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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESafe and effective visualization of the heart structure and cardiac blood flow for diagnostic evaluation or to guide cardiac procedures is at the heart of medical care. This article discusses the wide application of imaging in cardiovascular disease and new visualization techniques and technologies.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiac Imaging Techniques\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Genomics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EThe Multimodality Landscape Looking Forward\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003ESafe and effective visualization of the heart structure and cardiac blood flow for diagnostic evaluation or to guide cardiac procedures is at the heart of medical care. William A. Zoghbi, MD, Weill Cornell Medical College, New York, New York, USA, spoke about the wide application of imaging in cardiovascular disease and new visualization techniques and technologies.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EMultimodality imaging runs the gamut from the electrocardiogram to the most advanced trends in echocardiography. Its use is widely applied across all areas of cardiovascular disease, including ventricular function, coronary artery disease, valvular disease, congenital heart disease, and vascular disease. During his presentation, Dr. Zoghbi discussed imaging trends, applications, and implications.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EEchocardiography encompasses a family of techniques, including tissue Doppler and speckle tracking modalities. Current trends include the proliferation of 3D imaging, automation, miniaturization, and multimodality integration. Emerging left ventricular applications include twist, torsion, and rotation by 3D wall motion tracking.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe increased accuracy of real-time 3D echocardiography has given it a central role in the assessment of patients prior to valvular surgery. The use of contrast has broadened the indications for transthoracic echocardiography while reducing the number of patients who cannot be screened due to a limited acoustic window.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAssessment of left ventricular structure and function are the most frequent indications for echocardiography. More versatile cardiac magnetic resonance (CMR) imaging is suitable for diagnostic and prognostic applications in valve flow, cardiac mass, stress perfusion, right ventricular dysplasia, myocardial viability, pericardial constriction, aortic disease, and anomalous coronaries.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ECMR has provided important diagnostic and prognostic insights into various cardiomyopathies [Park JR et al. \u003Cem\u003EInt J Cardiovasc Imaging\u003C\/em\u003E 2011]. Myocardial delayed enhancement after administration of contrast accurately delineates a scar, a powerful marker of poor prognosis in dilated cardiomyopathy. In addition, the quantification of the myocardial parameter T2* on CMR has been validated for accurate quantification of iron myocardial overload and as the strongest predictor for incident heart failure.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ENew visualization techniques are leading to a future that includes 3D global diastolic function indices based on CMR imaging for aortic disease, anomalous coronaries, valve flow, cardiac mass, stress perfusion, RV dysplasia, myocardial viability, and pericardial constriction.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EWhite et al. [\u003Cem\u003EJACC Cardiovasc Imaging\u003C\/em\u003E 2010] assessed the feasibility of providing spatially matched, 3D myocardial scar and coronary imaging for the purpose of fused volumetric image display in patients undergoing cardiac resynchronization therapy (CRT) or coronary artery revascularization (CAR). A total of 55 studies were performed in patients referred for either CRT (n=42) or CAR (n=13). Combined 3D coronary and scar imaging was successful in 49 of them (89%). A quality score \u22652 was obtained for 97% of proximal- and mid-coronary artery and vein segments. The mean quality score of 3D scar imaging was 2.8\u00b11.0 and was scored as \u22652 in 86% of patients with myocardial scar. All patients with a scar quality score \u22652 achieved successful image fusion. Transmural scar was present below \u22651 planned target vessel in 9 patients (39%) planned for CRT and 8 patients (62%) planned for CAR. Physician surveys demonstrated incremental clinical impact in 67% of patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EFindings showed that 3D myocardial scar and coronary imaging with fused volumetric display is clinically feasible and may be valuable for the planning of vascular-based interventions when regional myocardial scar is pertinent to therapeutic success.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EFuture imaging technologies are likely to improve risk stratification and selection of patients for implantable cardioverter defibrillators, resynchronization devices, and other interventions by overcoming remaining problems in stress echocardiography and nuclear stress testing (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Motivated by the promise to transform preclinical research and clinical care, cardiovascular molecular imaging alone promises great progress via hybrid protocols and the pairing of technology-driven opportunities with those from genomics, proteomics, immunology, and vascular and systems biology [Leuschner F, Nahrendorf M. \u003Cem\u003ECirc Res\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12767\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12767\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12767\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ERemaining Problems of Imaging in Evaluation of Coronary Artery Disease.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EAmong other advances, Dr. Zoghbi foresees high-speed nuclear cardiology cameras with multidetector systems focused on the heart, cadmium zinc telluride semiconductor detectors that decrease the size of the camera head and improve energy resolution by almost 2-fold, improved imaging efficiency and count rate statistics, reduced image degradation by scattered radioactivity, higher spatial resolution, and reduced radiation dose.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThe last decade has already seen profound progress, and the future will bring new opportunities to multimodality cardiovascular imaging. These include detection of early disease\/cardiovascular phenotype; possible use of imaging for novel drug development and as a surrogate for patient outcome, and the demonstration that novel technologies ultimately have an impact on patient care and outcomes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EVascular imaging is moving toward the identification of total cardiovascular risk. Dr. Zoghbi predicts more robust quantitation and automation (eg, comparative volumetric 3D flows) in the imaging of valvular regurgitation as well as dynamic mapping of mitral valve strain pre- and post-valve repair. He also expects to see echo-guided interventions for valve repair\/replacement, determination of aortic regurgitation post transcatheter aortic valve replacement, noninvasive imaging of plaques, echocardiography and CMR-compatible imaging flow loops, and TAVR patient-specific modeling and 3D heart printing.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EChallenges will include the maintenance of innovation in individual modalities, avoidance of layering of multiple testing in individual patients to improve safety and lower costs, and the identification of the best and most cost-effective approaches to disease detection and management.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/8\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznacd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznacd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}