Structural heart disease (SHD) is an innovative field driven by the success of non-invasive modalities such as magnetic resonance imaging (MRI), computed tomography (CT), and echocardiography.
Cardiac CT is an imaging modality that has helped to diagnose and manage SHD; supporting structural heart interventions, assessing device function, and screening for complications post-procedure. In this article, we outline SHD and explain the role of advanced CT applications.
What is structural heart disease?
Structural heart disease (SHD) refers to issues related to the structure of your heart. The condition encompasses any abnormalities in the structure or function of valves, muscles, chambers, and walls of the heart. SHD can be congenital or develop with age. If left untreated, SHD can lead to other health issues.
Common types of structural heart disease
There are several common types of structural heart disease, including:
Cardiomyopathy – disease related to the heart muscle, preventing the heart from pumping blood effectively and producing symptoms such as heart palpitations, and shortness of breath.
Heart valve disease – conditions that prevent the heart valves, which control blood flow, from working properly. Heart valve disease causes the heart to work harder and can reduce the quality of life in patients, potentially being life-threatening.
Congenital heart disease – structural heart problems that are present from birth, but may be detected later in life. These conditions may include blood vessel issues, a hole in the heart wall, and heart valve problems.
Cardiac CT for structural heart disease
Cardiac CT allows images to be obtained from inside the chest and examined for structural problems. The modality’s high temporal and isotropic spatial resolution makes it suitable for pre-procedural imaging for structural heart disease interventions. CT allows precise dimensions measurement of the target structure and provides valuable information relating to access routes. Volumetric CT data sets enable the identification of fluoroscopic projection; which is optimal for visualizing the target structure and placing devices.
The modality can be used to diagnose and manage the various types of SHD in the following ways:
Cardiomyopathy – usually used in situations when echo or cardiac MRI is not possible, providing a comprehensive assessment including coronary artery evaluation, characterization of the phenotype, quantification of function, pre-procedural planning and post-treatment evaluation.
Heart valve disease – for planning transcatheter aortic valve replacement (TAVR), a procedure that involves the replacement of a diseased aortic valve with a man-made valve. CT also supports procedures such as percutaneous mitral valve intervention and paravalvular leak closure.
Congenital heart disease – in atrial septal defects, the most common congenital heart defect in adults, contrast-enhanced multislice CT using a saline-chaser can be used for the detection and differentiation of inter-atrial shunts.
Advanced CT applications for structural heart disease
Advanced CT tools are being used to plan procedures such as TAVR and transcatheter mitral valve replacement (TMVR), improving patient outcomes with confident screening. Experts have credited screening with CT as contributing significantly to a high procedural success rate.
Multidetector CT (MDCT) is required for the characterization of the landing zone in TMVR, allowing for a granular and clear definition of the mitral annulus. Advanced CT has proved invaluable to the segmentation of the saddle-shaped, non-planar mitral annulus. MDCT measurements are highly reproducible and effective in sizing the landing zone for transcatheter devices. This segmentation also helps assess the risk of left ventricular outflow tract obstruction (LVOT) ahead of the TMVR procedure.
MDCT can also be used for fluoroscopic angle assessment, allowing co-planar angle prediction, and optimizing fluoroscopic angles. The strides made by advanced CT imaging software have been key to the emergence of the modality in supporting interventions for SHD.
CT vs MRI in structural heart disease
MRI has developed to become an instrumental tool for SHD evaluation and management, enabling accurate diagnosis and in some cases negating the requirement for invasive methods to be used for investigation.
Using techniques from static imaging to cine imaging, phase velocity mapping, MR angiography, and perfusion imaging; advanced MRI tools are being used in SHD for tissue characterization and the assessment of cardiac mass, volumes, and function. This is useful in indications such as heart failure, ischemic heart disease, valvular disease, and pericardial disease.
Advanced CT applications cvi42
cvi42 from Circle CVI provides advanced CT applications that can help to diagnose and manage SHD. The leading imaging software’s surgical intervention modules include coronary arteries, aortic valves, and mitral valves.
Zero-click coronary artery segmentation powered by artificial intelligence improves clinical workflow. Simplified reporting facilitates straightforward documentation of cardiac CT evaluation, while quick editing and measurement tools add efficiency. Cvi42 provides automatic generation of the 3D view of the heart for qualitative assessment of the coronary artery.
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