Incremental value of advanced cardiac imaging modalities for diagnosis and patient management : focus on real-time three-dimensional echocardiography and magnetic resonance imaging

Marsan, N.A. (2011)

Doctoral Thesis

Advanced cardiac imaging modalities play a crucial role in the diagnostic process and clinical management of patients with different cardiac diseases, including heart failure, valvular heart disease, myocardial infarction and atrial fibrillation. RT3DE has made an important transition from a research tool to a clinically applicable imaging technique and has been demonstrated to provide important advantages over conventional 2D echocardiography, such as a more accurate quantification of cardiac chamber size and function and the possibility of unlimited image plane orientations for better understanding of valvular heart diseases. Contrast-enhanced echocardiography should be performed in every patient with suboptimal acoustic window, especially with RT3DE. Importantly, in patients underwent primary percutaneous coronary intervention, perfusion analysis can provide an accurate estimate of myocardial infarction size, which is crucial information for the patient management, together with more sophisticated assessment of LV mechanics. Myocardial deformation imaging has witnessed an enormous development in the last years and is now considered an accurate tool for a more sensitive assessment of LV regional and global function and for a more detailed assessment of LV mechanics and dyssynchrony. CMR represents the reference imaging modality for the quantification of LV volumes and function and for the identification of myocardial scar/fibrosis. It should be therefore considered for a comprehensive evaluation of heart failure patients, including more novel and sophisticated assessments of transvalvular flow and LV dyssynchrony. Advanced cardiac imaging modalities can be applied in heart failure patients referred for CRT to explore novel physiopathological aspects, such as the effect on LV rotation mechanics, on functional mitral regurgitation and cerebral blood flow.

• 3D echocardiography
• Real-time 3-dimensional echocardiography
• Myocardial deformation imaging
• Contrast echocardiography
• Cardiac resynchronization therapy
• Cardiac magnetic resonance imaging

• All authors: Marsan, N.A.
• Supervisor: Bax, J.J.; Schalij, M.J.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2011-11-07
• ISBN (print): 9789461691330
• Sponsorship: Philips Healthcare, Meda Pharma, Boehringer Ingelheim, Roche, Servier, Biotronik, Boston Scientific Nederland BV and Servier