Advances in Cardiovascular Imaging 2021

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 31701

Special Issue Editor


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Guest Editor
1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: cardiovascular magnetic resonance; heart failure; cardiovascular imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular imaging is growing rapidly and plays a pivotal role in modern cardiology. Cardiovascular imaging indices have a significant impact on the prevention, diagnosis, and treatment of cardiac diseases. Important therapeutic decisions are based on imaging biomarkers such as the left ventricular ejection fraction. This Special Issue focuses on recent advances on cardiovascular imaging, including current trends and future developments. A combination of original research articles and review articles attempt to shed light on important advances among all of the modalities we deal with in cardiovascular imaging, i.e., echocardiography, nuclear techniques (SPECT, PET), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT).

Prof. Theodoros D. Karamitsos
Guest Editor

Manuscript Submission Information

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Keywords

  • cardiovascular imaging
  • echocardiography
  • cardiovascular magnetic resonance (CMR)
  • nuclear scintigraphy
  • single-photon emission computed tomography (SPECT)
  • positron emission tomography (PET)
  • cardiac computed tomography (CCT)

Published Papers (11 papers)

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Editorial

Jump to: Research, Review

4 pages, 201 KiB  
Editorial
Procainamide for the Rapid Suppression of Premature Ventricular Contractions: An (Almost) Forgotten Tool in the Cardiologist’s Armamentarium
by Daniele Muser, Pasquale Santangeli and Gaetano Nucifora
Diagnostics 2021, 11(2), 357; https://doi.org/10.3390/diagnostics11020357 - 20 Feb 2021
Cited by 1 | Viewed by 1323
Abstract
In the last few years, cardiac magnetic resonance (CMR) imaging has progressively acquired a central role in the diagnosis and management of patients with ventricular arrhythmias (VA) [...] Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)

Research

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13 pages, 2142 KiB  
Article
Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques
by Patricia Wanping Wu, Pei-Kwei Tsay, Zhonghua Sun, Syu-Jyun Peng, Chia-Yen Lee, Ming-Yi Hsu, Yu-Shien Ko, I-Chang Hsieh, Ming-Shien Wen and Yung-Liang Wan
Diagnostics 2022, 12(2), 390; https://doi.org/10.3390/diagnostics12020390 - 03 Feb 2022
Cited by 2 | Viewed by 1811
Abstract
Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA [...] Read more.
Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA can be used to qualitatively assess the vascular lumen and might be helpful for overcoming this challenge. In this study, one hundred subjects with coronary stents underwent both CCTA and invasive coronary angiography (ICA). A total of 902 vessel segments were analyzed using CCTA and VIE. The vessel segments were first analyzed on CCTA alone. Then, using VIE, the segments were classified qualitatively as either negative or positive for in-stent restenosis (ISR) or CAD. These results were compared, using ICA as the reference, to determine the added diagnostic value of VIE. Of the 902 analyzed vessel segments, CCTA/VIE had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (shown in %) of 93.9/90.2, 96.2/98.2, 96.0/97.7, 70.0/83.1, and 99.4/99.0, respectively, in diagnosing ISR or CAD, with significantly improved specificity (p = 0.025), accuracy (p = 0.046), and positive predictive value (p = 0.047). VIE can be a helpful addition to CCTA when evaluating coronary arteries. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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13 pages, 1191 KiB  
Article
The Interplay between Myocardial Fibrosis, Strain Imaging and Collagen Biomarkers in Adults with Repaired Tetralogy of Fallot
by Konstantina Karali, Kali Makedou, Alexandros Kallifatidis, Matthaios Didagelos, George Giannakoulas, Constantinos H. Davos, Theodoros D. Karamitsos, Antonios Ziakas, Haralambos Karvounis and Stavros Hadjimiltiades
Diagnostics 2021, 11(11), 2101; https://doi.org/10.3390/diagnostics11112101 - 13 Nov 2021
Cited by 4 | Viewed by 1758
Abstract
Background: We sought to assess the interplay between right ventricle (RV) fibrosis, biventricular dysfunction based on global longitudinal strain (GLS) analysis, and biomarkers such as Galectin-3 (Gal-3), procollagen type III (PCIII), and NTproBNP. Methods: We studied 35 adult patients with rToF. All patients [...] Read more.
Background: We sought to assess the interplay between right ventricle (RV) fibrosis, biventricular dysfunction based on global longitudinal strain (GLS) analysis, and biomarkers such as Galectin-3 (Gal-3), procollagen type III (PCIII), and NTproBNP. Methods: We studied 35 adult patients with rToF. All patients underwent a cardiac magnetic resonance (CMR) scan including feature tracking for deformation imaging. Blood biomarkers were measured. Results: LGE RV was detected in all patients, mainly at surgical sites. Patients with the highest RV LGE scoring had greater RV dilatation and dysfunction whereas left ventricular (LV) function was preserved. LV GLS correlated with RV total fibrosis score (p = 0.007). A LV GLS value of −15.9% predicted LGE RV score > 8 (AUC 0.754 (p = 0.02)). Neither RV GLS nor biomarker levels were correlated with the extent of RV fibrosis. A cut-off value for NTproBNP of 145.25 pg/mL predicted LGE RV score > 8 points (AUC 0.729, (p = 0.03)). A cut-off value for Gal-3 of 7.42 ng/mL predicted PR Fraction > 20% [AUC 0.704, (p = 0.05)]. Conclusions: A significant extent of RV fibrosis was mainly detected at surgical sites of RV, affecting RV performance. CMR-FT reveals subtle LV dysfunction in rToF patients, due to decreased performance of the fibrotic RV. Impaired LV function and elevated NTproBNP in rToF reflect a dysfunctional fibrotic RV. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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13 pages, 8724 KiB  
Article
Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias
by Chrysovalantou Nikolaidou, Christos P. Kotanidis, Rohan Wijesurendra, Joana Leal-Pelado, Konstantinos Kouskouras, Vassilios P. Vassilikos, Haralambos Karvounis, Ntobeko Ntusi, Charalambos Antoniades, Stefan Neubauer and Theodoros D. Karamitsos
Diagnostics 2021, 11(6), 1109; https://doi.org/10.3390/diagnostics11061109 - 18 Jun 2021
Cited by 4 | Viewed by 2240
Abstract
Background: A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients. Methods: A single-centre prospective study was [...] Read more.
Background: A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients. Methods: A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease. Results: CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%), p < 0.001) and a global circumferential strain (GCS) (−17.66% (IQR: −19.62% to −16.23%) vs. −20.66% (IQR: −21.72% to −19.6%), p < 0.001). Conclusion: CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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20 pages, 1354 KiB  
Article
Effects of Anti-Inflammatory Treatment and Surgical Intervention on Endothelial Glycocalyx, Peripheral and Coronary Microcirculatory Function and Myocardial Deformation in Inflammatory Bowel Disease Patients: A Two-Arms Two-Stage Clinical Trial
by Charilaos Triantafyllou, Maria Nikolaou, Ignatios Ikonomidis, Giorgos Bamias, Dimitrios Kouretas, Ioanna Andreadou, Maria Tsoumani, John Thymis and Ioannis Papaconstantinou
Diagnostics 2021, 11(6), 993; https://doi.org/10.3390/diagnostics11060993 - 30 May 2021
Cited by 7 | Viewed by 2848
Abstract
Sixty inflammatory bowel disease (IBD) patients (45 Crohn disease and 15 ulcerative colitis, 40 ± 13 years, 53% male) were examined at baseline and 4 months after intervention (surgical (35 patients) or anti-TNFa treatment (25 patients)). IBD severity, using Mayo score, Harvey–Bradshaw Index [...] Read more.
Sixty inflammatory bowel disease (IBD) patients (45 Crohn disease and 15 ulcerative colitis, 40 ± 13 years, 53% male) were examined at baseline and 4 months after intervention (surgical (35 patients) or anti-TNFa treatment (25 patients)). IBD severity, using Mayo score, Harvey–Bradshaw Index (HBI) and biomarkers, was correlated with cardiovascular markers. At baseline, the disease severity, the white blood cells (WBC) values and the reducing power (RP) were significantly correlated with the aortic pulse wave velocity (PWV) (r = 0.4, r = 0.44 and r = 0.48, p < 0.05) and the lateral mitral E’ velocity (r = 0.35, p < 0.05 and r = 0.3, p < 0.05). Four months after intervention, there was a reduction of WBC (1962.8/mm3 ± 0.425/mm3, p < 0.001), C-reactive protein (CRP) (8.1 mg/L ± 1.7 mg/L, p < 0.001), malondialdehyde (MDA) (0.81 nmol/mg ± 0.37, p < 0.05) and glycocalyx perfused boundary region (PBR 5-25) (0.24 μm ± 0.05 μm, p < 0.01). Moreover, the brachial flow mediated dilatation (FMD), the coronary flow reserve (CFR) and the left ventricle global longitudinal strain (LV GLS) were significantly improved for both groups (4.5% ± 0.9%, 0.55 ± 0.08, 1.4% ± 0.35%, p < 0.01), while a more significant improvement of PWV/GLS was noticed in the anti-TNFa group. IBD severity is associated with vascular endothelial, cardiac diastolic, and coronary microcirculatory dysfunction. The systemic inflammatory inhibition and the local surgical intervention lead to significant improvement in endothelial function, coronary microcirculation and myocardial deformation. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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8 pages, 796 KiB  
Article
Bolus Intravenous Procainamide in Patients with Frequent Ventricular Ectopics during Cardiac Magnetic Resonance Scanning: A Way to Ensure High Quality Imaging
by Chrysovalantou Nikolaidou, Konstantinos Kouskouras, Nikolaos Fragakis, Vassilios P. Vassilikos, Haralambos Karvounis and Theodoros D. Karamitsos
Diagnostics 2021, 11(2), 178; https://doi.org/10.3390/diagnostics11020178 - 27 Jan 2021
Cited by 4 | Viewed by 2250
Abstract
Acquiring high-quality cardiac magnetic resonance (CMR) images in patients with frequent ventricular arrhythmias remains a challenge. We examined the safety and efficacy of procainamide when administered on the scanner table prior to CMR scanning to suppress ventricular ectopy and acquire high-quality images. Fifty [...] Read more.
Acquiring high-quality cardiac magnetic resonance (CMR) images in patients with frequent ventricular arrhythmias remains a challenge. We examined the safety and efficacy of procainamide when administered on the scanner table prior to CMR scanning to suppress ventricular ectopy and acquire high-quality images. Fifty consecutive patients (age 53.0 [42.0–58.0]; 52% female, left ventricular ejection fraction 55 ± 9%) were scanned in a 1.5 T scanner using a standard cardiac protocol. Procainamide was administered at intermittent intravenous bolus doses of 50 mg every minute until suppression of the ectopics or a maximum dose of 10 mg/kg. The average dose of procainamide was 567 ± 197 mg. Procainamide successfully suppressed premature ventricular contractions (PVCs) in 82% of patients, resulting in high-quality images. The baseline blood pressure (BP) was mildly reduced (mean change systolic BP −12 ± 9 mmHg; diastolic BP −4 ± 9 mmHg), while the baseline heart rate (HR) remained relatively unchanged (mean HR change −1 ± 6 bpm). None of the patients developed proarrhythmic changes. Bolus intravenous administration of procainamide prior to CMR scanning is a safe and effective alternative approach for suppressing PVCs and acquiring high-quality images in patients with frequent PVCs and normal or only mildly reduced systolic function. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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14 pages, 1757 KiB  
Article
Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major
by Maria Vlachou, Vasileios Kamperidis, Efthymia Vlachaki, Georgios Tziatzios, Despoina Pantelidou, Afroditi Boutou, Chrysa Apostolou, Despoina Papadopoulou, George Giannakoulas and Haralambos Karvounis
Diagnostics 2021, 11(1), 1; https://doi.org/10.3390/diagnostics11010001 - 22 Dec 2020
Cited by 4 | Viewed by 1819
Abstract
Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ [...] Read more.
Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032–1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019–1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009–20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783–0.964, p = 0.008), higher MV E/E′ average (OR: 1.407, 95% CI: 1.028–1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039–1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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Review

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14 pages, 621 KiB  
Review
Cardiac Autonomic Nervous System and Ventricular Arrhythmias: The Role of Radionuclide Molecular Imaging
by Andreas Fesas, Evanthia Giannoula, Alexis Vrachimis, Argyrios Doumas, Christian Wenning, Matthaios Didagelos and Ioannis Iakovou
Diagnostics 2021, 11(7), 1273; https://doi.org/10.3390/diagnostics11071273 - 15 Jul 2021
Cited by 5 | Viewed by 2211
Abstract
Widely established compared to myocardial perfusion imaging, cardiac autonomous nervous system (CANS) assessment by radiopharmaceutical means is of potential use especially to arrhythmogenic diseases not correlated with anatomic or functional alterations revealed by classical imaging techniques. Molecular imaging of both pre- and postsynaptic [...] Read more.
Widely established compared to myocardial perfusion imaging, cardiac autonomous nervous system (CANS) assessment by radiopharmaceutical means is of potential use especially to arrhythmogenic diseases not correlated with anatomic or functional alterations revealed by classical imaging techniques. Molecular imaging of both pre- and postsynaptic functions of the autonomous nervous system is currently feasible, since single photon emission tomography (SPECT) and positron emission tomography (PET) have the ability to reveal the insights of molecular pathophysiology depicting both sympathetic and parasympathetic imbalance in discrete heart pathologies. This review provides not only a brief presentation of radiopharmaceuticals used for non-invasive CANS imaging in the case of ventricular arrhythmias, but also a current update on ventricular tachycardias, cardiomyopathies, Brugada and Long QT syndrome literature. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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13 pages, 671 KiB  
Review
Nuclear Imaging for the Diagnosis of Cardiac Amyloidosis in 2021
by Weijia Li, Dipan Uppal, Yu Chiang Wang, Xiaobo Xu, Damianos G. Kokkinidis, Mark I. Travin and James M. Tauras
Diagnostics 2021, 11(6), 996; https://doi.org/10.3390/diagnostics11060996 - 30 May 2021
Cited by 13 | Viewed by 4944
Abstract
Cardiac amyloidosis is caused by the deposition of misfolded protein fibrils into the extracellular space of the heart. The diagnosis of cardiac amyloidosis remains challenging because of the heterogeneous manifestations of the disease. There are many different types of amyloidosis with light-chain (AL) [...] Read more.
Cardiac amyloidosis is caused by the deposition of misfolded protein fibrils into the extracellular space of the heart. The diagnosis of cardiac amyloidosis remains challenging because of the heterogeneous manifestations of the disease. There are many different types of amyloidosis with light-chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis being the most common types of cardiac amyloidosis. Endomyocardial biopsy is considered the gold standard for diagnosing cardiac amyloidosis and differentiating amyloid subtypes, but its use is limited because of the invasive nature of the procedure, with risks for complications and the need for specialized training and centers to perform the procedure. Radionuclide cardiac imaging has recently become the most commonly performed test for the diagnosis of ATTR amyloidosis but is of limited value for the diagnosis of AL amyloidosis. Positron emission tomography has been increasingly used for the diagnosis of cardiac amyloidosis and its applications are expected to expand in the future. Imaging protocols are under refinement to achieve better quantification of the disease burden and prediction of prognosis. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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15 pages, 2390 KiB  
Review
Myocardial Work: Methodology and Clinical Applications
by Konstantinos Papadopoulos, Özge Özden Tok, Konstantina Mitrousi and Ignatios Ikonomidis
Diagnostics 2021, 11(3), 573; https://doi.org/10.3390/diagnostics11030573 - 22 Mar 2021
Cited by 42 | Viewed by 4803
Abstract
A precise and accurate assessment of left ventricular (LV) contractility is of utmost importance in terms of prognosis in most cardiac pathologies. Given the limitations of ejection fraction (EF) and global longitudinal strain (GLS) due to their load dependency, a novel imaging tool [...] Read more.
A precise and accurate assessment of left ventricular (LV) contractility is of utmost importance in terms of prognosis in most cardiac pathologies. Given the limitations of ejection fraction (EF) and global longitudinal strain (GLS) due to their load dependency, a novel imaging tool called myocardial work (MW) has emerged as a promising method for LV performance evaluation. MW is a novel, less load-dependent method based on computation of myocardial strain–arterial blood pressure curves. This method provides a more detailed assessment of segmental and global LV function incorporating the patient’s LV pressure and is derived by brachial artery pressure utilizing an empiric reference curve adjusted to the duration of the isovolumic and ejection phases as determined by echocardiography. The clinical implications of this unique method have been expanding in the last few years, which attest to the robust additive role of MW in routine practice. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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17 pages, 27049 KiB  
Review
Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis
by Constantina Aggeli, Yannis Dimitroglou, Leonidas Raftopoulos, Georgia Sarri, Sophie Mavrogeni, Joyce Wong, Eleftherios Tsiamis and Costas Tsioufis
Diagnostics 2020, 10(12), 1088; https://doi.org/10.3390/diagnostics10121088 - 14 Dec 2020
Cited by 28 | Viewed by 4032
Abstract
Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic [...] Read more.
Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Imaging 2021)
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