Non‐invasive Imaging in Interventional Cardiology

Abstract

Non-invasive cardiac imaging covers a broad spectrum of investigations including echocardiography, radionuclide imaging, computed tomography (CT), and cardiac magnetic resonance (CMR). Major developments have been made over the last couple of decades and non-invasive imaging is currently not only important for our understanding of pathobiological mechanisms that underlie cardiovascular diseases, but also an integral part of the everyday practice of clinical cardiology for diagnosis, risk stratification, management decisions, as well as treatment monitoring and assessment of its effect. Of particular importance are the applications of various non-invasive techniques in the setting of interventional cardiology, an area in which a remarkable progress has been made with the expanding use of coronary and non-coronary stents, cardiac resynchronization therapy, and transcatheter heart-valve devices. The three review articles on echocardiography, cardiac CT, and CMR, which are included in this issue, focus specifically on the important advances and new directions in which the field is heading. The field can only advance and strengthen its role in the decision-making process, when comprehensive evidence-based information is used. We are privileged that the contributors to this issue are international opinion leaders who have made every effort to provide state of the art information on their respective topics. In the first article, Jones et al present the continuous evolution of cardiac CT not only as a valuable research tool, but also as an everyday adjunct to cardiac intervention. After a brief discussion on its diagnostic and prognostic value in the setting of CAD evaluation, they describe three novel functional indices for CAD assessment: non-invasive FFR, transluminal attenuation gradient, and CT perfusion imaging. All three appear promising to broaden the use of cardiac CT for assessing the functional consequences of CAD in addition to anatomy. The authors subsequently discuss the role of cardiac CT in the assessment of patients with previous revascularization, and more pertinent to the theme of this issue, its continuously increasing use for planning and guiding certain interventional procedures, including transcatheter aortic valve implantation, left atrial appendage closures, recanalization of chronic total occlusions, and treatment of bifurcations. In the second paper, Mike Henein provides a comprehensive report on the role of echocardiography, which remains the cornerstone of cardiac imaging. He discusses the key points on patients’ selection for various interventions, monitoring during their performance, as well as the post-intervention outcome assessment of common procedures, including aortic valve implantation, mitral valve repair, mitral valvuloplasty, closure of interatrial shunts, left atrial appendage closure, and ventricular procedures such as alcohol septal reduction for hypertrophic cardiomyopathy and myocardial biopsy, as well as pericardial procedures. Following this, Mavrogeni and Kolovou discuss the strengths and limitations of CMR. They highlight its versatility and ability to provide high quality images depicting the underlying pathology in a spectrum of different clinical scenarios, with an emphasis on its usefulness in the investigation of children and adults with congenital heart disease (CHD). CMR-guided catheterization not only facilitates assessment of pulmonary vascular resistance but in addition, it provides guidance for performance of EP studies. Its role in the management of CHD patients is expanding and potentially CMR-guided interventions will increase in the future. As this is a rapidly growing and highly specialized area, we are planning to include a focused article in the next issue of CCE. Moreover, to provide the readership with comprehensive and balanced information on the strengths and limitations of all non-invasive imaging techniques, there will be two further articles in the same issue: one on SPECT and SPECT/CT and a second on PET and PET/CT, respectively. Covering the full spectrum of non-invasive imaging, the aim is to increase awareness that the various techniques should be used judiciously by clinicians applying an evidence-based approach. Only then, it can be appreciated that they are not competitive but rather complementary to each other, offering unique information applicable to a particular clinical condition/scenario and individual patient. Dr. Anagnostopoulos has nothing to disclose.