Cardiovascular Imaging and Functional Assessment Techniques

Cardiovascular imaging and functional assessment encompass a spectrum of modalities designed to visualise cardiac and vascular structure, quantify haemodynamics and characterise tissue properties. Two-dimensional and three-dimensional echocardiography remain first-line tools for real-time assessment of chamber dimensions, wall motion and valvular function. Speckle-tracking adds strain analysis for early detection of subclinical dysfunction. Cardiovascular magnetic resonance (CMR) offers unparalleled soft-tissue contrast, enabling precise measurement of ventricular volumes, myocardial perfusion mapping, tissue characterisation through T1/T2 mapping and late gadolinium enhancement. Computed tomography angiography (CTA) provides high-resolution images of coronary anatomy, plaque composition and perivascular inflammation, with emerging radiotranscriptomic approaches refining risk stratification. Nuclear techniques, including single-photon emission tomography (SPECT) and positron emission tomography (PET), assess myocardial perfusion and metabolic viability. Invasive coronary angiography integrated with pressure-wire measurements such as fractional flow reserve (FFR) quantifies physiological significance of stenoses, while angiography-derived indices like quantitative flow ratio (QFR) are gaining traction as non-wire alternatives. Advanced methods such as four-dimensional flow MRI evaluate complex intracardiac and vascular flow patterns, and emerging artificial intelligence algorithms enhance image segmentation, automate stenosis detection and predict outcome. Together, these techniques inform diagnosis, guide revascularisation decisions, enable personalised therapy and drive preventive strategies across diverse patient populations.

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Research from all publishers

A deep-learning framework has been developed to automate interpretation of conventional coronary angiograms and quantify stenosis severity. Neural networks trained on large multicentre datasets achieved over 90 % accuracy in vessel detection, projection-angle identification and prediction of obstructive coronary disease, promising to standardise angiographic assessments and reduce interobserver variability. A non-invasive imaging biomarker, the perivascular fat attenuation index (FAI), has been validated as a quantitative measure of coronary inflammation on standard coronary CT angiography. High perivascular FAI values correlate with increased risk of cardiac mortality and improve risk discrimination beyond traditional clinical and imaging predictors, thus offering a novel tool for early identification of patients who may benefit from intensified preventive therapy. In the catheterisation laboratory, angiography-derived quantitative flow ratio (QFR) has emerged as a rapid, wire-free surrogate for pressure-wire FFR. Prospective studies demonstrate that online QFR computation during routine invasive angiography is feasible, reduces procedural time and attains sensitivity and specificity comparable to FFR for evaluation of intermediate coronary lesions, thereby streamlining functional lesion assessment without the need for hyperaemic agents.

Cardiovascular Imaging and Functional Assessment Techniques publication trend

The graph below shows the total number of articles in cardiovascular imaging and functional assessment techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Echocardiography: Ultrasound imaging of the heart to assess structure and function.

Cardiovascular magnetic resonance (CMR): MRI technique for detailed anatomical, functional and tissue characterisation of the heart and vessels.

Computed tomography angiography (CTA): X-ray based imaging that visualises vascular anatomy and plaque features following contrast injection.

Fractional flow reserve (FFR): Invasive pressure-wire index measuring the pressure gradient across a coronary stenosis under hyperaemia to assess its physiological impact.

Quantitative flow ratio (QFR): Angiography-derived, non-wire computational estimate of FFR based on vessel reconstruction and contrast flow velocity.

Perivascular fat attenuation index (FAI): CT-derived biomarker quantifying density changes in perivascular adipose tissue as a marker of local vascular inflammation.

References

1. CathAI: fully automated coronary angiography interpretation and stenosis estimation. npj Digital Medicine (2023).
2. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. The Lancet (2018).
3. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography. European Heart Journal (2019).
4. Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study. Journal of the American Heart Association (2018).
5. Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification. Journal of Cardiovascular Magnetic Resonance (2016).