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Imaging guided interventions

22.1 Introduction Recently, several minimally invasive approaches for interventional therapy of structural heart diseases have been developed. For example, transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option for high-risk patients that serves as an alternative for surgical aortic valve replacement. Also, high-risk patients with mitral valve regurgitation may benefit from interventional mitral valve clipping. Furthermore, left atrial appendage (LAA) closure devices may reduce the…

Arrhythmia

21.1 Introduction Electrophysiology comprises catheter ablations and cardiac implantable electrical devices (CIED) for malconduction and arrhythmia management, prevention of sudden cardiac death, or cardiac resynchronization, and is a rapidly growing field in cardiology. There is an increased clinical use of advanced cardiac imaging for pre-procedural assessment, procedure guidance, detection of complications, and follow-up in patients with arrhythmias or conduction disturbances ( Table 21.1 ) [ ].…

Diseases of the thoracic aorta and pulmonary arteries

20.1 Introduction A wide variety of diseases can affect the great thoracic arteries. They include entities resulting from long-standing atherosclerotic degeneration (e.g., aortic aneurysms) that as such can go undetected for a prolonged time, as well as diseases presenting with acute severe and potentially life-threatening symptoms, like pulmonary embolism and acute aortic dissection. As clinical signs and other preliminary tests are often unreliable to establish a…

Congenital heart disease

Abbreviations and acronyms 3D three-dimensional 4 CV apical 4-chamber view AICD automatic implantable cardiac defibrillator ASD atrial septal defect ccTGA congenitally corrected transposition of the great arteries CHD congenital heart disease CoA coarctation of the aorta CMR cardiac magnetic resonance CT computed tomography LV left ventricle LVOT left ventricular outflow tract RV right ventricle RVOT right ventricular outflow tract SPECT single photon emission computed tomography TAPSE…

Pericardial diseases

18.1 Introduction Pericardial diseases represent a broad range of clinical syndromes and may be present in various associated diseases conveying significant morbidity and mortality [ , ]. The evaluation of pericardial conditions can be complex, and imaging techniques play a key role for an appropriate clinical approach. Although echocardiography is the first-line imaging technique for the diagnosis and the follow-up of pericardial disease, computed tomography (CT),…

Cardiac tumours

17.1 Introduction Cardiac tumours are a rare finding, with an autopsy prevalence of less than 0.5% [ , ]. However, even when pathologically benign, they can fatally compromise cardiac haemodynamics or lead to serious complications such as embolism or arrhythmia [ ]. Approximately 75% of all primary cardiac tumours are benign, and the most common in adults are myxomas (50%), papillary elastomas (20%), lipomas (15–20%), and…

Acquired valvular heart disease

Aortic root V. Polsani X. Zhou M. Vannan Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA Chinese PLA General Hospital Echocardiography has an established role in the morphological and hemodynamic assessment of the disorders of aortic root; hence, this section will focus on the essentials of advanced, integrated quantitative imaging of the aortic root to guide interventions. The annulus, the aortic valve (AV) leaflets, the sinuses of…

Systemic diseases

15.1 Arterial systemic hypertension Arterial systemic hypertension is a well established, leading cardiovascular (CV) risk factor for morbidity and mortality in the general population. Myocardial infarction, heart failure, and sudden death are the main fatal and non-fatal complications in hypertensive patients [ ]. The clinical consequences of hypertension on the heart derive from chronic pressure overload, such as to induce left ventricular (LV) structural and functional…

Myocarditis

14.1 Clinical background 14.1.1 Etiology and presentation Acute myocardial inflammation can induce a broad clinical spectrum, from subclinical disease to fulminant acute heart failure [ ]. Myocarditis more often affects young male than female or elderly patients [ ]. The clinical presentation differs depending on age and gender [ ]. Young men often present with acute chest pain similar to myocardial infarction after a few days…

Cardiomyopathy

13.1 Introduction 13.1.1 Definition and spectrum of disease The term cardiomyopathy refers to a diverse range of diseases of the heart muscle associated with mechanical and/or electrical dysfunction [ ]. These conditions are of particular importance due to their propensity to cause significant morbidity and mortality, frequently through heart failure and arrhythmia. The myocardial disease may be primary or a secondary consequence of a systemic condition.…

Contractile function and heart failure

12.1 Introduction Heart failure (HF) is a growing problem worldwide. Almost 6 million Americans and 15 million Europeans have HF [ , ]. Normal ventricular function requires coordinated electrical activation and contraction but also appropriate pre- and after-loads. Given the 3D pattern of ventricular activation and contraction, the assessment of mechanical activation using conventional imaging methods is complex [ , ]. Several imaging techniques might be…

Myocardial viability

Acknowledgements The authors would like to thank The Royal Brompton Hospital CMR Unit, Dr Stephan Nekolla, Dr Filip Zemrak, and Dr Navtej Chahal for assistance with images. 11.1 Background, terms, and definitions 11.1.1 Introduction With advancing technology, non-invasive imaging has gone through exponential growth and myocardial viability assessment is now possible using several different imaging modalities with numerous different techniques. Echocardiography, computed tomography (CT), single-photon emission…

Myocardial infarction

10.1 Introduction Acute myocardial infarction (MI) is defined as death of the myocytes (myocardial necrosis) in a clinical setting consistent with acute myocardial ischemia [ ]. Echocardiography, nuclear imaging techniques, CMR, and CT play an important role in detecting and following patients with acute MI (AMI). 10.1.1 Pathophysiology of AMI AMI is most often caused by acute coronary artery plaque rupture and thrombosis, but it may…

Myocardial ischemia

Abbreviations BOLD blood–oxygen-level-dependent CAD coronary artery disease CFR coronary flow reserve CTCA computed tomography coronary angiography ECHO echocardiography FFR fractional flow reserve ICA invasive coronary angiography IHD ischemic heart disease IVUS intravascular ultrasound MR magnetic resonance MRA magnetic resonance imaging angiography MRS magnetic resonance spectroscopy OCT optical coherence tomography PET positron emission tomography PTP pretest probability SCAD stable coronary artery disease SPECT single-photon emission computer tomography…

Atherosclerotic plaque

8.1 Introduction Atherosclerosis is a chronic inflammatory disease [ ]. Although great strides have been made in the diagnosis and management of atherosclerotic cardiovascular disease (CVD), overall mortality due to underlying atherosclerosis remains a leading cause of death in industrialized countries [ , ]. For example, more than one-third of all deaths in the United States are attributed to CVD, including atherosclerotic coronary disease and stroke…

Noninvasive coronary angiography

7.1 Introduction Invasive coronary angiography (ICA) is the gold standard for the identification of anatomically obstructive coronary artery disease (CAD). However at many centers, ICA is a limited resource that is expensive and has periprocedural risks (death, cerebrovascular accident, myocardial infarction, and vascular complications). Thus, ICA may not be appropriate for all patients and best reserved for those at highest risk and who likely require coronary…

Magnetic resonance imaging

Acknowledgments The authors of this chapter acknowledge BioMed Central as the original publisher of selected figures in this chapter as indicated by references to the original authors and publications. The authors also acknowledge Oxford University Press as the original publisher of Figure 6.16 reproduced with permission from Schroeder et al., hyperpolarized C-13 magnetic resonance reveals early- and late-onset changes to in vivo pyruvate metabolism in the…

Computed tomography

5.1 Development of cardiac CT In 1972, the first CT scanner was designed by the engineer Geoffrey N. Hounsfield at an English company named EMI Ltd. Together with Allan C. Cormack, a physicist from Cape Town who developed the mathematical foundation for the reconstruction of cross-sectional images from transmission measurements, Hounsfield was honored with the Nobel Prize for Physiology or Medicine in 1979. The first CT…

Positron emission tomography

4.1 Introduction Positron emission tomography (PET) is a radionuclide imaging technique that allows for noninvasive quantification of biochemical pathways in vivo . Utilizing positron emitting labeled compounds of interest, a myriad of biological processes can be visualized in the human heart. As such, PET has been proven invaluable to investigate cardiovascular biology and physiology noninvasively. Due to its limited availability, methodologic complexity, and high cost, cardiac…

Single-photon emission computed tomography

3.1 Introduction Radionuclide imaging today is an active and growing branch of medical diagnostics. Over the past decades, radionuclide imaging has advanced to become a cornerstone for the accurate diagnosis and appropriate management of a variety of medical conditions. Interestingly, however, it has its origins in the cardiovascular field: it was in the late 1920s when Herrmann L. Blumgart published his “Studies on the velocity of…