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Recent Advances in Cardiovascular Imaging 2.0 Edition
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Recent Advances in Cardiovascular Imaging 2.0 Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 July 2022) | Viewed by 16007

Special Issue Editor

Dr. Andreas A. Kammerlander

E-Mail Website
Guest Editor
1. Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
2. The Division of Cardiology, Medical University of Vienna, Wien, Austria
Interests: amyloidosis; aortic valve; cardiac imaging techniques; coronary artery disease; fibrosis; heart failure; magnetic resonance imaging; metabolic health; mitral valve; multidetector computed tomography; myocardial infarction; tricuspid valve
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The field of cardiovascular imaging is evolving at an unprecedented pace. Over the last few years, we have seen significant advances across echocardiography, magnetic resonance imaging, computed tomography, and nuclear imaging. Much effort has been put into increasing safety for the patient, diagnostic accuracy, and decreasing the work burden for clinicians. 

With an increasing financial burden caused by multimodality imaging and further downstream testing, cost effectiveness for healthcare systems is becoming more and more important in the field of cardiovascular imaging. 

It is my honor and pleasure to invite you to contribute to this Special Issue on “Recent Advances in Cardiovascular Imaging”. The journal invites submissions on all imaging modalities that focus on diagnostic accuracy, risk prediction, cost effectiveness, and change of clinical practice based on cardiovascular imaging. Papers in the field of machine learning may be eligible for submission only if they have a dedicated clinical focus. 

Given the enormous success of the First Edition, I believe that it is time to move forward to the Second Edition of this Special Issue, collecting additional insights into cardiovascular imaging. The Second Edition is very keen to attract a global audience, welcoming any contributions on this subject from around the world.

We look forward to receiving your submissions.

Dr. Andreas A. Kammerlander
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Cardiovascular imaging
  • Echocardiography
  • Magnetic resonance imaging
  • Computed tomography
  • Heart failure
  • Coronary artery disease
  • Cost effectiveness
  • Multimodality imaging

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Published Papers (7 papers)

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Research

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15 pages, 2376 KiB  
Article
A Novel CT Perfusion-Based Fractional Flow Reserve Algorithm for Detecting Coronary Artery Disease
by Xuelian Gao, Rui Wang, Zhonghua Sun, Hongkai Zhang, Kairui Bo, Xiaofei Xue, Junjie Yang and Lei Xu
J. Clin. Med. 2023, 12(6), 2154; https://doi.org/10.3390/jcm12062154 - 9 Mar 2023
Cited by 3 | Viewed by 2343
Abstract
Background: The diagnostic accuracy of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFR-CT) needs to be further improved despite promising results available in the literature. While an innovative myocardial computed tomographic perfusion (CTP)-derived fractional flow reserve (CTP-FFR) model has [...] Read more.
Background: The diagnostic accuracy of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFR-CT) needs to be further improved despite promising results available in the literature. While an innovative myocardial computed tomographic perfusion (CTP)-derived fractional flow reserve (CTP-FFR) model has been initially established, the feasibility of CTP-FFR to detect coronary artery ischemia in patients with suspected coronary artery disease (CAD) has not been proven. Methods: This retrospective study included 93 patients (a total of 103 vessels) who received CCTA and CTP for suspected CAD. Invasive coronary angiography (ICA) was performed within 2 weeks after CCTA and CTP. CTP-FFR, CCTA (stenosis ≥ 50% and ≥70%), ICA, FFR-CT and CTP were assessed by independent laboratory experts. The diagnostic ability of the CTP-FFR grouped by quantitative coronary angiography (QCA) in mild (30–49%), moderate (50–69%) and severe stenosis (≥70%) was calculated. The effect of calcification of lesions, grouped by FFR on CTP-FFR measurements, was also assessed. Results: On the basis of per-vessel level, the AUCs for CTP-FFR, CTP, FFR-CT and CCTA were 0.953, 0.876, 0.873 and 0.830, respectively (all p < 0.001). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CTP-FFR for per-vessel level were 0.87, 0.88, 0.87, 0.85 and 0.89 respectively, compared with 0.87, 0.54, 0.69, 0.61, 0.83 and 0.75, 0.73, 0.74, 0.70, 0.77 for CCTA ≥ 50% and ≥70% stenosis, respectively. On the basis of per-vessel analysis, CTP-FFR had higher specificity, accuracy and AUC compared with CCTA and also higher AUC compared with FFR-CT or CTP (all p < 0.05). The sensitivity and accuracy of CTP-FFR + CTP + FFR-CT were also improved over FFR-CT alone (both p < 0.05). It also had improved specificity compared with FFR-CT or CTP alone (p < 0.01). A strong correlation between CTP-FFR and invasive FFR values was found on per-vessel analysis (Pearson’s correlation coefficient 0.89). The specificity of CTP-FFR was higher in the severe calcification group than in the low calcification group (p < 0.001). Conclusions: A novel CTP-FFR model has promising value to detect myocardial ischemia in CAD, particularly in mild-to-moderate stenotic lesions. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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18 pages, 3006 KiB  
Article
Machine Learning Based on Computed Tomography Pulmonary Angiography in Evaluating Pulmonary Artery Pressure in Patients with Pulmonary Hypertension
by Nan Zhang, Xin Zhao, Jie Li, Liqun Huang, Haotian Li, Haiyu Feng, Marcos A. Garcia, Yunshan Cao, Zhonghua Sun and Senchun Chai
J. Clin. Med. 2023, 12(4), 1297; https://doi.org/10.3390/jcm12041297 - 6 Feb 2023
Cited by 4 | Viewed by 2119
Abstract
Background: Right heart catheterization is the gold standard for evaluating hemodynamic parameters of pulmonary circulation, especially pulmonary artery pressure (PAP) for diagnosis of pulmonary hypertension (PH). However, the invasive and costly nature of RHC limits its widespread application in daily practice. Purpose: To [...] Read more.
Background: Right heart catheterization is the gold standard for evaluating hemodynamic parameters of pulmonary circulation, especially pulmonary artery pressure (PAP) for diagnosis of pulmonary hypertension (PH). However, the invasive and costly nature of RHC limits its widespread application in daily practice. Purpose: To develop a fully automatic framework for PAP assessment via machine learning based on computed tomography pulmonary angiography (CTPA). Materials and Methods: A machine learning model was developed to automatically extract morphological features of pulmonary artery and the heart on CTPA cases collected between June 2017 and July 2021 based on a single center experience. Patients with PH received CTPA and RHC examinations within 1 week. The eight substructures of pulmonary artery and heart were automatically segmented through our proposed segmentation framework. Eighty percent of patients were used for the training data set and twenty percent for the independent testing data set. PAP parameters, including mPAP, sPAP, dPAP, and TPR, were defined as ground-truth. A regression model was built to predict PAP parameters and a classification model to separate patients through mPAP and sPAP with cut-off values of 40 mm Hg and 55 mm Hg in PH patients, respectively. The performances of the regression model and the classification model were evaluated by analyzing the intraclass correlation coefficient (ICC) and the area under the receiver operating characteristic curve (AUC). Results: Study participants included 55 patients with PH (men 13; age 47.75 ± 14.87 years). The average dice score for segmentation increased from 87.3% ± 2.9 to 88.2% ± 2.9 through proposed segmentation framework. After features extraction, some of the AI automatic extractions (AAd, RVd, LAd, and RPAd) achieved good consistency with the manual measurements. The differences between them were not statistically significant (t = 1.222, p = 0.227; t = −0.347, p = 0.730; t = 0.484, p = 0.630; t = −0.320, p = 0.750, respectively). The Spearman test was used to find key features which are highly correlated with PAP parameters. Correlations between pulmonary artery pressure and CTPA features show a high correlation between mPAP and LAd, LVd, LAa (r = 0.333, p = 0.012; r = −0.400, p = 0.002; r = −0.208, p = 0.123; r = −0.470, p = 0.000; respectively). The ICC between the output of the regression model and the ground-truth from RHC of mPAP, sPAP, and dPAP were 0.934, 0.903, and 0.981, respectively. The AUC of the receiver operating characteristic curve of the classification model of mPAP and sPAP were 0.911 and 0.833. Conclusions: The proposed machine learning framework on CTPA enables accurate segmentation of pulmonary artery and heart and automatic assessment of the PAP parameters and has the ability to accurately distinguish different PH patients with mPAP and sPAP. Results of this study may provide additional risk stratification indicators in the future with non-invasive CTPA data. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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12 pages, 1602 KiB  
Article
Investigation of the Relationship between Right Coronary Artery–Aorta Angle and Coronary Artery Disease and Associated Risk Factors
by Jade Geerlings-Batt, Ashu Gupta and Zhonghua Sun
J. Clin. Med. 2023, 12(3), 1051; https://doi.org/10.3390/jcm12031051 - 29 Jan 2023
Cited by 1 | Viewed by 1605
Abstract
At the level of the left coronary artery tree, there is evidence showing an association between bifurcation angle and coronary artery disease (CAD), and this motivated us to explore similar associations at the level of the right coronary artery (RCA). The purpose of [...] Read more.
At the level of the left coronary artery tree, there is evidence showing an association between bifurcation angle and coronary artery disease (CAD), and this motivated us to explore similar associations at the level of the right coronary artery (RCA). The purpose of this study was to determine whether there is a relationship between RCA–aorta angle and CAD and age, sex, body mass index, smoking status, hypertension, and high blood cholesterol. The coronary computed tomography angiography datasets and CAD risk factor checklists of 250 patients were retrospectively reviewed, with RCA–aorta angles measured via multiplanar reformation images. Independent t-tests were used to compare mean RCA–aorta angle measurements between groups, correlations between continuous variables were assessed using Pearson and Spearman correlations, and a general linear model was used to adjust for potentially confounding variables. Coronary angle measurements were conducted by two independent assessors with very strong intraclass correlation (r=0.999, p<0.001). A significantly smaller mean RCA–aorta angle was observed in the CAD group (79.07 ± 24.88°) compared to the normal group (92.08 ± 19.51°, p=0.001), in smokers (76.63  ± 22.94°) compared to non-smokers (85.25  ± 23.84°, p=0.016), and a narrow RCA–aorta angle was negatively correlated with BMI (r=−0.174, p=0.010). This study suggests a relationship between narrow RCA–aorta angles and CAD, smoking, and increasing BMI. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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11 pages, 2458 KiB  
Article
The Dynamic Characteristics of Myocardial Contractility and Extracellular Volume in Type 2 Diabetes Mellitus Mice Investigated by 7.0T Cardiac Magnetic Resonance
by Chunyan Shi, Hongkai Zhang, Nan Zhang, Dongting Liu, Zhanming Fan, Zhonghua Sun, Jiayi Liu and Lei Xu
J. Clin. Med. 2022, 11(15), 4262; https://doi.org/10.3390/jcm11154262 - 22 Jul 2022
Cited by 2 | Viewed by 1991
Abstract
Type 2 diabetes mellitus (T2DM) is associated with a high prevalence of diastolic dysfunction and congestive heart failure. A potential contributing factor is the accelerated accumulation of diffuse myocardial fibrosis and stiffness. Novel cardiac magnetic resonance (CMR) imaging techniques can identify both myocardial [...] Read more.
Type 2 diabetes mellitus (T2DM) is associated with a high prevalence of diastolic dysfunction and congestive heart failure. A potential contributing factor is the accelerated accumulation of diffuse myocardial fibrosis and stiffness. Novel cardiac magnetic resonance (CMR) imaging techniques can identify both myocardial fibrosis and contractility quantitatively. This study aimed to investigate the dynamic characteristics of the myocardial strain and altered extracellular volume (ECV) fraction as determined by 7.0 T CMR in T2DM mice. C57Bl/6J mice were randomly divided into T2DM (fed a high-fat diet) and control (fed a normal diet) groups. They were scanned on 7.0 T MRI every 4 weeks until the end of week 24. The CMR protocol included multi-slice cine imaging to assess left ventricle strain and strain rate, and pre- and post-contrast T1 mapping images to quantify ECV. The ECV in the T2DM mice was significantly higher (p < 0.05) than that in the control group since week 12 with significantly impaired myocardial strain (p < 0.05). A significant linear correlation was established between myocardial strain and ECV (p < 0.001) and left ventricular-ejection fraction and ECV (p = 0.003). The results suggested that CMR feature tracking-derived myocardial strain analysis can assess functional abnormalities that may be associated with ECM alterations in diabetic cardiomyopathy, contributing to the study of diabetic therapy effects. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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10 pages, 657 KiB  
Article
Comparison of Hepatic Tissue Characterization between T1-Mapping and Non-Contrast Computed Tomography
by Constanze Bardach, Leonie Morski, Katharina Mascherbauer, Carolina Donà, Matthias Koschutnik, Kseniya Halavina, Christian Nitsche, Dietrich Beitzke, Christian Loewe, Elisabeth Waldmann, Michael Trauner, Julia Mascherbauer, Christian Hengstenberg and Andreas Kammerlander
J. Clin. Med. 2022, 11(10), 2863; https://doi.org/10.3390/jcm11102863 - 19 May 2022
Viewed by 1989
Abstract
Background: Non-contrast computed tomography (CT) is frequently used to assess non-alcoholic/metabolic fatty liver disease (NAFLD/MAFLD), which is associated with cardiovascular risk. Although liver biopsy is considered the gold standard for diagnosis, standardized scores and non-contrast computed tomography (CT) are used instead. On standard [...] Read more.
Background: Non-contrast computed tomography (CT) is frequently used to assess non-alcoholic/metabolic fatty liver disease (NAFLD/MAFLD), which is associated with cardiovascular risk. Although liver biopsy is considered the gold standard for diagnosis, standardized scores and non-contrast computed tomography (CT) are used instead. On standard cardiac T1-maps on cardiovascular imaging (CMR) exams for myocardial tissue characterization hepatic tissue is also visible. We hypothesized that there is a significant correlation between hepatic tissue T1-times on CMR and Hounsfield units (HU) on non-contrast CT. Methods: We retrospectively identified patients undergoing a non-contrast CT including the abdomen, a CMR including T1-mapping, and laboratory assessment within 30 days. Patients with storage diseases were excluded. Results: We identified 271 patients (62 ± 15 y/o, 49% female) undergoing non-contrast CT and CMR T1-mapping within 30 days. Mean hepatic HU values were 54 ± 11 on CT and native T1-times were 598 ± 102 ms on CMR and there was a weak, but significant, correlation between these parameters (r = −0.136, p = 0.025). On age and sex adjusted regression analysis, lower liver HU values indicated a dismal cardiometabolic risk profile, including higher HbA1C (p = 0.005) and higher body mass index (p < 0.001). In contrast, native hepatic T1-times yielded a more pronounced cardiac risk profile, including impaired systolic function (p = 0.045) and higher NT-proBNP values (N-Terminal Brain Natriuretic Peptide) (p = 0.004). Conclusions: Hepatic T1-times are easy to assess on standard T1-maps on CMR but only weakly correlated with hepatic HU values on CT and clinical NAFLD/MAFLD scores. Liver T1-times, however, are linked to impaired systolic function and higher natriuretic peptide levels. The prognostic value and clinical usefulness of hepatic T1-times in CMR cohorts warrants further research. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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Review

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16 pages, 1774 KiB  
Review
The Importance of the Assessment of Epicardial Adipose Tissue in Scientific Research
by Przemysław Cheładze, Adrian Martuszewski, Rafał Poręba and Paweł Gać
J. Clin. Med. 2022, 11(19), 5621; https://doi.org/10.3390/jcm11195621 - 23 Sep 2022
Cited by 2 | Viewed by 2323
Abstract
Epicardial adipose tissue (EAT) exhibits morphological similarities with pericardial adipose tissue, however, it has different embryological origin and vascularization. EAT is a metabolically active organ and a major source of anti-inflammatory and proinflammatory adipokines, which have a significant impact on cardiac function and [...] Read more.
Epicardial adipose tissue (EAT) exhibits morphological similarities with pericardial adipose tissue, however, it has different embryological origin and vascularization. EAT is a metabolically active organ and a major source of anti-inflammatory and proinflammatory adipokines, which have a significant impact on cardiac function and morphology. Moreover, it can regulate vascular tone by releasing various molecules. The relationship between EAT and cardiovascular disease and diseases of other organ systems is now considered a common discussion subject. The present clinical review article summarizes the epidemiological findings based on imaging techniques in studies conducted so far. In conclusion, evaluation of the epicardial adipose tissue constitutes a helpful scientific parameter, which can be assessed by means of different diagnostic imaging examinations. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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Other

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18 pages, 2708 KiB  
Systematic Review
Evaluation of the Relationship between Left Coronary Artery Bifurcation Angle and Coronary Artery Disease: A Systematic Review
by Jade Geerlings-Batt and Zhonghua Sun
J. Clin. Med. 2022, 11(17), 5143; https://doi.org/10.3390/jcm11175143 - 31 Aug 2022
Cited by 6 | Viewed by 2796
Abstract
Recent studies have suggested a relationship between wide left coronary artery bifurcation (left anterior descending [LAD]-left circumflex [LCx]) angle and coronary artery disease (CAD). Current literature is multifaceted. Different studies have analysed this relationship using computational fluid dynamics, by considering CAD risk factors, [...] Read more.
Recent studies have suggested a relationship between wide left coronary artery bifurcation (left anterior descending [LAD]-left circumflex [LCx]) angle and coronary artery disease (CAD). Current literature is multifaceted. Different studies have analysed this relationship using computational fluid dynamics, by considering CAD risk factors, and from simple causal-comparative and correlational perspectives. Hence, the purpose of this systematic review was to critically evaluate the current literature and determine whether there is sufficient evidence available to prove the relationship between LAD-LCx angle and CAD. Five electronic databases (ProQuest, Scopus, PubMed, CINAHL Plus with Full Text, and Emcare) were used to locate relevant texts, which were then screened according to predefined eligibility criteria. Thirteen eligible articles were selected for review. Current evidence suggests individuals with a wide LAD-LCx angle experience altered haemodynamics at the bifurcation site compared to those with narrower angles, which likely facilitates a predisposition to developing CAD. However, further research is required to determine causality regarding relationships between LAD-LCx angle and CAD risk factors. Insufficient valid evidence exists to support associations between LAD-LCx angle and degree of coronary stenosis, and future haemodynamic analyses should explore more accurate coronary artery modelling, as well as CAD progression in already stenosed bifurcations. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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