Multimodality imaging: Bird’s eye view from The European Society of Cardiology Congress 2018 Munich, August 25–29, 2018

Figures

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  Figure 1. PROMIS-HFpEF study algorithm. In patients diagnosed with heart failure with preserved left ventricular ejection fraction (HFpEF) and nonsignificant coronary artery disease, coronary microvascular dysfunction was assessed based on quantification of coronary flow reserve with adenosine stress transthoracic Doppler echocardiography. In addition, conventional and speckle-tracking echocardiography was used to evaluate left and right ventricular systolic function. Peripheral arterial tonometry was used to measure systemic endothelial dysfunction. Reproduced with permission from Shah et al1

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  Figure 2. 18F-fluoride positron emission tomography and computed tomography predicting deterioration in bioprosthetic valve function. Cases 1-4 depict the role of 18F-fluoride positron emission tomography (PET) and computed tomography (CT) in predicting new bioprosthetic valve dysfunction. None of the patients had known bioprosthetic degeneration at enrolment. Contrast-enhanced CT images in the short axis of the valve (top row) show no clear structural CT changes in case 1, non-calcific leaflet thickening in case 2 and circumferential pannus in cases 3 and 4. Hybrid 18F-fluoride PET-CT images (middle row) show high intensity 18F-fluoride uptake in each valve. Doppler echocardiography (bottom row) shows the development of new valve dysfunction during follow-up with progression to hemodynamically severe stenosis in cases 1 and 2, and new prosthetic regurgitation in cases 3 and 4. Image courtesy of T. Cartridge

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  Figure 3. Short-term adverse cardiac remodeling in asymptomatic moderate and severe aortic stenosis by cardiovascular magnetic resonance. A representative patient undergoing cardiovascular magnetic resonance at baseline at 12-month follow-up. There is a progressive increase in left ventricular end-diastolic volume (LVEDV) and left ventricular mass index (LVMI), reduction in left ventricular ejection fraction (LVEF) and increases in myocardial fibrosis by both native T1 mapping and late gadolinium enhancement (LGE) in the interval of 12 months, whereas the indexed aortic valve area remained unchanged. These changes suggest adverse cardiac remodeling despite no further reduction in indexed aortic valve area. Reproduced with permission from Singh et al13

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  Figure 4. Intravascular ultrasound, optical coherence tomography, 18F-sodium fluoride-PET, and volume-rendered coronary computed tomography angiography images of three representative coronary lesions to assess plaque vulnerability. Morphologic vulnerability was defined as the presence of positive remodeling and posterior attenuation on intravascular ultrasound (IVUS) and the presence of thin-cap fibroatheroma (TCFA) or intraplaque microvessels or macrophage infiltration on optical coherence tomography (OCT). Metabolic vulnerability was defined as any plaque showing > 25% uptake on 18F-sodium fluoride-PET (NaF18-PET) images. Upper row depicts a plaque showing morphologic characteristics of vulnerability. Middle row shows a lesion with metabolic characteristics of vulnerability. Bottom row displays a plaque showing neither morphologic nor metabolic characteristics of vulnerability. Image courtesy of M. Kolossvary. CTA, computed tomography angiography