Cardiac Imaging

Every patient’s heart is different. And every patient’s cardiovascular health is unique. That’s why The George Washington University Hospital Cardiac Imaging Program aims to provide evidence-based, advanced diagnostic approaches to the heart through nationally recognized expert level care, consultation, and collaboration with referring cardiovascular clinicians.

“Enhanced identification of early heart disease allows for personalized treatment and prevention for patients,” says Andrew D. Choi, MD, FACC, FSCCT, Co-director, Cardiac CT and MRI and Associate Professor of Medicine and Radiology at The George Washington University School of Medicine and Health Sciences, Division of Cardiology.

In addition to established approaches in echocardiography and stress testing, GW Hospital offers:

• 3D/4D cardiac computed tomography angiography (CCTA)
• 3D transesophageal echocardiography (TEE) and strain imaging
• Cardiac MRI (CMR)
• Nuclear imaging, including SPECT and PET scans

Cardiac CTA

Two types of cardiac CT scans are used for risk stratification vs. coronary vessel and cardiac structural assessment.  

• A non-contrast (e.g., no IV dye) coronary artery calcium scan measures calcium (CAC) in the coronary arteries, but cannot assess for blockages of heart function.  Recent 2018 ACC/AHA prevention guidelines have established the role of CAC in risk prevention beyond established risk calculators for patients at intermediate risk of heart disease as part of a paradigm of shared decision-making between clinician and patient.  
• Cardiac computed tomography angiography (CCTA) uses IV contrast to detect the presence of plaque and narrowing. At GW Hospital, CCTA can be performed at very low radiation doses (<1 – 5 mSv, which is significantly lower than traditional, nuclear-based stress tests). This scan provides 95 to 99 percent sensitivity for the detection of obstructive coronary artery disease while also identifying early atherosclerosis to enhance prevention. CCTA also can be used to look at the heart muscle and assess if transcatheter aortic valve replacement (TAVR) is an option, as well as looking for clots in the heart. CCTA is very useful for patients with symptoms suggestive of heart disease as a first-line test or improved diagnostic accuracy of prior equivocal stress tests. CCTA use has expanded greatly in the assessment of structural heart disease, including in cardiomyopathy, endocarditis, congenital heart disease, aortopathy and as an alternative to CMR in patients with implanted cardiac devices.

Cardiac MRI

Cardiac magnetic resonance imaging uses a strong magnet and radio waves to create a 3D image of the heart and, therefore, no radiation. CMR allows for the best assessment of the myocardium to assess for scarring, fibrosis and changes from acute and chronic coronary artery disease (e.g., viability imaging). CMR allows for assessment of the pericardium, congenital heart diseases, aorta/aortic valve and masses, while often serving as a definitive approach that clarifies results from other imaging modalities such as echocardiography. 

3D Echocardiography

3D echocardiography represents a major innovation in cardiovascular ultrasound that presents realistic views of the heart valve, allows for direct quantification of chamber dimensions, and provides an assessment of patients evaluated for interventional catheter-based therapies, such as TAVR, percutaneous mitral valve repair and left atrial assessment. If a 3D transesophageal echocardiogram (TEE) is needed, patients at GW Hospital can undergo this procedure safely and comfortably with support from GW Anesthesiology for every patient. 

Why Choose GW Hospital for Cardiac Imaging

GW Hospital uses a distinctive, collaborative approach across all modalities to evaluate and review cardiac imaging studies. Most nuclear, CCTA and CMR studies are jointly read between expert cardiologists and radiologists.

GW Hospital’s imaging leadership consists of national experts who write guidelines and direct the national, cutting-edge practice of cardiovascular imaging.  

“We aim to provide a personalized and individualized follow-up for referring clinicians and the opportunity to discuss and review cardiac imaging findings to enable personalized care plans for each patient,” Dr. Choi says. “And if needed, we offer the opportunity to access the full spectrum of cardiovascular care, including interventional cardiology, electrophysiology, pulmonary hypertension, advanced heart failure and prevention to enable the best follow-up for patients.”