The Ideal Cardiovascular Multimodality Imaging Program: Education, Collaboration and Standardization
Prof. Dr. Jeroen J Bax, Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre speaks about The year in cardiology: imaging: The year in cardiology 2020.
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This year has seen a lot of interest in multimodality imaging and artificial intelligence applied to imaging techniques. The pathophysiological insights offered by various imaging modalities in a variety of clinical settings (heart failure, coronary artery disease, and valvular heart disease) have an impact on how we evaluate and treat patients. The use of traditional imaging to examine heart anatomy and function is still the initial step in evaluating patients and deciding on treatment options. Advanced echocardiography with strain imaging techniques, tissue characterization with cardiovascular magnetic resonance (CMR), and assessment of biological processes with nuclear imaging techniques have all helped to understand that early intervention may be required to prevent or slow disease progression. We can create algorithms that can recognize specific patterns of sickness or risk and develop judgments in a more customized way by using machine learning approaches to all of these imaging modalities. The Year in Cardiology review articles highlight the most important imaging research published in the previous year.
One of the key breakthroughs this year has been the application of artificial intelligence and machine learning to cardiac imaging. This Year in Cardiology review article summarizes other non-invasive cardiac imaging breakthroughs made in 2019.
Numerous papers in 2019 have focused on early diagnosis of left ventricular (LV) dysfunction in diverse populations. Left ventricular diastolic dysfunction generally occurs before LV systolic failure and is linked to an increased risk of cardiovascular disease and death. Lassen et al.3 analyzed the relationship between LV filling pressures measured on tissue Doppler imaging (E/E′) and speckle tracking echocardiography (E/E′sr) and the occurrence of cardiovascular death, admission for incident heart failure, or myocardial infarction in the Copenhagen City Heart Study, a population-based study with 6238 participants (MI). During a median follow-up of 11 years, 140 (11.3%) of the 1238 individuals met the main goal. E/E′sr was independently related with the endpoint [hazard ratio (HR) 1.08, 95 percent confidence interval (CI) 1.02–1.13 per each 10 cm increase; P = 0.003] after controlling for different clinical and echocardiographic markers, but E/E′ was not. Furthermore, E/E′sr outperformed the SCORE risk chart, which is presently utilized to assess the risk of cardiovascular morbidity and death in the general population. Increased LV filling pressures might be a sign of the heart's aging process, which is marked by increased fibrosis. This fibrosis can cause conduction anomalies, which can affect the LV's contractile function. Modin et al.4 investigated the predictive significance of LV mechanical dispersion, which is assessed as the standard deviation from time to peak longitudinal strain of the three LV apical views, in 1138 participants of the Copenhagen City Heart Study. In the general population, the mean LV mechanical dispersion was 45 38 ms, and it increased with age, hypertension, BMI, and the occurrence of MI. Poor LV systolic and diastolic function were linked to large LV mechanical dispersion. The risk of cardiovascular mortality was independently related with each 10 ms increase in LV mechanical dispersion (HR 1.04, 95 percent CI 1.01–1.06; P = 0.004).
Despite mounting evidence for the diagnostic and prognostic usefulness of strain-derived measures of LV systolic and diastolic function, LV ejection fraction (EF) remains the gold standard in clinical practice for risk stratification. In 403 977 echocardiograms conducted on 203 135 patients in the United States, the relationship between physician-reported LVEF and survival was investigated. 5 Fifty percent of the population had an LVEF ranging from 55 to 65 percent. Over the course of a four-year follow-up, 23% of patients died. The nadir of the U-shaped association between LVEF and all-cause mortality was seen in the 60–65 percent LVEF group. These findings were replicated in a New Zealand dataset that included 45 531 echocardiograms from 35 976 individuals. In men and women, inpatients and outpatients with heart failure, the U-shaped association was also seen, with departures from LVEF of 60–65 percent linked with a larger multiplicative increase in risk for younger patients compared to older patients.