La Mura, Lucia (2023) Medico Chirurgo, specialista in Malattie dell'Apparato Cardiovascolare. [Tesi di dottorato]

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Abstract

In the last years, the development of imaging techniques has marked improved cardiovascular prevention thanks to faster and more correct diagnoses. Echocardiography, for its wide availability, is considered the first-line examination for all cardiovascular diagnostic pathways. Thanks to the use of ultrasound, it is a well-tolerated and risk-free examination for patients, it allows an anatomical and functional evaluation of the heart in all its components in real time and, thanks to the advancement of technology, it allows early detection of myocardial damage even before clear ventricular systolic dysfunction occurs. The advent of speckle tracking imaging, a tool now present in daily clinical practice, has allowed, for example, early diagnosis of myocardial damage from cardiotoxicity and initial cardiac involvement in storage diseases such as amyloidosis or Anderson-Fabry disease . Furthermore three-dimensional (3D) echocardiography allows a more accurate evaluation of cardiac volumes . Among the imaging methods, cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are also increasingly popular. Cardiac MRI, without exposing the patient to radiation, allows not only an anatomical and functional evaluation, but also a tissue characterization of the myocardium because of the different reaction of the tissues to magnetic fields exposure; it is also considered the gold standard for the quantification of cardiac volumes , ventricular ejection fraction (EF) and regurgitant volume (RV) in valve regurgitation . Thanks to the advent of T mapping sequences it is possible to recognize early myocardial damage or to distinguish between the different storage diseases in an accurate way , furthermore the use of speckle tracking MRI could help in the diagnostic process . 4Dflow in MRI seems to be of great use in congenital heart disease and valve dysfunction , however further investigations are needed to be able to include it as a new tool in clinical practice. Cardiac CT is widely used for the evaluation of coronary arteries and aortic diseases. With the advancement of technology, it is now possible to perform a CT examination by exposing the patient to a very low dose of ionizing radiation and obtaining functional images, making the method even more usable. The thesis is structured in three parts: PART I. Advanced cardiovascular imaging in aortic disease PART II. Advanced cardiovascular imaging in valvular heart disease PART III: Advanced cardiovascular imaging in myocardial disease

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