SF 13b - Cardiac imaging in prevention and screening: who, when and how?
1. To recognise and interpret cardiac alterations in athletes, individuals with elevated cardiac risk factors and patients with suspected genetic cardiac disease.
2. To understand when and in whom cardiac imaging is indicated according the best available evidence today.
3. To perscribe practical MR and CT approaches in populations that qualify for prevention and screening using imaging.
The widespread availability of ultrasonography, multidetector row CT and fast-gradient MR systems has enabled high-quality cardiac imaging in many centres. This has converged with the recognition that early and subtle alterations in cardiac structure and function can be detected before becoming clinically relevant. In this session, we explore the role of cardiac imaging in prevention and screening. In the first part, the role of cardiac imaging in athletes is discussed, including the ability of imaging techniques to differentiate effects of physical training from cardiac disease. The second lecture will focus on the complementary role of imaging in individuals with elevated cardiac risk factors over clinical risk scoring systems. The third lecture will cover the role of imaging in screening for cardiac disease of suspected or known genetic origin.
1. To recognise the spectrum of cardiac alterations due to physical activity and how to differentiate these from disease.
2. To understand the differences in cardiac alterations due to different types of physical activity and training duration.
3. To understand the benefits and limitations of coronary CT in athletes.
High levels of sports training generate physiological cardiac adaptation with balanced increase in biventricular size and ventricular hypertrophy. The degree of ventricular dilatation and myocardial wall thickness depends on several factors, including sex, ethnicity, sport discipline, training level and doping. Understanding these changes is essential to distinguish normal variance and sport-adaptation from mild forms of cardiomyopathy. The largest dimensions are usually seen in male endurance athletes. African/Afro-Caribbean athletes can show higher wall thickness and more hypertrabeculation which should not be confused with hypertrophic or non-compaction cardiomyopathy. Long-term high-level endurance sports can induce atrial fibrillation, myocardial fibrosis, more coronary artery calcification and ARVC-like right ventricular dilatation and arrhythmias. Cardiac events in young athletes (<35 years of age) are rare and mostly caused by cardiomyopathy, channelopathies, malignant coronary artery anomalies and myocarditis. Echocardiography is the first imaging investigation if screening reveals abnormalities or athletes are symptomatic, but cardiac MRI is the most all-round imaging modality. Cardiac MRI is better for assessing possible cardiomyopathies, myocardial fibrosis and ischaemia detection. Most cardiac events occur in older male recreational sportsmen and the majority are related to atherosclerotic coronary artery disease (CAD). Low-dose coronary CT, with non-contrast CT to evaluate coronary artery calcium and CT angiography to assess the full extent of the atherosclerotic burden and degree of stenosis, has additional value to a sports-medical examination for screening older athletes or in athletes with atypical complaints. Cardiac events can be triggered by demand ischaemia, even without a significant coronary stenosis.
1. To understand the role of imaging techniques in patients with elevated risk for cardiovascular events.
2. To understand the strengths and weaknesses of different imaging modalities.
3. To understand when and in whom cardiac imaging is indicated.
Addressing patients with an increased cardiac risk clinically is difficult. Magnetic resonance (MR) imaging and/or computed tomography (CT) might improve the discrimination of patients with an increased cardiac event risk from those without. The strengths and weaknesses of MR imaging and CT will be discussed. Randomised controlled trials such as PACC, FACTOR-64 and EISNER as well as large-scale population studies such as MESA, SHIP, SCAPIS, UK Biobank, German NaKo, and ROBINSCA will be introduced. Finally, I will outline when and in whom cardiac imaging might be beneficial as a screening approach to better target preventive therapies.
1. To review cardiac imaging findings that can provide clinically important information in patients with suspected genetic cardiac disease.
2. To understand when and in whom cardiac imaging is indicated for screening for manifestations of genetic diseases involving the heart.
"no abstract submitted"