The Heart Imaging Program at the Mount Sinai Health System is nationally renowned for its academic excellence and clinical achievements. We perform a full spectrum of echocardiographic services with a strong emphasis on echocardiographic research and cutting edge technology. The program is run by the leaders in the field of echocardiography and employs a highly trained technical staff including registered sonographers, nurses, and level-3 echo fellows.
We store all echocardiographic studies digitally and can review them at any of our workstations. We perform 23,000 echocardiographic studies annually, including more than 2,400 stress echocardiographic studies and approximately 1,600 transesophageal studies. We also perform sophisticated quantitative images such as strain and strain rate, echo imaging for structural heart disease including transcatheter aortic valve replacement, mitral clip and transcatheter mitral valve replacement, septal ablation, and left atrial appendage closure.
Tools for Detecting Heart Disease
Throughout the Sinai System, our cardiologists use a variety of diagnostic technologies including:
For more than 100 years, Mount Sinai physicians have pioneered new technologies to diagnose and treat heart disease. Our rich history in cardiac testing stretches back to 1909, when Alfred E. Cohn, a Mount Sinai cardiologist, brought the first electrocardiogram machine to the United States. Since then, Mount Sinai physicians have continued to make fundamental contributions to the development of cardiac testing including exercise stress testing, cardiac ultrasound imaging, arrhythmia detection, and high-resolution imaging.
Here are some of the ways that we continue to push the boundaries of cardiac imaging.
- In April 2010, we became the first medical center in the United States to use cadmium zinc telluride, the latest generation of imaging cameras for stress testing, resulting in faster, safer, and more accurate detection of heart disease. "The cadmium zinc telluride technology improves image quality while significantly reducing the patient’s exposure to radiation, says Lori Croft, MD, Associate Professor and Director of Nuclear Cardiology Laboratory. “Additionally, we are able to reduce the imaging time from 15 to 20 minutes to only 3 to 5 minutes.”
- We were the first hospital in the world to pair ultra-powerful magnetic resonance imaging (MRI) with a positron emission tomography (PET) scanner in the same room. The combination of the PET's ability to detect diseased heart cells and the MRI's three-dimensional resolution allows physicians to diagnose and pinpoint heart problems at earlier. Zahi A. Fayad, PhD, Director of the Translational and Molecular Imaging Institute and Professor of Cardiology, is directing this effort, which offers unparalleled resolution of heart and blood vessel imaging and information about inflammation and other markers of disease.
- Mount Sinai Heart is thoroughly expert at echocardiography, performing more than 10,000 echocardiograms every year. The newest advance in this imaging technology is three-dimensional echocardiography: a series of images that, when viewed in sequence, offers surgeons a view of heart valves as they would appear in the operating room.
Nuclear cardiology studies use noninvasive techniques to assess myocardial blood flow, evaluate the pumping function of the heart, and visualize the size and location of heart attacks.
Myocardial perfusion imaging is a non-invasive imaging testing modality that shows how well the blood flows through (perfuses) your heart muscle. It can show areas of the heart muscle that are not getting enough blood flow and can lead to symptoms such as chest pain or shortness of breath. We combine myocardial perfusion images with exercise (walking on a treadmill) to assess the blood flow to the heart muscle. We perform a chemical or pharmacological stress test using the drugs regadenoson, dipyridamole, adenosine or dobutamine in patients who are unable to exercise maximally. This approach provides similar information about the heart's blood flow.
We inject a small amount of an imaging agent Tc-99m sestamibi or Thallium, into the blood stream during rest and during exercise or chemical stress. Then we use a scanning device (gamma camera) to measure the uptake of the imaging agent in the heart during stress and at rest. If there is significant blockage of a coronary artery, your heart muscle may not get enough blood when you are exercising or during chemical stress. The imaging tests can show this decrease in blood flow.
Myocardial perfusion studies can identify areas of your heart muscle that are not getting enough blood as well as the areas that are scarred from a heart attack. We can also see where your coronary artery may have atherosclerosis (hardening or narrowing), how much of your heart is not getting enough blood, and how well your heart is pumping. This information helps us identify whether you are at an increased risk and may be a candidate for invasive procedures such as coronary angiography, angioplasty, or heart surgery.
When your heart is inflamed or does not receive enough blood, it can irreversibly affect the basic cellular component of the heart muscle. Nuclear cardiology techniques can help us determine which areas of the heart muscle have been damaged by infection or by a heart attack. These techniques can also help us monitor your heart after cardiac transplantation.
The Mount Sinai Hospital’s Nuclear Cardiology Laboratory opened in 1991 and currently performs close to 5,000 tests a year. We use CZT SPECT cameras and our lab is accredited by the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories. All attendings in nuclear cardiology are Board certified in internal medicine, cardiovascular diseases, and nuclear cardiology. Our technical personnel include experienced registered nurses and certified nuclear technologists. All laboratory employees are certified in basic life support or advanced life support.
We perform both exercise and pharmacological stress (e.g., regadenoson, dipyridamole, adenosine, or dobutamine) cardiovascular stressing. We use perfusion tracers (Tc99m sestamibi, and Tl-201) according to the appropriate indication for individual patients.
The laboratory also performs cardiopulmonary stress testing with measurement of oxygen consumption and cardiac output during exercise using inert gas rebreathing method. This testing is most appropriate for patients with advanced congestive heart failure.
We perform coronary calcium scoring, coronary computed tomography (CT) angiography, and other specialized cardiac CT studies using state-of-the-art 256-slice CT systems. We review all studies on high definition workstations using advanced 3D analysis tools and our nationally recognized experts interpret the results.
We perform cardiac CT at the lowest possible radiation dose using the most advanced image acquisition technologies including model-based iterative reconstruction, prospective electrocardiogram triggering, and dose modulation. These safety features allow us to perform cardiac CT with as little as is 0.5 mSv which is equivalent to approximately five chest X-rays. It is also much less than that of nuclear stress tests (3-5 mSv).
The American Heart Association has endorsed the coronary calcium score scan for risk stratification in asymptomatic patients with intermediate Framingham Risk Scores. The calcium score can predict future cardiac events more accurately than traditional risk factors, it does not require contrast administration, and it is completed within minutes. We use computer-aided quantitative analysis to interpret these tests and our reports provide an estimate of cardiac event risk based on age- and gender-adjusted normalcy tables.
Coronary CT angiography (CTA) is an ideal test for the evaluation of symptomatic patients with low to intermediate probability of obstructive coronary artery disease and for those with equivocal stress test results. Coronary CTA can reveal potentially life-threatening coronary plaques with outstanding spatial resolution, temporal resolution, and diagnostic accuracy.
Coronary CTA is a non-invasive imaging modality that can be compared to cardiac catheterization for evaluation of coronary arteries without the use of wires or catheters. This non-invasive test eliminates the risks associated with cardiac catheterization and uses less contrast volume than cardiac catheterization. Ambulatory patients tolerate the test well and the results are immediately available. We also find that coronary CTA is valuable for patients who require evaluation of coronary artery bypass graft and stent patency.
Cardiac CT is also a suitable alternative for patients who cannot use MRI and require evaluation of cardiac masses, congenital heart disease, non-ischemic cardiomyopathies, pericardial disease, or vascular abnormalities. It provides an excellent three-dimensional evaluation of the left atrial and cardiac vein anatomy in patients undergoing electrophysiological procedures. CT is also suitable for rapidly evaluating large anatomical regions such as the thoraco-abdominal aorta and its branch vessels in patients with aneurysms, vasculitis, and other vascular diseases. It is a state-of-the-art cardiovascular imaging modality for assessment of patient eligibility for percutaneous trancatheter aortic valve replacement (TAVR).
We perform cardiac MRI (CMR) studies on cardiac-dedicated systems that are regularly calibrated to provide optimal performance. We review all studies on high-definition workstations using advanced 3D analysis tools and they are interpreted by nationally recognized experts in the field.
Cardiac MRI uses magnets and a computer to generate detailed pictures of the heart. Unlike X-rays or CT scans, CMR does not involve ionizing radiation. Cardiac MRI tells us about the type and severity of heart disease including myocardial infarction (heart attacks), cardiomyopathy (cardiac muscle disease), myocarditis (inflammation or infection of the heart), and heart valve disease. It is especially useful for identifying and quantifying the amount of heart muscle that can be rescued after a heart attack.
CMR is the most accurate method for evaluating ventricular mass, volume, and function. With special MRI images, we can perform ‘tissue characterization’ of cardiac masses to determine the type of mass or tumor. This is far more advanced than other non-invasive imaging modalities. Cardiac MRI also allows us to diagnose disorders such as sarcoidosis, amyloidosis, and hemochromatosis. It is also helpful for diagnosis of right ventricular dysplasia.
We can perform CMR in combination with pharmacological stress, making it a suitable alternative for patients who are technically difficult candidates for stress echocardiography or single-photon emission computed tomography.
If you have regional or global left ventricular dysfunction, imaging with intravenous gadolinium-based contrast media detects the presence and extent of myocardial fibrosis in various diseases. Late gadolinium imaging can also reveal the distribution and severity of myocardial injury in myocardial infarction. The absence of late gadolinium enhancement is an excellent predictor of functional recovery in patients being considered for revascularization.
CMR provides a comprehensive evaluation of atrial and ventricular chamber size, right and left ventricular function, and valvular function. CMR can accurately quantify the severity of valve stenosis (hardening) or regurgitation (leakage) without the need for intravenous contrast administration. CMR is also an excellent imaging modality in patients with complex congenital heart disease. CMR can delineate cardiac morphology in great detail and can help us detect and measure the degree of intracardiac shunt for those who have congenital heart disease.
CMR angiography (MRA) evaluates the three-dimensional anatomy of the systemic, pulmonic, and venous vasculature. Due to the absence of ionizing radiation, MRA is an ideal test for the serial follow-up of patients with aortic aneurysms or dissections. Using the latest technologies available, we can evaluate these cardiovascular structures using EKG gating and diaphragmatic gating for improved spatial resolution and image quality. For many indications, we can perform MRA without intravenous contrast while maintaining excellent diagnostic accuracy.