INTRODUCTION:Myocarditis and pericarditis represent a broad spectrum of inflammatory heart diseases and are important differential diagnoses in patients presenting with chest pain, heart failure, or arrhythmias. Diagnosis is often challenging due to non-specific clinical presentation and biomarkers. Growing recognition of the clinical relevance of myocardial inflammation, together with accumulating evidence, has led to increased scientific and clinical attention. This is reflected in emerging concepts such as the introduction of the new term "inflammatory myocardial syndrome (IMPS)" in the recently published guidelines of the European Society of Cardiology (ESC). Notably, these are the first ESC guidelines to cover the full spectrum of inflammatory diseases of the myocardium and pericardium - marking an important paradigm shift in the field. Current ESC guidelines highlight the central role of multimodality cardiac imaging in the evaluation of myocardial inflammation. While echocardiography serves as a first-line tool, cardiac magnetic resonance imaging (CMR) is considered the non-invasive gold standard for tissue characterization. Nuclear imaging techniques such as positron emission tomography (PET) are increasingly relevant, particularly in specific entities such as cardiac sarcoidosis. This review highlights the practical role of multimodality imaging in the diagnostic work-up of myocardial inflammation, with emphasis on clinically relevant decision-making.
INTRODUCTION:Sudden cardiac death (SCD) in athletes is usually the result of an undetected underlying heart disease, with physical exertion acting as the trigger. Commotio cordis is a rare cause of SCD. In young athletes, genetically determined cardiomyopathies predominate, while in older athletes coronary artery disease remains the most important differential diagnosis. Regular screening programs - consisting of medical history, physical examination, and resting ECG - can detect over 90 % of relevant conditions, particularly when international ECG criteria are applied correctly. However, these assessments are not always sufficient, as some pathologies may manifest later in life and/or require additional diagnostic tests to be recognized. The main task of screening athletes is to distinguish physiological adaptations of the athlete's heart from pathological changes. Echocardiography, MRI, and CT play a central role here.
INTRODUCTION:Cardiac amyloidosis and cardiac sarcoidosis can be classified as infiltrative cardiomyopathies. Although the aetiology and underlying pathophysiology of these two conditions differ substantially, imaging techniques are becoming increasingly important for both. Only a decade ago myocardial biopsy used to be essential for establishing the diagnosis, contemporary diagnostic algorithms for both diseases now rely predominantly on non-invasive cardiac imaging, enabling not only accurate diagnosis but also guiding therapeutic decision-making. In this review, we aim to highlight the respective strengths and limitations of the available cardiac imaging modalities as they relate to these disorders. Particular emphasis will be placed on disease detection and the differential diagnosis between amyloidosis and sarcoidosis, and its value for prognostic assessment. Where appropriate, we will also discuss recent advances in multimodality imaging and how they have reshaped clinical pathways and management strategies.
INTRODUCTION:Coronary angiography has evolved from the first cardiac catheterization performed by Werner Forssmann into a highly precise imaging modality of the coronary arteries. Modern techniques such as intravascular ultrasound, optical coherence tomography, and physiological measurements including FFR and iFR enable combined structural and functional assessment of coronary stenoses. At the same time, non-invasive coronary computed tomography, particularly with photon-counting technology, is gaining importance for diagnosis and procedural planning. Cardiovascular imaging is therefore becoming central to personalized management of coronary artery disease.
INTRODUCTION:Artificial intelligence (AI) has rapidly gained importance in medicine over recent years, particularly in medical imaging. AI is transforming cardiac imaging along the entire workflow - from image acquisition and reconstruction to interpretation and diagnosis. In echocardio-graphy, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine, AI systems have the potential to automatically capture and standardize measurements, reduce noise and artifacts, shorten acquisition and analysis times, and improve reproducibility. Applications range from real-time automated analysis of transthoracic echocardiograms and CT-based calcium scoring and plaque quantification to the detection of rare coronary anomalies, AI-assisted MRI planning and the identification of subtle pathological patterns of cardiac amyloidosis. In the future, multimodal AI models combining imaging, clinical, laboratory, and genetic data will enable highly precise risk stratification and individualized therapies. However, challenges remain in terms of generalizability, prospective validation, explainability, and integration into real-world workflows. Clinical validation, quality control, and physician oversight remain essential cornerstones for the responsible use of AI in cardiac imaging.
