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Real-Time Three-Dimensional Echocardiographic Assessment of Severity of Mitral Regurgitation Using Proximal Isovelocity Surface Area and Vena Contracta Area Method. Lessons We Learned and Clinical Implications
Abstract Mitral regurgitation (MR) is considered the most common valve disease with a prevalence of 2–3 % of significant regurgitation (moderate to severe and severe) in the general population. Accurate assessment of the severity of regurgitation was demonstrated to be of significant importance for patient management and prognosis and consequently has been widely recognized in recent guidelines. However, evaluation of severity of valvular regurgitation can be potentially difficult with the largest challenges presenting in cases of mitral regurgitation. Real-time three-dimensional echocardiography (RT...
Source: Current Cardiovascular Imaging Reports - August 25, 2015 Category: Radiology Source Type: research

The Burden of Australian Indigenous Cardiac Disease and the Emerging Role of Cardiac Imaging
Abstract Cardiac imaging frequently serves as a gatekeeper to triage management decisions. Utilization trends differ not only globally but also within individual countries and may be directed by the presence of an indigenous population with unique needs. We reviewed the current state of Australian indigenous cardiovascular health, and contributing factors to outcome disparity with mainstream Australia are discussed. We also considered the utility of contemporary cardiac imaging modalities and their established and potential roles in the assessment of cardiovascular disease in both the indigenous and wid...
Source: Current Cardiovascular Imaging Reports - August 20, 2015 Category: Radiology Source Type: research

Cardiovascular Imaging for the Primary Prevention of Atherosclerotic Cardiovascular Disease Events
Abstract Traditional cardiovascular risk factors have well-known limitations for the accurate assessment of individual cardiovascular risk. Unlike risk factor-based scores which rely on probabilistic calculations derived from population-based studies, coronary artery calcium (CAC) scoring, and carotid ultrasound allow for the direct visualization and quantification of subclinical atherosclerosis with the potential for a more accurate, personalized risk assessment and treatment approach. Among strategies used to guide preventive management, CAC scoring has consistently and convincingly outperformed tradi...
Source: Current Cardiovascular Imaging Reports - August 14, 2015 Category: Radiology Source Type: research

Transcaval TAVR—What the Radiologist Needs to Know
Abstract Transcaval transcatheter aortic valve replacement is a new approach in performing percutaneous aortic valve replacement in which aortic access is obtained by way of the femoral vein and inferior vena cava. Computed tomographic angiography is used to determine patient suitability and in preprocedural planning. CTA is also part of routine follow-up care to assess for potential caval-aortic access site complications. Postprocedural imaging findings at the caval-aortic site include aortocaval fistula, aortic dissection, retroperitoneal hemorrhage, and pseudoaneurysm. The purpose of this manuscript ...
Source: Current Cardiovascular Imaging Reports - July 25, 2015 Category: Radiology Source Type: research

Cardiac CT in 2015: Clinical Role According to Current Multi-Societal Guidelines
This article aims to review the use of CT in cardiovascular risk stratification, the diagnosis of coronary artery disease in various clinical settings including acute presentations, and the expanding role of CT in non-coronary indications with a focus on the guidelines and the data that impacts the clinical application of CT in these varied scenarios. (Source: Current Cardiovascular Imaging Reports)
Source: Current Cardiovascular Imaging Reports - July 24, 2015 Category: Radiology Source Type: research

Hybrid Imaging During Transcatheter Structural Heart Interventions
Abstract Fusion of different imaging modalities has gained increasing popularity over the last decade. However, most fusions are done between static rather than dynamic images. In order to adequately visualize the complex three-dimensional structures of the beating heart, high-temporal and spatial image resolutions are mandatory. Currently, only the combination of transesophageal echocardiography with fluoroscopy allows real-time image fusion of high quality during structural heart disease (SHD) interventions. The use of markers as well as real-time image overlay greatly facilitates communication betwee...
Source: Current Cardiovascular Imaging Reports - July 16, 2015 Category: Radiology Source Type: research

An Increasing Mexican Population with Metabolic Syndrome-Emerging Role of Hybrid SPECT/CT and PET/CT in Cardiovascular Disease Detection
Abstract Metabolic syndrome represents a growing burden in the Mexican population with an increasing presence as evidenced by the most recent epidemiological data, showing a prevalence of 49.8 % in 2006. The cardiovascular hazard of metabolic syndrome has been proven in numerous occasions; these patients present an increased risk of cardiovascular disease not only because of epicardial coronary occlusion but also from microvascular disease secondary to endothelial dysfunction. Myocardial perfusion imaging using both single-photon emission computed tomography and positron emission tomography can be effe...
Source: Current Cardiovascular Imaging Reports - July 7, 2015 Category: Radiology Source Type: research

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations
Abstract Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many health care systems rely on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows for the accurate noninvasive visualization of coronary artery disease, challenging the role of stress testing as...
Source: Current Cardiovascular Imaging Reports - June 17, 2015 Category: Radiology Source Type: research

Translating Intravascular Optical Coherence Tomography from a Research to a Clinical Tool
Abstract Intravascular optical coherence tomography (IVOCT) continues to be a hot topic as a method for studying vulnerable plaque in research laboratories across the globe. It is also growing in popularity as a tool for interventional cardiologists to guide percutaneous coronary intervention (PCI). The power of IVOCT for diagnosis of thin-capped fibroatheromas (TCFAs) has yet to receive mainstream clinical attention due to the fact that clinicians still do not have a protocol to follow if TCFA are identified and that TCFA identification requires extensive training in IVOCT image analysis—it is not ye...
Source: Current Cardiovascular Imaging Reports - June 17, 2015 Category: Radiology Source Type: research

Is Attenuation Correction for Myocardial Perfusion Imaging Underutilized?
Abstract Myocardial SPECT remains an important diagnostic technique in patients suspected of significant coronary artery disease. However, the diagnostic accuracy is hampered by several clinical and technical difficulties. Among these, soft tissue attenuation is one of the most frequent causes. Attenuation correction has the power to correct for these artifacts, increasing the diagnostic accuracy of myocardial SPECT. The current review summarizes the available clinical evidence for attenuation correction and raises the question if this technique is not underutilized in current clinical practice. (Source...
Source: Current Cardiovascular Imaging Reports - June 17, 2015 Category: Radiology Source Type: research

The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries
Abstract Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity worldwide. Seven to fifteen percent of patients presenting with ACS have unobstructed coronary artery disease (CAD) on urgent angiography. Patients with ACS and unobstructed coronary arteries represent a clinical dilemma and their diagnosis and management is quite variable in current practice. Cardiovascular magnetic resonance imaging with its unique non-invasive myocardial tissue characterization property has the potential to identify underlying etiologies and reach a final diagnosis. These include...
Source: Current Cardiovascular Imaging Reports - June 12, 2015 Category: Radiology Source Type: research

Noncalcified Plaque in Cardiac CT: Quantification and Clinical Implications
Abstract Coronary computed tomography angiography (CTA) is being increasingly used for direct, noninvasive evaluation of the coronary arteries. Beyond stenosis, coronary CTA also permits assessment of atherosclerotic plaque (including total and noncalcified plaque burden) and coronary artery remodeling, previously only measurable through invasive techniques. It has been shown that coronary plaque volume for noncalcified and mixed plaques and the arterial remodeling index correlate closely with corresponding measures from invasive intravascular ultrasound. Several studies have also shown a strong relatio...
Source: Current Cardiovascular Imaging Reports - May 29, 2015 Category: Radiology Source Type: research

Present Status and Future Direction of NIRS-IVUS Multimodality Direct Coronary Imaging
Abstract Intracoronary near-infrared spectroscopy (NIRS)-IVUS is a direct coronary imaging catheter for the identification and quantification of lipid core plaque (LCP). NIRS is combined with traditional grayscale IVUS in a hybrid catheter that provides co-registered architectural and compositional plaque characterization data. The novel capability of the NIRS catheter component is its ability to directly identify LCP, which underlies the majority of vulnerable and unstable plaques. NIRS-IVUS has potential to optimize percutaneous coronary intervention (PCI) by delineating precise lesion length, assurin...
Source: Current Cardiovascular Imaging Reports - May 26, 2015 Category: Radiology Source Type: research

Value of Hybrid Imaging with PET/CT to Guide Percutaneous Revascularization of Chronic Total Coronary Occlusion
Abstract Chronic total coronary occlusions (CTO) are documented in approximately one fifth of diagnostic invasive coronary angiographies (ICA). Percutaneous coronary interventions (PCI) of CTO are challenging and are accompanied by higher complication and lower success rates in comparison with non-CTO PCI. Scrutinous evaluation of ischemia and viability to justify percutaneous revascularization is therefore of importance to select eligible patients for such a procedure. Furthermore, knowledge of the anatomical features of the occlusion may predict the chances of success of PCI CTO and could even guide t...
Source: Current Cardiovascular Imaging Reports - May 26, 2015 Category: Radiology Source Type: research

Coronary Artery Disease Progression: Insights from Cardiac CT
Abstract Coronary plaque progression is a multi-faceted process influenced by cardiovascular risk factors, as well as the presence, extent, stenosis, morphology, and vulnerability of plaque, which may ultimately result in myocardial infarction or death. Traditionally, intravascular ultrasound (IVUS) has been the primary modality to study atherosclerosis progression. However, it is invasive and impractical for screening or monitoring. While coronary artery calcium (CAC) scoring has been widely studied as a non-invasive method to measure plaque progression, it is limited to visualization of stenosis and n...
Source: Current Cardiovascular Imaging Reports - May 16, 2015 Category: Radiology Source Type: research