Non-invasive cardiac imaging

The aim of the cluster non-invasive cardiac imaging is to integrate the different non-invasive imaging modalities. The modalieties will be used to optimize the diagnosis and treatment of clinically relevant diseases.

The non-invasive imaging modalities include:

  • echocardiography;
  • TEE;
  • tissue doppler echocardiography;
  • contrast echocardiography;
  • intracardiac ultrasound;
  • nuclear cardiology;
  • magnetic resonance imaging (MRI);
  • multislice computed tomography (MSCT).

These modalities will be integrated in the assessment of 3 major subjects in clinical cardiology, namely:

  1. coronary artery disease;
  2. heart failure;
  3. arrhythmias: supraventricular (mainly atrial fibrillation) and ventricular.

Altogether, these 3 subjects include more than 85% of the patients in clinical cardiology; these 3 topics also form the main interest of the department of Cardiology at the Leiden University Medical Center (LUMC).

I. Coronary artery disease

Initially, stress echocardiography and/or myocardial perfusion scintigraphy (nuclear imaging) were used to detect coronary artery disease. Currently, extensive research is invested in non-invasisve angiography using MSCT and MRI.

II. Heart failure

One needs to realise that at least 80% of the patients with heart failure has coronary artery disease underlying the heart failure. Current methods to detect heart failure are adequate. The main challenge is in the optimization of therapy, in particular to provide a patient-tailored therapeutic approach. At present, multiple therapies are available:

  • medical therapy;
  • surgical therapy (revascularization, mitral valve repair, ventricular remodeling, etc)
  • resynchronization therapy;
  • and maybe stem cell therapy.

The challenge will be to select the optimal therapy for the individual patient using multi-modality imaging. This approach is currently being explored and patients are being referred for viability assessment with MRI, echocardiography and nuclear imaging. IN addition, TEE is being used for evaluation and analysis of ischemic mitral regurgitation. And also, tisse Doppler imaging is used for the assessment of left ventricular dyssynchrony. MRI can potentially become a very important technique in the evaluation of patients with heart failure, since MRI can assess a variety of the aforementioned characteristics.

III. Arrhythmias

Two forms of arrhythmia have a major impact on clinical cardiology, namely:

  • atrial fibrillation;
  • ventricular tachycardias.

At the LUMC, integration of imaging modalities is already being used in patients with atrial fibrillation. Initially, an MSCT is performed to determine the number and precise localization of pulmonary veins.
The MSCT serves as a roadmap for the clinician who will perform the ablation. During the ablation procedure, intracardial ultrasound is performed to guide the ablation procedure. Integration with 3D mapping systems and fluoroscopy allows optimal treatment.
In addition, a large number of patients after aborted sudden death is referred to the LUMC for diagnostic and therapeutic assessment. In these patients, the integration of imaging modalities results in a stepwise approach (and not every technique in all patients) to optimize diagnosis, which forms the basis for further therapeutic treatment.