Basic principles
Pim J de Feyter, Gabriel P Krestin, Filippo Cademartiri, Carlos van Mieghem, Bob Meijboom, Nico Mollet, Koen Nieman, Denise Vrouenraets in Computed Tomography of the Coronary Arteries, 2008
Cardiac imaging is currently one of the most rapidly advancing fields in clinical cardiology. Continuing technical innovations are expanding the applicability and usefulness of non-invasive imaging modalities such as ultrasound, nuclear imaging, positron emission tomography, magnetic resonance imaging and, most recently, computed tomography (CT). While CT became an essential imaging tool in general medicine early on, for a long time it was considered an unsuitable technique for imaging moving structures. However, current multislice spiral CT scanners, with rapid gantry rotation, are able to provide detailed and motion-free imaging of the heart and coronary arteries. It is undeniable that spiral CT has entered the arena of non-invasive cardiac imaging, and while its exact role in the clinical setting is still under investigation, expansive employment of cardiac spiral CT is anticipated by both cardiologists and radiologists.
Cardiac Image Segmentation Using Generalized Polynomial Chaos Expansion and Level Set Function
Ayman El-Baz, Jasjit S. Suri in Level Set Method in Medical Imaging Segmentation, 2019
Heart diseases are the leading cause of death and claim more than 18 million lives worldwide per year [1]. Diagnosis and treatment of heart diseases can rely on numerous cardiac imaging modalities such as echocardiography [2], computerized tomography [3], coronary angiography [4], and cardiac magnetic resonance (CMR) images [5]. It is well recognized that CMR, as a non-invasive assessment of cardiac functions, can provide accurate information about morphology, muscle perfusion, tissue viability, and blood flow. Thus, CMR has recently become a useful technique in clinical cardiology practice [6] and can be used for precise diagnosis of cardiovascular diseases and evaluation of heart functions in order to reduce mortality and improve personalized cardiac care.
Radiation safety
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
According to a National Council on Radiation Protection and Measurements report,[1] Americans were exposed to seven times as much ionizing radiation in 2006 than in the early 1980s. While much of this increase is the result of com- puted tomography (CT) and nuclear imaging, procedures performed in the cardiac catheterization laboratory also are responsible for this increased exposure to radiation. The public has become increasingly aware of the potential hazards of ionizing radiation,[2] as have governmental agen- cies.[3] As a consequence, the use of as-low-as-reasonably- achievable (ALARA) radiation has become a mantra for health-care providers to more carefully examine the use of medical radiation. A review from the American Heart Association Science Advisory committee[4] and editorials[5,7]have emphasized the importance of considering radiation effects in cardiac imaging. In general, the effects of ion- izing radiation have been a greater focus for radiologists than cardiologists. This overview will discuss the manner in which X-ray images are created to better understand the means by which a reduction in radiation dose may be accomplished. The radiobiology of ionizing radiation will also be addressed to provide insight into the consequences of X-rays on biologic tissue and how these adverse effects can be minimized.
Omaveloxolone: an activator of Nrf2 for the treatment of Friedreich ataxia
Published in Expert Opinion on Investigational Drugs, 2023
Victoria Profeta, Kellie McIntyre, McKenzie Wells, Courtney Park, David R Lynch
Cardiomyopathy is found to some degree in >50% of FRDA patients, making ongoing cardiac monitoring important. Cardiac disease is the most common reason for premature death [4,18]. Patients with impactful cardiac disease almost always have onset prior to age 18 and more commonly have longer GAA repeat length (>700) [14,18]. In FRDA, cardiac hypertrophy predominates early, but later evolves into fibrosis and myocyte dropout [4,18–21]. Screening by means of cardiac imaging detects structural features of disease, but the management of functional cardiac issues is more complex. No intervention convincingly reduces increased wall thickness in FRDA, but hypertrophy itself is not directly problematic in most situations, as wall thicknesses are not commonly large enough to cause outflow tract obstruction [19,21]. Diastolic dysfunction from hypertrophy can become apparent during times of volume overload or depletion, leading to a need for tight fluid management during anesthesia [18]. Treatment of systolic cardiac dysfunction (as walls become fibrotic) is limited to standard heart failure therapy (β blockers, ACE inhibitors or ARBs, diuretics, and occasionally calcium channel blockers). Patients with end-stage heart failure should be considered for advanced heart failure therapies (AICD, LVAD, and transplantation) [19,22–25]. Arrhythmias, which are most commonly atrial or supraventricular, can be treated with rate control medications (b Blocker or calcium channel blocker), anti-arrhythmic agents, ablation, or device insertion (pacemaker, AICD) [4,26].
Artificial intelligence: improving the efficiency of cardiovascular imaging
Published in Expert Review of Medical Devices, 2020
Andrew Lin, Márton Kolossváry, Ivana Išgum, Pál Maurovich-Horvat, Piotr J Slomka, Damini Dey
Echocardiography remains the most widely used cardiac imaging modality. The increasing uptake of hand-held ultrasound devices and focused scanning protocols have enabled the rapid, point-of-care evaluation of cardiac structure, function and hemodynamics [13]. However, performance of echocardiographic examinations is operator-dependent and intensive training is required for proficiency. The automation of image acquisition may eliminate some of these training and skill maintenance requirements. Commercial vendors have developed DL-based real-time guidance software to guide untrained providers in acquiring standard echocardiographic views, whereby the operator optimizes an accuracy signal that indicates how close they are to the desired view [14]. These DL models can automatically analyze the acquired image dataset to identify and label heart anatomy, then slice standard views for presentation. This process reduces inter-operator variability, as the optimal views are selected based on thousands of deep learned examinations representing the spectrum of anatomical variations. Recently, a CNN used to identify 8 standard 3D echocardiographic views achieved an accuracy of 92% compared to ground truth training data labeled by clinicians [15]. Such automation of image acquisition may enable non-cardiologists to perform echocardiography as a first-line diagnostic tool in acute settings, and also facilitate the training of cardiac sonographers.
Proinflammatory circulating markers: new players for evaluating asymptomatic acute cardiovascular toxicity in breast cancer treatment
Published in Journal of Chemotherapy, 2021
P. L. Micheletti, J. Carla-da-Silva, T. B. Scandolara, R. Kern, V. D. Alves, J. Malanowski, V. J. Victorino, A. C. S. A. Herrera, D. Rech, J. A. O. Souza, A. N. C. Simão, C. Panis, I. Dichi
In spite of our study showing some limitations (modest sample size, need for long-term follow-up, measurement of other circulating markers). This is the first study, as far as we know, to show that routine circulating markers of cardiac injury can be used as possible predictors of drug-induced cardiotoxicity, as early as the first cycle of chemotherapy (DOX, PTX, TZ) in patients diagnosed with breast cancer. In the meantime, based on current guidelines, biomarkers alone should not dictate changes in cancer therapy regimens, both markers and cardiac imaging should be considered for monitoring patients at high risk of developing cancer therapy-related cardiotoxicity.8,15 Nevertheless, conventional cardiac imaging allows only the late diagnosis of cardiac dysfunction, whereas there is a major need for other accurate and reproducible parameters, able to detect early, subclinical dysfunctions, able to identify patients at risk for rapid progression toward irreversible cardiac failure, favoring them from early therapeutic measures.18,77 Further studies are needed in order to identify circulating markers as a putative concomitant marker of cardiovascular risk in breast cancer patients.
Related Knowledge Centers
- Cardiac Magnetic Resonance Imaging
- Cardiac Pet
- Echocardiography
- Positron Emission Tomography
- Ultrasound
- Magnetic Resonance Imaging
- CT Scan
- Nuclear Medicine
- Single-Photon Emission Computed Tomography
- Myocardial Perfusion Imaging