JournalTOCs

Current Cardiovascular Imaging Reports
Journal Prestige (SJR): 0.34

Citation Impact (citeScore): 1
Number of Followers: 1

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1941-9074 - ISSN (Online) 1941-9066
Published by Springer-Verlag

[2570 journals]

Coronary Computed Tomography Angiography Improving Outcomes in Patients
with Chest Pain
- Abstract: Purpose of Review To provide an overview of recent studies of coronary computed tomography angiography (CCTA) and how it has helped to improve clinical outcomes for patients presenting with chest pain. Recent Findings Randomised controlled trials have uniformly demonstrated that the use of CCTA is associated with improvements in patient diagnosis, management and treatments as well as the avoidance of unnecessary invasive coronary angiography. These changes have been associated with consistent reductions in long-term rates of fatal or non-fatal myocardial infarction. Summary Major beneficial effects in clinical management and patient outcomes are seen with the use of coronary computed tomography angiography. CCTA might be considered to be the first test of choice for the investigation of coronary heart disease.
  PubDate: 2019-03-22
Artificial Intelligence in Nuclear Cardiology: Adding Value to
Prognostication
- Abstract: Purpose of the Review Radionuclide myocardial perfusion imaging (MPI) continues to be an accurate and reproducible method of diagnosing obstructive coronary artery disease (CAD) with predictive, prognostic, and economic value. We review the evolutionary potential of machine learning (ML), a subset of artificial intelligence, as an adjunct to MPI. Recent Findings Applying the broad scope of ML, including the integration of deep learning, can leverage the knowledge representation and automated reasoning to detect and extrapolate patterns from high-dimensional features of MPI. There is growing evidence to suggest superior abilities of ML over parametric statistical models for predicting the presence of obstructive CAD, the need for revascularization, and the occurrence of major adverse cardiac events including cardiac death. Summary ML is uniquely positioned to provide the next great advancement in the field of nuclear cardiology for improving patient-specific risk stratification.
  PubDate: 2019-03-19
CMR in Transcatheter Valve Interventions: State of the Art and Future
Directions
- Abstract: Purpose of Review Transcatheter valve interventions require careful planning and rely heavily on multimodality imaging. In contrast to echocardiography and computed tomography cardiovascular magnetic resonance (CMR) remains underused in clinical practice. Recent Findings CMR techniques such as multiplanar cine imaging unlimited by echo windows or ionizing radiation exposure, quantification of flow, and advanced tissue characterization have the potential to add valuable complimentary information to the evaluation of patients with valvular heart disease. Summary In this paper, we review the evidence for CMR to guide transcatheter valve interventions with a focus on practical applications for the interventionist.
  PubDate: 2019-03-01
Choosing the Appropriate Stress Test for Myocardial Perfusion Imaging
- Abstract: Purpose of Review Choosing the most appropriate test or protocol to ensure patient safety along with accurate and informative results can be challenging. The aim of this article is to review important considerations when choosing a nuclear stress perfusion study. Recent Findings Single-photon emission computed tomography (SPECT) has a sensitivity of 70% and a specificity of 78% for the diagnosis of coronary artery disease (CAD), and positron emission tomography (PET) has a sensitivity of 90% and specificity of 88%. The addition of either SPECT or PET to cardiac-gated computed tomography (CCTA) confers an increase in specificity when compared to CCTA alone, at the cost of a lower sensitivity. Summary SPECT sets itself aside because of its relative low cost and easy accessibility. PET has a superior diagnostic performance and lower radiation exposure, but is less available and relatively more expensive for most clinicians. When ordering a nuclear stress perfusion test, the type of protocol and radiotracers used should be tailored to achieve the best overall accuracy and prognostic assessment with the lowest radiation dose achievable.
  PubDate: 2019-02-28
Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure
- Abstract: Purpose of Review Cardiovascular diseases are the leading cause of deaths worldwide. Many complex cellular and molecular pathways lead to myocardial remodeling after ischemic insults. Anatomy, function, and viability of the myocardium can be assessed by modern medical imaging techniques by both visualizing and quantifying damages. Novel imaging techniques aim for a precise and accurate visualization of the myocardium and for the detection of alternations at the molecular level. Recent Findings Magnetic resonance imaging assesses anatomy, function, and tissue characterization of the myocardium non-invasively with high spatial resolution, sensitivity, and specificity. Using hyperpolarized magnetic resonance imaging, molecular and metabolic conditions can be assessed non-invasively. Single photon-emission tomography and positron-emission tomography are the most sensitive techniques to detect biological processes in the myocardium. Cardiac perfusion, metabolism, and viability are the most common clinical targets. In addition, molecular-targeted imaging of biological processes involved in heart failure, such as myocardial innervation, inflammation, and extracellular matrix remodeling, is feasible. Summary Novel imaging techniques can provide a precise and accurate visualization of the myocardium and for the detection of alternations at molecular level.
  PubDate: 2019-02-26
Advances in PET Imaging of Sarcoidosis
- Abstract: Purpose of Review The purpose of this paper is to provide an updated review of recent advances in protocols for positron emission tomography (PET) or PET/computed tomography (PET/CT) imaging in patients with sarcoidosis. Recent Findings There has been more research focused on developing newer and improved PET imaging modalities to diagnose and follow-up cardiac sarcoidosis (CS). Fluorine-18-fluorodeoxyglucose (18F- FDG)-PET are widely used to diagnose CS, with or without concurrent rest nuclear myocardial perfusion study. There have been various patient preparation strategies for FDG PET/CT in CS. Interpretation criteria for cardiac FDG PET/CT in diagnosing CS also varies. There are emerging data utilizing new PET radiotracers (i.e., 68Ga-DOTATATE, 18F-Flurpiridaz) and PET/MRI imaging for CS diagnosis. Summary Based on published imaging data, patient preparation with a 72-h high-fat, high-protein, and very-low-carbohydrate diet protocol generates the most promising results in suppression of physiological myocardial FDG uptake in cardiac PET/CT. The “focal-on-diffuse uptake” pattern on myocardial uptake is not convincing and should not be interpreted as active CS. Nuclear myocardial perfusion test might not be needed to diagnose CS if optimal suppression of myocardial background uptake of FDG is achieved. FDG PET/MRI with optimal patient preparation may increase diagnostic confidence. More data will be needed for new tracers to be used for CS diagnosis.
  PubDate: 2019-02-14
Contemporary Issues in Quantitative Myocardial Perfusion CMR Imaging
- Abstract: Purpose of Review This review highlights the development and application of quantitative myocardial perfusion by cardiac magnetic resonance (CMR) and discusses recent innovations in this area. Recent Findings First pass, contrast-enhanced CMR can accurately quantify myocardial perfusion in order to diagnose obstructive coronary artery disease and microvascular dysfunction. Quantitative analysis conveys additional prognostic information beyond other CMR findings. New, fully automated techniques may aid standardization of methods across centers. Summary CMR quantitative perfusion has robust performance for the diagnosis of obstructive coronary disease and microvascular dysfunction and conveys prognostic information. Adoption of automated post-processing and standardized protocols will further strengthen CMR in its position as the modality of choice for the evaluation of possible myocardial ischemia.
  PubDate: 2019-02-14
Plaque Assessment on Serial Coronary CTA
- Abstract: Purpose of Review This review addresses the role of serial coronary computed tomography angiography (CTA) on the evaluation of atherosclerosis progression, risk stratification, and targeting individual pharmacotherapy. Recent Findings The presence, extent, and severity of coronary artery disease (CAD) detected by coronary CTA are associated with an adverse prognosis. Similarly, the presence of high-risk plaque features such as positive remodeling, low-attenuation plaque, spotty calcifications, and napkin-ring sign are associated with major adverse cardiac events. More recently, examinations using serial coronary CTA have also shown that these static CTA plaque features are associated with a more rapid progression of atherosclerosis on follow-up imaging and may identify a subset of patients at increased risk for plaque rupture. While the impact of serial CTA findings on management and hard outcomes remains a topic of ongoing investigation, available data supports the ability of statin therapy to reduce CTA-identified plaque burden and modify plaque composition. Summary Coronary CTA identifies various plaque features associated with an increased risk of plaque progression and adverse cardiac events. Available data support the use of CTA to individualize statin therapy and utilize serial CTA imaging to study the impact of pharmacotherapy on plaque burden and outcomes.
  PubDate: 2019-02-14
Radionuclide Imaging in Chagas Cardiomyopathy
- Abstract: Purpose of Review To review the contributions of radionuclide imaging to understanding the manifestations and pathophysiology of chronic Chagas cardiomyopathy (CCC). Recent Findings Experimental studies using high-resolution SPECT myocardial perfusion imaging (MPI) show that myocardial perfusion derangement that corresponds to dysfunctional, viable myocardium is closely linked to inflammation and precedes LV regional systolic dysfunction. Clinical studies show that microvascular ischemia is strictly related to the areas of cardiac sympathetic denervation, assessed by 123I-MIBG imaging, which correlates with severe ventricular arrhythmia incidence. Initial case reports suggest that 18F-FDG-PET imaging is a promising, non-invasive detection method for myocardial inflammation. Summary Available evidence indicates that microvascular ischemia participates in the mechanisms causing myocardial injury in CCC, with potential implication for monitoring subclinical disease progression. Moreover, MIBG imaging is a promising tool for risk stratification of sudden death. Preliminary clinical experience suggests a role for 18F-FDG-PET in detection of inflammation in CCC.
  PubDate: 2019-02-12
Advances in Real-Time MRI–Guided Electrophysiology
- Abstract: Purpose of Review Theoretical benefits of real-time MRI guidance over conventional electrophysiology include contemporaneous 3D substrate assessment and accurate intra-procedural guidance and evaluation of ablation lesions. We review the unique challenges inherent to MRI-guided electrophysiology and how to translate the potential benefits in the treatment of cardiac arrhythmias. Recent Findings Over the last 5 years, there has been substantial progress, initially in animal models and more recently in clinical studies, to establish methods and develop workflows within the MR environment that resemble those of conventional electrophysiology laboratories. Real-time MRI-guided systems have been used to perform electroanatomic mapping and ablation in patients with atrial flutter, and there is interest in developing the technology to tackle more complex arrhythmias including atrial fibrillation and ventricular tachycardia. Summary Mainstream adoption of real-time MRI-guided electrophysiology will require demonstration of clinical benefit and will be aided by increased availability of devices suitable for use in the MRI environment.
  PubDate: 2019-02-12
Machine Learning in the Evaluation of Myocardial Ischemia Through Nuclear
Cardiology
- Abstract: Purpose of Review To summarize the advances achieved in the detection and characterization of myocardial ischemia and prediction of related outcomes through machine learning (ML)-based artificial intelligence (AI) workflows in both single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Recent Findings In the field of cardiology, the implementation of ML algorithms has recently gravitated around image processing for characterization, diagnostic, and prognostic purposes. Nuclear cardiology represents a particular niche for AI as it deals with complex images of semi-quantitative and quantitative nature acquired with SPECT and PET. Summary AI is revolutionizing clinical research. Since the recent convergence of powerful ML algorithms and increasing computational power, the study of very large datasets has demonstrated that clinical classification and prediction can be optimized by exploring very high-dimensional non-linear patterns. In the evaluation of myocardial ischemia, ML is optimizing the recognition of perfusion abnormalities beyond traditional measures and refining prediction of adverse cardiovascular events at the individual-patient level.
  PubDate: 2019-02-09
Myocardial Perfusion Imaging for the Evaluation of Ischemic Heart Disease
in Women
- Abstract: Purpose of the Review To review the value of myocardial blood flow and coronary flow reserve (CFR) measurements, as assessed by positron emission tomography (PET), in women with suspected ischemic heart disease. Recent Findings CFR is a noninvasive measure of coronary vasomotor function that integrates the hemodynamic effects of epicardial coronary stenosis, diffuse atherosclerosis, and microvascular dysfunction on myocardial tissue perfusion and has emerged as an imaging marker of cardiovascular risk, independently of the degree of obstructive coronary artery disease (CAD). Summary Normal coronary arteries or nonobstructive CAD is a common finding in women with ischemia. Thus, assessment of risk based on a coronary stenosis approach may fail in women. PET is able to quantify absolute myocardial blood flow and CFR which may help to elucidate other mechanisms involved such as microvascular dysfunction and diffuse epicardial CAD, responsible for the disease in women.
  PubDate: 2019-01-25
Stress Protocol and Myocardial Perfusion Imaging Accuracy
- Abstract: Purpose of Review To evaluate the most recent evolutions in the field of single photon emission computed tomography (SPECT) nuclear cardiac imaging (NCI), particularly regarding the influence of stress protocol specifics on test accuracy. Recent Findings The substantial improvement in both software and hardware SPECT settings may allow a drastic redefinition of the acquisition parameters, with a radical reduction of scanning time. Moreover, recent evidence has identified novel (contra)-indications to the different cardiac stressors, defining the categories of patients in which a specific stressor is most appropriate. Summary Whilst exercise stress is favoured in the majority of patients submitted to SPECT NCI, in patients with atrial fibrillation or diabetes mellitus, a vasodilator stress may be preferred because of a significantly higher specificity. Moreover, the use of non-perfusion variables, such as post-stress diastolic left ventricular parameters or eccentricity index, is favoured to increase the accuracy of SPECT imaging. Finally, the quantification of myocardial blood flow through dynamic scans with cadmium-zinc-telluride cameras is gaining its way in clinical practice, possibly further increasing NCI accuracy in the most difficult patients.
  PubDate: 2019-01-16
Microvascular Dysfunction in Hypertrophic Cardiomyopathy
- Abstract: Purpose of Review In hypertrophic cardiomyopathy (HCM), the presence of vessel abnormalities with microvascular dysfunction is a well-known feature. The aim of this review is to present the evidences that support this notion and to describe the physiopathologic and clinical consequences of microvascular dysfunction. Recent Findings After having demonstrated the presence and significance of microvascular dysfunction in HCM, the myocardial blood flow (MBF) measurement by positron emission tomography (PET) is ready to develop into a clinical tool for disease evaluation, in particular for patient prognostication. Alternative methods are becoming available, but they are not yet equally reliable. Summary By means of MBF measurement using quantitative PET, the importance of microvascular dysfunction in HCM has been clearly demonstrated, explaining the chest pain and the ischemic abnormalities frequently registered in this disease. The physiopathologic implications of microvascular dysfunction have been established, and an increasing number of reports indicate that the assessment of microvascular dysfunction is as well important for patient characterization and prognostication. Most recently, perfusion measurements using magnetic resonance imaging have been used, but their role is still under debate.
  PubDate: 2019-01-16
Correction to: Coronary CTA for Surveillance of Cardiac Allograft
Vasculopathy
- Abstract: The article Coronary CTA for Surveillance of Cardiac Allograft Vasculopathy, written by Nishant R. Shah, Ron Blankstein, Todd Villines, Hafiz Imran, Alan R. Morrison and Michael K. Cheezum, was originally published electronically on the publisher’s internet portal.
  PubDate: 2018-11-08
Diastolic Assessment: Application of the New ASE Guidelines
- Abstract: Purpose of Review The purpose of this review is to summarize the new guidelines from the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) for the diagnosis and grading of diastolic dysfunction (DD), with commentary on the rationale behind the use of the recommended individual parameters. Recent Findings Previous guidelines for assessment of diastolic function have been criticized for being too complex with modest diagnostic performance and inter-observer variability. Summary The new ASE/EACVI diastology guidelines aim to simplify the diagnosis and gradation of DD by using a limited set of echocardiographic variables. The robustness of these recommendations has been subsequently validated in several trials. Understanding the physiological principles that govern changes in echocardiographic parameters during normal and abnormal diastolic function is critical for the appropriate application of these recommendations.
  PubDate: 2018-10-31
IVUS- Versus OCT-Guided Coronary Stent Implantation: a Comparison of
Intravascular Imaging for Stent Optimization
- Abstract: Purpose of Review Intravascular imaging provides improved diagnostic accuracy and optimization of percutaneous coronary interventions (PCI) compared with angiography alone. We review the latest literature on the predominant intravascular imaging modalities, intravascular ultrasound (IVUS), and optical coherence tomography (OCT). Recent Findings A number of recently published clinical studies evaluating OCT and IVUS use have demonstrated improved procedural and clinical outcomes over angiography. Recent literature also reports on novel potential applications of these technologies. Summary Intravascular imaging is an important diagnostic tool that augments angiography. IVUS has been the primary adjunctive intravascular imaging modality in interventional cardiology over the past three decades, while OCT is a newer modality of growing clinical importance. Both modalities augment angiography alone while having their own specific advantages and disadvantages.
  PubDate: 2018-10-31
Diagnosis of Cardiac Amyloidosis: Clinical and Echocardiographic Features
- Abstract: Purpose of Review This review is geared to address the various forms of amyloidosis which have cardiac involvement and discuss the echocardiographic findings that may be present in patients with cardiac amyloidosis. Recent Findings The use of echocardiography has revolutionized the diagnosis of cardiac amyloidosis. The diagnosis is often first suspected due to characteristic echocardiographic findings. Although no single finding is pathognomonic, there are a constellation of features that point to the diagnosis including increased left and right ventricular wall thickness, thickened cardiac valves and atrial walls, and a pericardial effusion. Alterations in diastolic function with evidence of elevated filling pressures are common. The use of myocardial strain imaging has allowed for earlier detection of cardiac amyloidosis and has revealed a distinctive pattern, sometimes suggesting the diagnosis when more classic findings are subtle or absent. Multiple echocardiographic findings have been found to be prognostic in cardiac amyloid. Using current techniques, functional measures such as myocardial strain and stroke volume index are more powerful predictors of outcome than myocardial thickness. While other imaging modalities are complementary including cardiac magnetic resonance imaging and nuclear medicine scintigraphy techniques using bone tracers, echocardiography remains a mainstay in the diagnosis and follow-up of patients with cardiac amyloidosis. Summary Echocardiography is a critical tool in the evaluation of the patient with heart failure, as well as those with unexplained chest pain and arrhythmias. Key findings on an echocardiogram can help alert the clinician to the presence of cardiac amyloidosis. The degree of cardiac dysfunction in a patient with systemic amyloidosis correlates with prognosis. Recognition of subtle echocardiographic findings may allow for earlier and more aggressive treatment to improve overall mortality in patients with cardiac amyloidosis.
  PubDate: 2018-10-23
Stress Echocardiography: the Role in Assessing Valvular Heart Diseases
- Abstract: Purpose of Review Stress echocardiography (SE) has clinical utility beyond its conventional use for the evaluation of myocardial ischemia. More specifically, SE has been shown to have significant clinical value in patients with valvular heart disease (VHD), hypertrophic cardiomyopathy (HCM), and congenital heart disease (CHD). Echocardiography laboratories providing services to such patient should be familiar with the principals of SE beyond coronary artery disease to ensure its optimum application and performance. Recent Findings The increased demand for SE standardization specifically in patients with VHD instigated recent recommendations by relevant cardiology societies. Summary This manuscript reviews the key concepts in performance and interpretation of hemodynamic SE in patients with VHD and HCM, including patient selection, stress modality of choice, and integration of all diagnostic and prognostic information.
  PubDate: 2018-10-23
Intravascular Imaging for Chronic Total Occlusion Intervention
- Abstract: Purpose of Review We sought to summarize the current evidence on use of intravascular imaging (with intravascular ultrasound [IVUS] or optical coherence tomography [OCT]) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Recent Findings Utilization of intravascular imaging in CTO PCI is increasing over time, both to facilitate CTO crossing and for optimization of the final result. OCT is used less often than IVUS due to its lower depth of penetration and need for contrast injection. Summary Intravascular imaging has multiple uses in CTO PCI: (a) it can facilitate CTO crossing by resolving proximal cap ambiguity and facilitating and confirming true lumen wire re-entry in case of initial subintimal wire crossing in both the antegrade and retrograde direction (for example by selecting the appropriate balloon size during the reverse controlled antegrade and retrograde tracking (reverse CART) technique; (b) it can be used to optimize the PCI result by ensuring good stent expansion and stent strut apposition, which may in turn result in lower rates of subsequent in-stent restenosis and stent thrombosis; (c) can facilitate evaluation and treatment of complications.
  PubDate: 2018-10-17