failure, each serving as cardiac manifestations of broader systemic diseases. Advancements in imaging techniques and the emergence of novel therapies—particularly for cardiac amyloidosis—have brought these conditions into sharper focus for both clinicians and researchers. Methods: We conducted a comprehensive review of the literature by searching databases including PubMed and Scopus for studies published since 1990 regarding clinical features, diagnostic techniques, and treatment strategies for cardiac amyloidosis and cardiac sarcoidosis. Studies were selected based on relevance to imaging methods, including echocardiography, cardiac magnetic resonance imaging (CMR), positron emission tomography (PET), and technetium-labeled nuclear scintigraphy, as well as treatment modalities for both conditions. Results: Imaging techniques, particularly CMR, technetium-labeled nuclear scan, and PET, were found to be crucial for the early identification and differentiation of cardiac amyloidosis and cardiac sarcoidosis. Distinct late gadolinium enhancement patterns were observed in CMR along with morphological differences, aiding in diagnosis. Technetium-labeled nuclear scintigraphy can definitively distinguish between subtypes of cardiac amyloidosis in the absence of paraproteinemia. Early diagnosis has been shown to significantly improve patient outcomes. Early treatment can reduce morbidity in both cardiomyopathies. Conclusions: Multimodality imaging can help in the early detection of cardiac amyloidosis and cardiac sarcoidosis. Treatment strategies differ substantially: cardiac amyloidosis is primarily managed with disease-modifying therapies for the transthyretin subtype and chemotherapy/stem cell transplant for the AL subtype, while cardiac sarcoidosis is treated with corticosteroids and immunosuppressive drugs to reduce inflammation. Early and accurate diagnosis through advanced imaging techniques is critical to improving outcomes for patients with these conditions. Full article
(This article belongs to the Section Cardiology)
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17 pages, 1862 KiB  
Review
Prevalence, Diagnosis, and Treatment of Cardiac Tumors: A Narrative Review
by Mohamed Rahouma, Hosny Mohsen, Mahmoud Morsi, Sherif Khairallah, Lilian Azab, Maya Abdelhemid, Akshay Kumar and Magdy M. El-Sayed Ahmed
J. Clin. Med. 2025, 14(10), 3392; https://doi.org/10.3390/jcm14103392 - 13 May 2025
Cited by 2 | Viewed by 977
Abstract
Cardiac tumors, though rare, present significant diagnostic and therapeutic challenges due to their heterogeneous nature and anatomical complexity. This narrative review synthesizes current evidence on prevalence, diagnostic modalities, and management strategies for primary and metastatic cardiac tumors. Echocardiography, cardiac MRI, and CT remain [...] Read more.
Cardiac tumors, though rare, present significant diagnostic and therapeutic challenges due to their heterogeneous nature and anatomical complexity. This narrative review synthesizes current evidence on prevalence, diagnostic modalities, and management strategies for primary and metastatic cardiac tumors. Echocardiography, cardiac MRI, and CT remain cornerstone imaging tools for differentiating tumors from non-neoplastic masses, while advances in PET/CT and tissue characterization techniques refine staging and treatment planning. Surgical resection with clear margins (R0) is critical for resectable tumors, particularly benign myxomas, though malignant tumors like sarcomas require multimodal approaches combining surgery, radiotherapy, and systemic therapies. Emerging strategies such as heart autotransplantation and staged resections offer promise for complex cases, while oligometastatic disease management highlights the role of stereotactic radiotherapy and immunotherapy. Key challenges include standardizing resection margins, optimizing neoadjuvant therapies, and addressing high recurrence rates in malignancies. Future directions emphasize integrating AI-driven imaging analysis, molecular biomarkers, and genomic profiling to personalize therapies, alongside global registries to enhance data on rare tumors. Equitable access to advanced diagnostics and multidisciplinary collaboration are essential to improve outcomes. This review underscores the need for standardized guidelines, technological innovation, and patient-centered research to address gaps in cardiac oncology. Full article
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18 pages, 2586 KiB  
Systematic Review
Brain Metastases from Primary Cardiac Tumors: A Systematic Review of Diagnosis, Treatment, and Prognosis
by Salvatore Marrone, Ignazio Alessio Gueli, Roberta Lo Coco, Lorenzo Scalia, Salvatore Rizzica, Giuliana Baiamonte, Roberta Costanzo, Antonino Salvatore Rubino, Gianluca Ferini, Giuseppe Emmanuele Umana and Gianluca Scalia
Cancers 2025, 17(10), 1621; https://doi.org/10.3390/cancers17101621 - 10 May 2025
Viewed by 689
Abstract
Background: Primary cardiac tumors (PCTs) are rare entities, with only a minority being malignant and capable of distant dissemination. Among the rarest and most challenging metastatic events are brain metastases originating from cardiac tumors. Due to the heart’s direct access to systemic [...] Read more.
Background: Primary cardiac tumors (PCTs) are rare entities, with only a minority being malignant and capable of distant dissemination. Among the rarest and most challenging metastatic events are brain metastases originating from cardiac tumors. Due to the heart’s direct access to systemic circulation, even benign tumors such as atrial myxomas may cause cerebral embolic phenomena. Understanding the distinct biological behavior, diagnostic pathways, therapeutic strategies, and prognostic implications of these cases remains limited by the scarcity of the available literature. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, Embase, and other major databases were systematically searched using specific MeSH terms and keywords related to cardiac tumors and brain metastases. After applying strict inclusion and exclusion criteria, nineteen studies were included, comprising sixteen single-patient case reports and three multi-patient series. Extracted data included tumor histology, cardiac and brain imaging findings, neurological presentation, treatment approaches, and patient outcomes. Results: A total of 320 patients were analyzed. Atrial myxomas represented the predominant benign tumors causing embolic cerebral events, while angiosarcomas and other cardiac sarcomas were responsible for true hematogenous brain metastases. Brain involvement was frequently hemorrhagic and manifested with seizures, focal deficits, or signs of intracranial hypertension. Cardiac echocardiography and cardiac magnetic resonance imaging (CMR) were essential for tumor detection, while brain MRI, including SWI and DWI sequences, and CT scanning were critical for cerebral lesion characterization. Treatment strategies varied according to tumor type and included surgery, radiotherapy, and systemic therapies. Malignant cardiac tumors correlated with a poor prognosis, with median survival post-CNS involvement ranging from 12 to 14 months. Conclusions: Brain metastases from PCTs, though rare, represent a distinct and serious clinical phenomenon. Benign tumors like myxomas mainly cause embolic cerebral events, whereas malignant tumors, particularly sarcomas, lead to true metastatic brain lesions. Recognizing this biological distinction is crucial for diagnosis, prognostication, and therapeutic planning. An integrated multidisciplinary approach combining advanced cardiac and neuroimaging techniques is vital for early detection and appropriate management. Despite multimodal treatment, survival remains limited, underscoring the urgent need for novel targeted therapies and improved surveillance strategies. Full article
(This article belongs to the Special Issue Cancer Cells Fostered Microenvironment in Metastasis)
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23 pages, 2425 KiB  
Systematic Review
Emerging Image-Guided Navigation Techniques for Cardiovascular Interventions: A Scoping Review
by Majid Roshanfar, Mohammadhossein Salimi, Sun-Joo Jang, Albert J. Sinusas, Jiwon Kim and Bobak Mosadegh
Bioengineering 2025, 12(5), 488; https://doi.org/10.3390/bioengineering12050488 - 2 May 2025
Viewed by 872
Abstract
Background: Image-guided navigation has revolutionized precision cardiac interventions, yet current technologies face critical limitations in real-time guidance and procedural accuracy. Method: Here, we comprehensively evaluate state-of-the-art imaging modalities, from conventional fluoroscopy to emerging hybrid systems, analyzing their applications across coronary, structural, and electrophysiological [...] Read more.
Background: Image-guided navigation has revolutionized precision cardiac interventions, yet current technologies face critical limitations in real-time guidance and procedural accuracy. Method: Here, we comprehensively evaluate state-of-the-art imaging modalities, from conventional fluoroscopy to emerging hybrid systems, analyzing their applications across coronary, structural, and electrophysiological interventions. Results: We demonstrate that novel approaches combining optical coherence tomography with near-infrared spectroscopy or fluorescence achieve unprecedented plaque characterization and procedural guidance through simultaneous structural and molecular imaging. Our analysis reveals key challenges, including imaging artifacts and resolution constraints, while highlighting recent technological solutions incorporating artificial intelligence and robotics. We show that non-imaging alternatives, such as fiber optic real-shape sensing and electromagnetic tracking, complement traditional techniques by providing real-time navigation without radiation exposure. This paper also discusses the integration of image-guided navigation techniques into augmented reality systems and patient-specific modeling, highlighting initial clinical studies that demonstrate their significant promise in reducing procedural times and improving accuracy. These findings establish a framework for next-generation cardiac interventions, emphasizing the critical role of multimodal imaging platforms enhanced by AI-driven decision support. Conclusions: We conclude that continued innovation in hybrid imaging systems, coupled with advances in automation, will be essential for optimizing procedural outcomes and expanding access to complex cardiac interventions. Full article
(This article belongs to the Special Issue Advancements in Medical Imaging Technology)
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5 pages, 1203 KiB  
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A Rare Case of Severe Aortic Regurgitation Secondary to Tenting of Chordae Tendineae Strands: A Multimodality Imaging Approach for a Challenging Diagnosis
by Dario Catapano, Santo Dellegrottaglie, Alessandra Scatteia, Carlo Maria Gallinoro, Carmine Emanuele Pascale, Luigi Falco, Emilio Di Lorenzo and Daniele Masarone
Diagnostics 2025, 15(9), 1071; https://doi.org/10.3390/diagnostics15091071 - 23 Apr 2025
Viewed by 381
Abstract
We discuss a case of a patient who was referred to our department for an in-depth evaluation of aortic regurgitation severity and its underlying causes. By employing a multimodal imaging strategy that combined transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance [...] Read more.
We discuss a case of a patient who was referred to our department for an in-depth evaluation of aortic regurgitation severity and its underlying causes. By employing a multimodal imaging strategy that combined transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging (cMRI), we successfully identified a particularly rare cause of aortic regurgitation: chordae tendineae that lead to asymmetric retraction of the aortic cusps. Furthermore, this approach provided a clearer understanding of the aortic root anatomy and the hemodynamic effects of the regurgitant flow on the ventricle. This case demonstrates the diagnostic effectiveness of various imaging techniques and emphasizes the crucial importance of multimodal imaging for a thorough assessment of aortic valvular issues. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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12 pages, 753 KiB  
Review
Diagnostic Challenges in the Management of Aortic Valve Stenosis and the Role of Imaging: A Narrative Review
by Dimitrios Karelas, Evangelos Tatsis, Dimitrios Oikonomidis and Constantinos Hristou Papadopoulos
J. Clin. Med. 2025, 14(4), 1231; https://doi.org/10.3390/jcm14041231 - 13 Feb 2025
Cited by 1 | Viewed by 1160
Abstract
Aortic valve stenosis (AS) is a prevalent and progressive valvular disease that poses significant diagnostic challenges, particularly in low-flow, low-gradient (LF-LG) states. Accurate assessment of AS severity is crucial for timely intervention and improved clinical outcomes. This narrative review critically evaluates the limitations [...] Read more.
Aortic valve stenosis (AS) is a prevalent and progressive valvular disease that poses significant diagnostic challenges, particularly in low-flow, low-gradient (LF-LG) states. Accurate assessment of AS severity is crucial for timely intervention and improved clinical outcomes. This narrative review critically evaluates the limitations of conventional echocardiographic techniques and explores the role of multimodal imaging—including advanced echocardiography, computed tomography (CT), and cardiac magnetic resonance (CMR)—in enhancing diagnostic accuracy. Special emphasis is placed on the unique challenges of LF-LG AS, where standard Doppler-derived assessments may misclassify disease severity, necessitating a more integrative diagnostic approach. By addressing these key diagnostic uncertainties and proposing a multimodal framework for improved assessment, this review provides a comprehensive update on best practices in AS evaluation, with the goal of optimizing clinical decision making and patient outcomes. Full article
(This article belongs to the Special Issue Current Advances in Aortic Valve Stenosis)
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20 pages, 2341 KiB  
Review
Diagnostic Algorithm Using Multimodal Imaging for the Differential Diagnosis of Intra-Cardiac Masses
by Fabiola B. Sozzi, Eleonora Gnan, Andrea Pandolfi, Laura Iacuzio, Jin Kyung Kim, Ciro Canetta, Alessandra S. Rizzuto, Massimiliano Ruscica and Stefano Carugo
J. Clin. Med. 2025, 14(2), 508; https://doi.org/10.3390/jcm14020508 - 15 Jan 2025
Cited by 1 | Viewed by 1326
Abstract
Cardiac masses are complex clinical conditions that frequently pose diagnostic challenges in cardiology practice. These masses can form within heart chambers or near the pericardium and are generally categorized as either non-neoplastic or neoplastic. These latter are further classified into benign and malignant [...] Read more.
Cardiac masses are complex clinical conditions that frequently pose diagnostic challenges in cardiology practice. These masses can form within heart chambers or near the pericardium and are generally categorized as either non-neoplastic or neoplastic. These latter are further classified into benign and malignant (primary and secondary or metastatic). Diagnosing these conditions often requires a multiparametric approach that includes both clinical features, such as the patient’s and associated clinical conditions, and multimodality imaging. However, histological examination of the resected specimen is often necessary to ascertain the nature of the mass. Given their heterogeneity and the rarity of many cardiac masses, there are no guidelines or consensus on the best diagnostic approach. Modern imaging protocols must be tailored to the specific clinical issues and patient characteristics, given the rapid advancements in technology. Thus, it is imperative to use a multimodality approach, combining different imaging techniques and multidisciplinary teamwork. Hereby, we propose a practical algorithm for evaluating cardiac lesions using a step-by-step implementation of multimodal imaging. Ultimately, the goal is to tailor the most suitable imaging technique to the patient’s needs. Full article
(This article belongs to the Section Cardiology)
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21 pages, 3125 KiB  
Review
Advances in Cardiovascular Multimodality Imaging in Patients with Marfan Syndrome
by Marco Alfonso Perrone, Sara Moscatelli, Giulia Guglielmi, Francesco Bianco, Deborah Cappelletti, Amedeo Pellizzon, Andrea Baggiano, Enrico Emilio Diviggiano, Maria Ricci, Pier Paolo Bassareo, Akshyaya Pradhan, Giulia Elena Mandoli, Andrea Cimini and Giuseppe Caminiti
Diagnostics 2025, 15(2), 172; https://doi.org/10.3390/diagnostics15020172 - 14 Jan 2025
Cited by 1 | Viewed by 1606
Abstract
Marfan syndrome (MFS) is a genetic disorder affecting connective tissue, often leading to cardiovascular complications such as aortic aneurysms and mitral valve prolapse. Cardiovascular multimodality imaging plays a crucial role in the diagnosis, monitoring, and management of MFS patients. This review explores the [...] Read more.
Marfan syndrome (MFS) is a genetic disorder affecting connective tissue, often leading to cardiovascular complications such as aortic aneurysms and mitral valve prolapse. Cardiovascular multimodality imaging plays a crucial role in the diagnosis, monitoring, and management of MFS patients. This review explores the advancements in echocardiography, cardiovascular magnetic resonance (CMR), cardiac computed tomography (CCT), and nuclear medicine techniques in MFS. Echocardiography remains the first-line tool, essential for assessing aortic root, mitral valve abnormalities, and cardiac function. CMR provides detailed anatomical and functional assessments without radiation exposure, making it ideal for long-term follow-up. CT offers high-resolution imaging of the aorta, crucial for surgical planning, despite its ionizing radiation. Emerging nuclear medicine techniques, though less common, show promise in evaluating myocardial involvement and inflammatory conditions. This review underscores the importance of a comprehensive imaging approach to improve outcomes and guide interventions in MFS patients. It also introduces novel aspects of multimodality approaches, emphasizing their impact on early detection and management of cardiovascular complications in MFS. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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19 pages, 2762 KiB  
Review
The Role of Advanced Cardiac Imaging in Monitoring Cardiovascular Complications in Patients with Extracardiac Tumors: A Descriptive Review
by Annamaria Tavernese, Valeria Cammalleri, Rocco Mollace, Giorgio Antonelli, Mariagrazia Piscione, Nino Cocco, Myriam Carpenito, Carmelo Dominici, Massimo Federici and Gian Paolo Ussia
J. Cardiovasc. Dev. Dis. 2025, 12(1), 9; https://doi.org/10.3390/jcdd12010009 - 29 Dec 2024
Cited by 1 | Viewed by 1533
Abstract
Cardiac involvement in cancer is increasingly important in the diagnosis and follow-up of patients. A thorough cardiovascular evaluation using multimodal imaging is crucial to assess any direct cardiac involvement from oncological disease progression and to determine the cardiovascular risk of patients undergoing oncological [...] Read more.
Cardiac involvement in cancer is increasingly important in the diagnosis and follow-up of patients. A thorough cardiovascular evaluation using multimodal imaging is crucial to assess any direct cardiac involvement from oncological disease progression and to determine the cardiovascular risk of patients undergoing oncological therapies. Early detection of cardiac dysfunction, particularly due to cardiotoxicity from chemotherapy or radiotherapy, is essential to establish the disease’s overall prognostic impact. Comprehensive cardiovascular imaging should be integral to the clinical management of cancer patients. Echocardiography remains highly effective for assessing cardiac function, including systolic performance and ventricular filling pressures, with speckle-tracking echocardiography offering early insights into chemotoxicity-related myocardial damage. Cardiac computed tomography (CT) provides precise anatomical detail, especially for cardiac involvement due to metastasis or adjacent mediastinal or lung tumors. Coronary assessment is also important for initial risk stratification and monitoring potential coronary artery disease progression after radiotherapy or chemotherapeutic treatment. Finally, cardiac magnetic resonance (CMR) is the gold standard for myocardial tissue characterization, aiding in the differential diagnosis of cardiac masses. CMR’s mapping techniques allow for early detection of myocardial inflammation caused by cardiotoxicity. This review explores the applicability of echocardiography, cardiac CT, and CMR in cancer patients with extracardiac tumors. Full article
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13 pages, 2308 KiB  
Review
Cardiac Surgery and Transcatheter Intervention for Valvular Heart Disease in Carcinoid Syndrome: Risk Factors, Outcomes, and Evolving Therapeutic Strategies
by Mariagrazia Piscione, Valeria Cammalleri, Giorgio Antonelli, Valeria Maria De Luca, Myriam Carpenito, Dario Gaudio, Nino Cocco, Antonio Nenna, Carmelo Dominici, Antonio Bianchi, Francesco Grigioni and Gian Paolo Ussia
J. Cardiovasc. Dev. Dis. 2024, 11(11), 359; https://doi.org/10.3390/jcdd11110359 - 7 Nov 2024
Cited by 1 | Viewed by 1277
Abstract
Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing [...] Read more.
Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing valvular heart disease. Cardiac imaging plays a critical role in the management of CHD, so the final diagnosis can be performed through multimodal imaging techniques and the measurement of biomarkers. Moreover, in observational studies, surgical treatment of carcinoid-induced valve disease has been found to improve outcomes. Despite advancements in pre-operative preparation in recent years, mortality rates remain high in elderly patients and those with multiple comorbidities due to the risk of intra-operative carcinoid crisis and high post-operative bleeding. In this comprehensive review, we will analyze the causes of carcinoid syndrome and how it can result in severe right heart failure. The role of different imaging modalities in detecting heart valve disease will be discussed together with the therapeutic options at our disposal, such as medical treatment, surgery, and the novel role of transcatheter intervention. Full article
(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)
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22 pages, 2200 KiB  
Article
Intra- and Interpatient ECG Heartbeat Classification Based on Multimodal Convolutional Neural Networks with an Adaptive Attention Mechanism
by Ítalo Flexa Di Paolo and Adriana Rosa Garcez Castro
Appl. Sci. 2024, 14(20), 9307; https://doi.org/10.3390/app14209307 - 12 Oct 2024
Cited by 4 | Viewed by 2743
Abstract
Echocardiography (ECG) is a noninvasive technology that is widely used for recording heartbeats and diagnosing cardiac arrhythmias. However, interpreting ECG signals is challenging and may require substantial time from medical specialists. The evolution of technology and artificial intelligence has led to advances in [...] Read more.
Echocardiography (ECG) is a noninvasive technology that is widely used for recording heartbeats and diagnosing cardiac arrhythmias. However, interpreting ECG signals is challenging and may require substantial time from medical specialists. The evolution of technology and artificial intelligence has led to advances in the study and development of automatic arrhythmia classification systems to aid in medical diagnoses. Within this context, this paper introduces a framework for classifying cardiac arrhythmias on the basis of a multimodal convolutional neural network (CNN) with an adaptive attention mechanism. ECG signal segments are transformed into images via the Hilbert space-filling curve (HSFC) and recurrence plot (RP) techniques. The framework is developed and evaluated using the MIT-BIH public database in alignment with AAMI guidelines (ANSI/AAMI EC57). The evaluations accounted for interpatient and intrapatient paradigms, considering variations in the input structure related to the number of ECG leads (lead MLII and V1 + MLII). The results indicate that the framework is competitive with those in state-of-the-art studies, particularly for two ECG leads. The accuracy, precision, sensitivity, specificity and F1 score are 98.48%, 94.15%, 80.23%, 96.34% and 81.91%, respectively, for the interpatient paradigm and 99.70%, 98.01%, 97.26%, 99.28% and 97.64%, respectively, for the intrapatient paradigm. Full article
(This article belongs to the Section Computing and Artificial Intelligence)
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12 pages, 4191 KiB  
Review
Assessment of Tricuspid Regurgitation by Cardiac Magnetic Resonance Imaging: Current Role and Future Applications
by Lobke L. Pype, Blanca Domenech-Ximenos, Bernard P. Paelinck, Nicole Sturkenboom and Caroline M. Van De Heyning
J. Clin. Med. 2024, 13(15), 4481; https://doi.org/10.3390/jcm13154481 - 31 Jul 2024
Cited by 1 | Viewed by 2066
Abstract
Tricuspid regurgitation (TR) is a prevalent valvular disease with a significant mortality rate. The evaluation of TR severity and associated right heart remodeling and dysfunction is crucial to determine the optimal therapeutic strategy and to improve prognosis. While echocardiography remains the first-line imaging [...] Read more.
Tricuspid regurgitation (TR) is a prevalent valvular disease with a significant mortality rate. The evaluation of TR severity and associated right heart remodeling and dysfunction is crucial to determine the optimal therapeutic strategy and to improve prognosis. While echocardiography remains the first-line imaging technique to evaluate TR, it has many limitations, both operator- and patient-related. Cardiovascular magnetic resonance imaging (CMR) has emerged as an innovative and comprehensive non-invasive cardiac imaging technique with additional value beyond routine echocardiographic assessment. Besides its established role as the gold standard for the evaluation of cardiac volumes, CMR can add important insights with regard to valvular anatomy and function. Accurate quantification of TR severity, including calculation of regurgitant volume and fraction, can be performed using either the well-known indirect volumetric method or novel 4D flow imaging. In addition, CMR can be used to assess the impact on the right heart, including right heart remodeling, function and tissue characterization. Several CMR-derived parameters have been associated with outcome, highlighting the importance of multi-modality imaging in patients with TR. The aim of this review is to provide an overview of the current role of CMR in the assessment and management of patients with TR and its future applications. Full article
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14 pages, 5376 KiB  
Review
Aortic Regurgitation in Bicuspid Aortic Valve: The Role of Multimodality Imaging
by Lucia La Mura, Maria Lembo, Francesca Musella, Marianna D’Amato, Antonello D’Andrea, Raffaele Izzo and Giovanni Esposito
J. Clin. Med. 2024, 13(13), 3924; https://doi.org/10.3390/jcm13133924 - 4 Jul 2024
Cited by 1 | Viewed by 2447
Abstract
The evaluation of aortic regurgitation (AR) in bicuspid valve (BAV) is still a challenge because of the eccentricity of the jet, which may under/overestimate the regurgitation. The commonly used echocardiography parameters (such as vena contracta, pressure half-time, etc.) may not be useful in [...] Read more.
The evaluation of aortic regurgitation (AR) in bicuspid valve (BAV) is still a challenge because of the eccentricity of the jet, which may under/overestimate the regurgitation. The commonly used echocardiography parameters (such as vena contracta, pressure half-time, etc.) may not be useful in this kind of patient. A multimodality approach combining echocardiography, cardiac MRI, cardiac CT, and advanced technologies applied to non-invasive cardiac imaging (e.g., 4D flow and strain imaging) may be useful to better quantify regurgitation and to select patients suitable for valve replacement. This review provides an overview of the most recent insights about cardiovascular imaging tools and their utility in BAV evaluation, focusing on chronic regurgitation. We describe the role of multimodality imaging in both diagnosis and risk assessment of this disease, pointing out the advantages and disadvantages of the imaging techniques, aiming to provide a guide to clinicians and cardiovascular imaging specialists in choosing the best imaging tools to use. Full article
(This article belongs to the Special Issue Heart Valve Disease and Imaging Techniques)
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19 pages, 4961 KiB  
Review
Diagnostic Challenges in Aortic Stenosis
by André González-García, Pablo Pazos-López, Francisco Eugenio Calvo-Iglesias, Tatiana Mallely Matajira-Chía, Raquel Bilbao-Quesada, Elisa Blanco-González, Carina González-Ríos, María Castiñeira-Busto, Manuel Barreiro-Pérez and Andrés Íñiguez-Romo
J. Cardiovasc. Dev. Dis. 2024, 11(6), 162; https://doi.org/10.3390/jcdd11060162 - 23 May 2024
Cited by 2 | Viewed by 5011
Abstract
Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic [...] Read more.
Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. On the one hand, the acoustic window may be inadequate and the TTE limited in some cases. On the other hand, a growing body of evidence shows that patients with low gradients (due to systolic dysfunction, concentric hypertrophy or coexistence of another valve disease such as mitral stenosis or regurgitation) may develop severe AS (low-flow low-gradient severe AS) with a similar or even worse prognosis. The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients. Full article
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