Evolving imaging techniques for the assessment of cardiac structure and function and their potential clinical applications

The objectives of this thesis were to study the clinical applications of the novel echocardiographic imaging modalities in the patients with cardiovascular diseases. Part I focuses on the evaluation of the novel parameters of myocardial function in the common cardiac conditions using 2-dimensional speckle tracking imaging and tissue Doppler imaging. In patients with ischemic heart disease, changes in the left ventricular myocardial mechanics and their incremental prognostic value for the cardiovascular outcomes are described. In addition, the mechanical properties of the left ventricle in heart failure patients, their role in predicting outcome, and their changes with therapy are explored. Part II explores the role of the novel imaging modalities in the assessment of the cardiac anatomy and valvular function. Advanced clinical applications of 3-dimensional echocardiography in various cardiac conditions are described in Part IIA. The accuracy and clinical feasibility of the assessment of the mitral valve geometry from 3-dimensional images using dedicated mitral valve quantification software that is comparable to the multi-row detector cardiac tomography measurements was demonstrated in Chapter 6. In addition, 3-dimensional echocardiography was evaluated for its accuracy for quantification of mitral regurgitation, using magnetic resonance imaging as gold standard (Chapter 7). The role of multimodality imaging in the emerging transcatheter aortic valve implantation procedures is discussed in Part IIB, including its usefulness in pre-procedural screening, procedural guidance and post-procedural follow-up.