Cardiac Imaging: A Multimodality Approach

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Rosa Sicari. Article history. Cite Citation. Permissions Icon Permissions. Abstract Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy HCM , imaging techniques play an essential role in the evaluation of patients with this disease.

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Hypertrophic cardiomyopathy , Left ventricular hypertrophy , Echocardiography , Cardiac magnetic resonance , Cardiac computed tomography , Cardiac nuclear imaging , Multimodality imaging. Differential diagnoses with phenocopies. View Large. Resolution and contrast to noise ratio of the different imaging techniques.

View large Download slide. Experts in different imaging techniques must collaborate and the different imaging methods must be seen as complementary rather than competitive. Each test must be selected in an integrated and rational way, providing answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, always taking into account its availability, benefits, risks, and cost.

Echocardiography is recommended in all HCM patients and should be performed every 1—2 years in clinically stable patients. It should be performed at least once at the initial evaluation if local resources and expertise permit, and may be repeated according to potential changes in the clinical status, in order to answer to specific clinical questions and problems. Cardiac CT and nuclear imaging techniques have more limited indications in this disease and are only indicated in specific clinical situations.

The presence, distribution, and severity of LVH should be documented in all HCM patients using a common standardized protocol for all imaging modalities. Measurements of LV wall thickness should be performed at end diastole and are more accurate in short-axis views. The systematic assessment of intraventricular obstruction at rest and with bedside manoeuvres—Valsalva and standing and of all the components of the mitral valve apparatus is mandatory.

CMR with LGE assessment should be performed to provide tissue characterization presence, location, type, and extension of fibrosis and to accurately document anatomy WT, mitral valve apparatus, and mechanism of obstruction and MR when these are not conclusively defined on echocardiography. Echocardiography is the first-line technique to assess systolic and diastolic function in HCM.

The 2D-STE assessment of LV systolic radial and circumferential function as well as rotational and twist mechanics are currently not recommended as clinical but as research tools. Isolated transmitral inflow patterns and grades should not be used to quantify LV FPs. Nuclear imaging methods and cardiac CT have limited indications in the assessment of systolic and diastolic function in this disease. The assessment of myocardial ischaemia is an important but often forgotten topic in HCM and its assessment remains controversial.

Alternatively, stress echocardiography CFR assessment of the LAD with concomitant wall motion analysis provides diagnostic and prognostic information and may allow the distinction between obstructive epicardial CAD and microvascular ischaemia. For studying pathophysiological processes related to ischaemia, metabolism, myocardial receptors and innervation, nuclear imaging techniques may be useful, though their routine clinical use is not recommended.

Echocardiography is recommended in all patients undergoing medical and invasive treatment. ASA and on the type of surgery valve replacement vs. CT can be used to evaluate the anatomical distribution of the septal arteries before ASA. Moreover, CT is a suitable alternative when echocardiographic images are inadequate and CMR is contraindicated.

Routine nuclear imaging for the assessment of therapeutic procedures non-invasive and invasive is not recommended in patients with HCM. Nuclear testing may be performed when there are technical limitations, non-availability or contraindications for echocardiography, CMR, or cardiac CT. No radiation, usually no contrast. HCM, hypertrophic cardiomyopathy.

Anatomical assessment before invasive gradient reduction therapy surgery vs. Echocardiography is the first-line imaging modality for family screening and for preclinical diagnosis. CMR is indicated in cases of suboptimal echocardiographic image quality, doubtful or borderline echo data, abnormal ECG with normal echo, or in high-risk families with a non-diagnostic echocardiogram. In the classical SCD risk assessment, echocardiography identifies one classical risk factor massive LVH and several non-conventional ones.

CMR, nuclear imaging techniques, and CT may be indicated for a more complete SCD risk assessment, including the assessment of fibrosis, ischaemia, and anatomical information on the coronary arteries. In the recent SCD risk prediction model, of the eight pre-specified predictor variables assessed at baseline evaluation related to SCD risk at 5 years, half are derived from echocardiography: maximal WT, fractional shortening not included in the final model , LA diameter, and LV outflow gradient, strengthening the crucial role of imaging in SCD risk prediction.

Echocardiography is still first-line modality, with CMR indicated when echocardiography is inconclusive or when information related to tissue characterization or to the presence of myocardial fibrosis is needed. In the staging process of the natural history of the disease, echocardiography, CMR, and nuclear imaging may be used. In the AF profile, echocardiography remains the first-line technique to assess LA dimensions and remodelling.

CMR, CT, and nuclear techniques may be useful if echo data are inconclusive or for specific information. In the differential diagnosis with phenocopies, an integrated sequential assessment in whom all different imaging techniques may be useful is indicated. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology working group on myocardial and pericardial diseases. Search ADS. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Prevalence of idiopathic hypertrophic cardiomyopathy in China: a population-based echocardiographic analysis of adults.

Diagnostic, prognostic, and therapeutic implications of genetic testing for hypertrophic cardiomyopathy. Google Preview. The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. Cardiac magnetic resonance detection of myocardial scarring in hypertrophic cardiomyopathy. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance.

Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. Research priorities in hypertrophic cardiomyopathy: report of a working group of the National Heart, Lung, and Blood Institute. Patterns of disease progression in hypertrophic cardiomyopathy: an individualized approach to clinical staging.

Enhanced active cross-bridges during diastole: molecular pathogenesis of Tropomyosin's HCM mutations. Myocardial fibrosis as an early manifestation of hypertrophic cardiomyopathy. Clinical profile and significance of delayed enhancement in hypertrophic cardiomyopathy. Spectrum and clinical significance of systolic function and myocardial fibrosis assessed by cardiovascular magnetic resonance in hypertrophic cardiomyopathy. Prognostic significance of left atrial size in patients with hypertrophic cardiomyopathy from the Italian Registry for Hypertrophic Cardiomyopathy.

The many faces of hypertrophic cardiomyopathy: from developmental biology to clinical practice. Microvascular function is selectively impaired in patients with hypertrophic cardiomyopathy and sarcomere myofilament gene mutations. Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. Evidence for microvascular dysfunction in hypertrophic cardiomyopathy: new insights from multiparametric magnetic resonance imaging.

American Society of Echocardiography Clinical Recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy.

Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy phenotype revisited after 50 years with cardiovascular magnetic resonance. Clinical significance and therapeutic implications of the left ventricular outflow tract pressure gradient in hypertrophic cardiomyopathy. Experience from clinical genetics in hypertrophic cardiomyopathy: proposal for new diagnostic criteria in adult members of affected families. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two-dimensional echocardiography in patients.

Patterns and significance of distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy. A wide angle, two dimensional echocardiographic study of patients. Evaluation of pathological criteria for diagnosis of hypertrophic cardiomyopathy. Distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy: a two-dimensional echocardiographic study. Hypertrophic cardiomyopathy.

The importance of the site and the extent of hypertrophy. A review. Assessment of left ventricular mass in hypertrophic cardiomyopathy by real-time three-dimensional echocardiography using single-beat capture image. Steep left ventricle to aortic root angle and hypertrophic obstructive cardiomyopathy: study of a novel association using three-dimensional multimodality imaging. Can transthoracic live 3-dimensional echocardiography improve the recognition of midventricular obliteration in hypertrophic obstructive cardiomyopathy? Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography.

Utility of cardiac magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Diagnostic utility of cardiac magnetic resonance imaging in monozygotic twins with hypertrophic cardiomyopathy and identical pattern of left ventricular hypertrophy. Differentiation of athlete's heart from pathological forms of cardiac hypertrophy by means of geometric indices derived from cardiovascular magnetic resonance.

Mitral valve abnormalities identified by cardiovascular magnetic resonance represent a primary phenotypic expression of hypertrophic cardiomyopathy. Diversity of mitral valve abnormalities in obstructive hypertrophic cardiomyopathy. Echocardiographic assessment of mitral valve size in obstructive hypertrophic cardiomyopathy. Anatomic validation from mitral valve specimen.

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Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Paradoxical response to exercise in asymptomatic hypertrophic cardiomyopathy: a new description of outflow tract obstruction dynamics. The current and emerging role of cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. Mitral annular shape, size, and motion in normals and in patients with cardiomyopathy: evaluation with computed tomography.

Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. Prevalence of exercise-induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy. Papillary muscle displacement causes systolic anterior motion of the mitral valve. Experimental validation and insights into the mechanism of subaortic obstruction. Spontaneous variability of left ventricular outflow tract gradient in hypertrophic obstructive cardiomyopathy.

Are intraventricular gradients a cause of false positive treadmill exercise tests? Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Cardiomyopathy: appearances on ECG-gated detector row computed tomography. Quantification of left and right ventricular function and myocardial mass: comparison of low-radiation dose 2nd generation dual-source CT and cardiac MRI.

Assessment of mitral valve adaptation with gated cardiac computed tomography: validation with three-dimensional echocardiography and mechanistic insight to functional mitral regurgitation. A new echocardiographic approach for the detection of non-ischaemic fibrosis in hypertrophic myocardium. Noninvasive assessment of myocardial fibrosis in patients with obstructive hypertrophic cardiomyopathy. Progression of myocardial fibrosis assessed with cardiac magnetic resonance in hypertrophic cardiomyopathy.

Natural history of hypertrophic cardiomyopathy. A population-based study, through Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Myocardial scar detected by contrast-enhanced cardiac magnetic resonance imaging is associated with ventricular tachycardia in hypertrophic cardiomyopathy patients. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy.

Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy.

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Noninvasive imaging of myocardial extracellular matrix for assessment of fibrosis. Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Ultrasound elastic tensor imaging: comparison with MR diffusion tensor imaging in the myocardium. Assessment of myocardial fibrosis and coronary arteries in hypertrophic cardiomyopathy using combined arterial and delayed enhanced CT: comparison with MR and coronary angiography.

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A new method for quantification of left ventricular systolic function using a corrected ejection fraction. Tissue Doppler imaging assessment of long axis left ventricular function in hypertensive patients with concentric left ventricular hypertrophy: differential diagnosis with hypertrophic cardiomyopathy. Detection of left ventricular regional relaxation abnormalities and asynchrony in patients with hypertrophic cardiomyopathy with the use of tissue Doppler imaging. Characterization of left ventricular diastolic function by tissue Doppler imaging and clinical status in children with hypertrophic cardiomyopathy.

Tissue Doppler imaging to predict clinical course of patients with hypertrophic cardiomyopathy. Quantitative assessment of intrinsic regional myocardial deformation by Doppler strain rate echocardiography in humans: validation against three-dimensional tagged magnetic resonance imaging. Quantification of regional nonuniformity and paradoxical intramural mechanics in hypertrophic cardiomyopathy by high frame rate ultrasound myocardial strain mapping.

Use of strain imaging in detecting segmental dysfunction in patients with hypertrophic cardiomyopathy. Noninvasive myocardial strain measurement by speckle tracking echocardiography. Global and regional myocardial function quantification by two-dimensional strain. Systolic myocardial mechanics in hypertrophic cardiomyopathy: novel concepts and implications for clinical status. Tissue Doppler imaging predicts the development of hypertrophic cardiomyopathy in subjects with subclinical disease. Prevalence and clinical significance of systolic impairment in hypertrophic cardiomyopathy.

Association between regional ventricular function and myocardial fibrosis in hypertrophic cardiomyopathy assessed by speckle tracking echocardiography and delayed hyperenhancement magnetic resonance imaging. Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy.

Prolonged left ventricular twist in cardiomyopathies: a potential link between systolic and diastolic dysfunction. Assessment of regional systolic and diastolic dysfunction in familial hypertrophic cardiomyopathy using MR tagging. Delayed enhancement in hypertrophic cardiomyopathy: comparison with myocardial tagging MRI. Histopathological factors related to diastolic function in myocardial hypertrophy. Quantifying diastolic function in hypertrophic cardiomyopathy: the ongoing search for the Holy Grail.

Differences in distribution of myocardial abnormalities in patients with obstructive and nonobstructive asymmetric septal hypertrophy ASH : light and electron microscopic findings. Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy.

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Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Enlarged left atrial volume in hypertrophic cardiomyopathy: a marker for disease severity. Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study.

Changes in left ventricular filling and left atrial function six months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. An integrated approach to determine left atrial volume, mass and function in hypertrophic cardiomyopathy by two-dimensional echocardiography.

Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy. Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic cardiomyopathy. Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic cardiomyopathy: relation to symptoms and exercise capacity.

Aortic stiffness is increased in hypertrophic cardiomyopathy with myocardial fibrosis. Aortic stiffness independently predicts exercise capacity in hypertrophic cardiomyopathy: a multimodality imaging study. Verapamil-induced improvement in left ventricular diastolic filling and increased exercise tolerance in patients with hypertrophic cardiomyopathy: short- and long-term effects.

Myocardial ischemia in patients with hypertrophic cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Myocardial ischemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy and sudden death in the young: pathologic evidence of myocardial ischemia. Alterations of the architecture of subendocardial arterioles in patients with hypertrophic cardiomyopathy and impaired coronary vasodilator reserve: a possible cause for myocardial ischemia.

Hypertrophic cardiomyopathy: management, risk stratification, and prevention of sudden death. Prognostic implications of coronary flow reserve on left anterior descending coronary artery in hypertrophic cardiomyopathy. Dipyridamole echocardiography for diagnosis of coexistent coronary artery disease in hypertrophic cardiomyopathy. Prognostic value of exercise echocardiography in patients with hypertrophic cardiomyopathy. Regional heterogeneity of resting perfusion in hypertrophic cardiomyopathy is related to delayed contrast enhancement but not to systolic function: a PET and MRI study.

Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium emission computed tomography. Impact of surgical relief of outflow obstruction on thallium perfusion abnormalities in hypertrophic cardiomyopathy.

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  7. Effect of alcohol septal ablation in patients with hypertrophic cardiomyopathy on left-ventricular mechanical dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging. Coronary vasodilation is impaired in both hypertrophied and nonhypertrophied myocardium of patients with hypertrophic cardiomyopathy: a study with nitrogen ammonia and positron emission tomography. Coronary microvascular dysfunction and ischemia in hypertrophic cardiomyopathy.

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    Mechanisms and clinical consequences. Myocardial beta adrenoceptor density in primary and secondary left ventricular hypertrophy. Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment. Symptomatic myocardial bridges: overview of ischemic mechanisms and current diagnostic and treatment strategies. Functional characteristics of myocardial bridging. A combined angiographic and intracoronary Doppler flow study. Functional, angiographic and intracoronary Doppler flow characteristics in symptomatic patients with myocardial bridging: effect of short-term intravenous beta-blocker medication.

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    Myocardial bridging, a frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with sudden cardiac death. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a writing group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology.

    Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: meta-analysis of diagnostic accuracy, image quality, and radiation dose. Meta-analysis and systematic review of the long-term predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography. Coronary CT angiography can be used as a substitute for coronary angiography in patients with significant LV dysfunction.

    Myocardial bridging: depiction rate and morphology at CT coronary angiography—comparison with conventional coronary angiography. Assessment of myocardial bridge and mural coronary artery using ECG-gated slice CT angiography: a retrospective study. Anatomy and terminology for the interpretation and reporting of cardiac MDCT: part 1, structured report, coronary calcium screening, and coronary artery anatomy. Hypertrophic cardiomyopathy due to sarcomeric gene mutations is characterized by impaired energy metabolism irrespective of the degree of hypertrophy.

    Heterogeneity of myocardial fluoro 2-deoxyglucose uptake in patients with apical hypertrophic cardiomyopathy.

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    Myocardial presynaptic and postsynaptic autonomic dysfunction in hypertrophic cardiomyopathy. Iodine metaiodobenzylguanidine imaging and carbon hydroxyephedrine positron emission tomography compared in patients with left ventricular dysfunction. Hypertrophic cardiomyopathy in pediatric patients: effect of verapamil on regional and global left ventricular diastolic function. Effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy: pressure-volume analysis with a nonimaging scintillation probe.

    Benefits of intraoperative echocardiography in the surgical management of hypertrophic cardiomyopathy. Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. An excellent collection of information of all cardiac imaging modalities It is a good first textbook for physicians interested in the multimodality approach of cardiac imaging today Clinical Imaging May Written by an interdisciplinary team of experts Throughout all the chapters there are lavish high quality images - more than - along with many illustrations complementing the text.

    The text is also generously interspersed with key facts for quick revision and learning The book has a light, modern feel to is with an excellent use of tables One of the highlights of the book is the use of 'essential points' boxes to stress key areas The authors are to be commended on their use of high quality images as well as the book being well written and easy to follow The concept of the book and the design strcutrue are excellent. Help Centre. My Wishlist Sign In Join. Be the first to write a review. Add to Wishlist.

    Ships in 15 business days. These contrast-free protocols open up medical imaging to these patients and are important in imaging vascular disease and patients with kidney dysfunction. Aplio Artida At Dr. Echocardiography provides important heart imaging information and is a noninvasive, less expensive test without radiation. Albert to measure LV volumes, ejection fraction, regional and global quantification by means of 3D echocardiography in the same heart beat.

    Cardiac Magnetic Resonance Imaging (MRI) Basic Principles (Dipan Shah, MD) Sep. 29, 2015

    The 3D wall motion tracking feature is an industry first and provides quantification of wall motion used to assess abnormal motion often seen in ischemic heart disease. Together with SmartSlice, plane selection and i-style ergonomics that improve workflow and increase productivity, the Artida provides improved performance with advanced applications for any clinical setting. Future Leader in Cardiac Care and Medical Education The full suite of Toshiba imaging technologies is allowing the CVDC to diagnose and provide treatment plans for a variety of cardiovascular diseases without using invasive procedures.

    This multimodality approach improves patient safety and reduces healthcare costs as it allows patients to be imaged on the most efficient imaging system for their condition. The high image quality across all modalities and industry leading technology is paving the way for innovations in cardiac imaging and diagnosis. In addition to helping patients, the multimodality approach is positioning CVDC as a leader in cardiovascular medical education. Since opening the center, Dr. Albert has been involved in creating a cardiac MR education series for physicians and technologists through an education grant sponsored by Toshiba.

    The educational series, one of the first cardiac MR programs in the country, focuses on the latest techniques in cardiovascular MR imaging. Additionally, CVDC and Toshiba conducted a demonstration with physicians in Japan to operate the Vantage MR system remotely to aid in diagnosing a patient with an arrhythmic heart condition. This remote technology will allow Dr.

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    Cardiac Imaging: A Multimodality Approach Cardiac Imaging: A Multimodality Approach
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