Imaging Early Life Cardiovascular Phenotype

Abstract

The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.

Keywords: atherosclerosis; cardiovascular diseases; heart failure; phenotype.

Figure 1:

Natural History of CVD development

Figure 2:

A) curved multiplanar CT image of atherosclerotic plaque in the left anterior descending artery (LAD). B) cross-sectional image of coronary calcium of the same artery at the level of the blue line in the panel A. C) A curved multiplanar reformatted CT image of LAD of a different patient. D) Cross-sectional image of the same artery at the level of the blue line in the panel C.

Figure 3:

CT image of descending aorta showing calcification and significant atherosclerosis. A) Orthogonal view of descending aorta. B) cross-sectional view of the descending aorta.

Figure 4:

The upper panel shows the presence of atherosclerotic plaque in the left anterior descending artery (LAD) which was not denoted as having significant CAD by CTA visual assessment but was denoted as significant CAD by CTA and semi-quantitative CTP metrics. Lower Panel shows the presence of atherosclerotic plaque in the lateral circumflex artery of a patient that was not denoted as significant CAD by CTA visual assessment, however, was denoted as having significant CAD by combined CTA and quantitative CTP metrics.

Figure 5:

Two longitudinal orthogonal plane display of left ventricular with strain analysis in four chamber (A) and two chamber views (B).

Figure 6:

Left panel shows the MRI image of the left ventricle. Left upper panel shows the LV in 2 chamber and 4 chamber view. Left lower panel shows the LV in short axis where the scar in the myocardium can be appreciated. Right Panel shows the T1 mapping of LV myocardium.

Figure 7:

Multiplane display of LA 3d full volume showing three cross-sectional slices (C3, C5, and C7) and two longitudinal orthogonal planes (four chamber(A) and two-chamber (B) views).

Figure 8:

MRI image of LA showing contours drawn using Multimodality tissue tracking software at end- diastole and end systole.