Echocardiography
As the major imaging tool in cardiology, echocardiography provides fast and comprehensive cardiac imaging at low cost: Today, transthoracic, transesophageal and intracardiac echocardiography not only help in diagnosing cardiovascular disease but also in guiding treatment e.g. in patients undergoing interventional ASD closure or pulmonary vein ablation by enabling accurate real-time visualization of devices. The introduction of real-time full-volume imaging with the Acuson SC2000 will change the standard of care in echocardiography.
Echocardiography

Card Angiography
Still the gold standard for coronary artery assessment, x-ray coronary angiography is the basis for percutaneous interventions or surgical therapy in significant Coronary Artery Disease. With new tools such as syngo IC3D or syngo DynaCT, 3D coronary imaging and CT-like cross-sectional imaging is possible directly in the cath lab. syngo DynaCT provides CT-like soft tissue differentiation, which is especially beneficial in new procedures like Transcatheter aortic valve implantation or aortic interventions.
Card Angiography

Cardiac Molecular Imaging
Apart from established indications, nuclear cardiology with higher resolution and highly specific tracers can help clinicians and researchers to support novel approaches such as stem cell therapy and plaque imaging. But also innovations like IQ SPECT reduce acquisition times by ~ 75% while even increasing image quality. Hybrid solutions such as SPECT•CT and PET•CT enable a fast and accurate evaluation of myocardial perfusion and viability as well as coronary morphology.
Cardiac Molecular Imaging

Cardiovascular CT
Coronary CTA using state-of-the-art technology offers very high diagnostic accuracy to rule out significant Coronary Artery Disease and is thus very useful in patients with unclear chest pain. Cardiac CT now offers new possibilities for visualizing coronary arteries and plaques with Dual Energy applications and looks promising for assessment of myocardial perfusion and viability. From image acquisition to post-processing – Cardiac CT provides push-button functionality for maximum ease of use. But even further, with SOMATOM Definition Flash, Cardiac CT can now be performed with very low radiation exposure and without the need for heart-rate lowering medication.
Cardiovascular CT

Cardiovascular MR
As a modality free of ionizing radiation and with high spatial and temporal resolution, Cardiovascular MR allows a comprehensive assessment of the cardiac status including anatomy, morphology, function at rest and under stress, myocardial perfusion and viability. Thus Cardiovascular MR has become a versatile tool in clinical routine, even in complex cases. Today, parallel imaging technology powered by Tim® enables very fast imaging up to real-time Cardiovascular MR with high spatial resolution, in one breath-hold or even in free-breathing.
Cardiovascular MR

Coronary Angiography
Coronary angiography is capable to visualize even smallest coronary lumen alterations due to its high temporal and spatial resolution in all patients, irrespective of heart rhythm and heart rate. However it does not deliver any information about the coronary wall morphology. Coronary angiography is the only modality offering immediate therapeutic intervention in the case of a flow limiting coronary stenosis.
Coronary Angiography

Coronary CT Angiography
Coronary CT angiography (CTA) is a useful diagnostic method in specific clinical situations, especially in acute patients with inconclusive results from initial ECG and lab testing (Appropriateness Criteria for Cardiac CT and Cardiac MRI1). The diagnostic accuracy of coronary CTA relates to the detection of significant coronary artery stenosis (> 50%), diagnosed by invasive coronary angiography. Coronary CTA has a high negative predictive value (NPV) and therefore is especially useful for the exclusion of significant coronary artery stenosis. 2,3 In several studies it could be demonstrated that cardiac CT not only improves quality of care for acute chest pain patients, but may also save money.4 Recent studies could demonstrate that Dual Source CT may overcome limitations of Single Source coronary CTA.5 Dual Source CT allows not only the evaluation of native coronary arteries, but also of stents and bypass grafts independent of the heart rate, e.g. in patients after heart transplantation.
Cardiovascular CT

Coronary MR Angiography
Coronary MR Angiography (MRA) is a promising technique for the diagnostic evaluation of the coronary arteries. According to the Appropriateness Criteria (Appropriateness Criteria for Cardiac CT and Cardiac MRI1), CMR is indicated for the evaluation of coronary anomalies. The diagnostic accuracy to detect significant coronary stenoses is: sensitivity 72-93% and specificity 42-90%. Although MRA is not the method of choice for routine coronary evaluation, it can achieve better diagnostic performance compared to other non-invasive tests in patients with high coronary calcification.7 New non-invasive coronary MRA techniques, such as the 3D Whole-Heart MRA, enable a CT-like easy exam planning and image handling. 3D datasets can be reformatted in all planes and volume rendered images (VRT) can be created in a similar fashion. In a free-breathing acquisition, a 3D coronary MRA can be performed in less than 10 minutes. With motion adaptive respiratory gating, even diaphragm shifts can be compensated.
Cardiovascular MR

Echocardiography
Echocardiography is well suited for evaluation of myocardial function in patients with (suspected) CAD. Echo offers good delineation of endocardial and epicardial borders and enables assessment of left ventricular ejection fraction and wall motion analysis. New technologies including instantaneous full volume echo imaging will further improve global assessment of the heart and improve the diagnostic accuracy while reducing examination time.
Echocardiography

Cardiovascular MR
Cardiovascular MR (CMR) is the current gold standard for non-invasive evaluation of cardiac function. Image quality in CMR doesn’t depend on patient’s habitus. Thus, high-quality imaging can be achieved in most patients. In all orientations, all chambers and wall segments including those of the right ventricle, can be visualized with high reproducibility. Therefore, analysis of regional and global myocardial function can be performed using CMR with highest possible accuracy. Using myocardial tagging, even small wall motion abnormalities can be detected. Additionally, Dobutamine stress CMR offers ischemia evaluation, with the same examination protocol known from stress echocardiography (4).
Cardiovascular MR

Cardiac Molecular Imaging
When using ECG-gated acquisition techniques in myocardial perfusion scintigraphy both SPECT and PET techniques allow global and regional function analysis. This is a well established diagnostic measure.
Cardiac Molecular Imaging

Cardiovascular CT
Cardiac CT offers high temporal and spatial resolution, thereby being able to provide important functional cardiac information. Volumetric analysis by CT compares to magnetic resonance in accuracy and allows the calculation of left ventricular functional parameters like end-diastole volumes and ejection fraction. Also regional wall motion abnormalities in acute and chronic settings can be diagnosed with good diagnostic accuracy. (5) syngo Circulation is the only scientifically evaluated postprocessing software in the market to meet those clinical needs.
Cardiovascular CT

Cardiac Molecular Imaging: Overview
In Cardiac Molecular Imaging two techniques are used to assess myocardial viability: SPECT and PET. They both are able to assess myocardial perfusion and / or myocardial function. PET may also be used to evaluate myocardial metabolism.

Cardiac Molecular Imaging: SPECT
Besides analysis of myocardial perfusion and function in gated exams (see chapter function & perfusion), SPECT allows the identification of ischemic but viable myocardium when applying Thallium redistribution studies. The initial uptake of 201Tl depends on regional perfusion, whereas the sustained 201Tl uptake depends on cell membrane integrity and thus myocyte viability. Innovations like IQ SPECT reduce exam time drastically while increasing diagnostic accuracy.

Cardiac Molecular Imaging: PET
Besides analysis of myocardial perfusion and function in gated studies (see chapter function & perfusion), PET allows the identification of v iable myocardium. Viable myocardium shows affinity for glucose compared to irreversibly damaged heart muscle. This effect is used in PET imaging. Increased FDG uptake thus indicates viable myocardium. 18F-FDG is the PET tracer to assess myocardial viability. FDG PET is the gold standard for myocardial metabolism assessment (Assessment of Myocardial Viability [...]1), its accuracy is increased when using PET/CT.
Cardiac Molecular Imaging

Cardiovascular MR: Ischemic Cardiomyopathy
Over the last years CMR has been acknowledged as a valuable diagnostic tool for the detection of myocardial viability. LV dysfunction at rest and contractile reserve during the infusion of low-dose dobutamine can be assessed by CMR in a similar way as in echocardiography. In addition, CMR can also be used to assess myocardial perfusion. But most importantly, CMR offers the direct visualization of irreversibly damaged myocardium by a technique called “delayed enhancement” (DE CMR). DE CMR offers better diagnostic accuracy than SPECT, especially for the detection of small and subendocardial infarctions. (Contrast-enhanced MRI and routine SPECT perfusion imaging [...] 2).

Cardiovascular MR: Subendocardial Septal MI
Therefore DE CMR has become the new gold standard for evaluation of myocardial viability. The major advantage of DE CMR is its superior spatial resolution, which enables differentiation between subendocardial and transmural scars. The basis of DE CMR is the fact that contrast agent accumulates in irreversibly damaged myocardium. This accumulation can be imaged approximately ten minutes after intravenous administration of contrast agent (Myocardial MRI Contrast Agent Concentrations […] 3). DE CMR is of prognostic value before revascularization as can be seen in these two illustrative patients (Cases: Duke University, USA 4). Image quality of DE CMR depends on optimal setting of the inversion time (TI), a parameter which changes during the acquisition. Siemens offers a technique that overcomes this issue: With PSIR delayed enhancement, there is no need for parameter adjustments, which saves time and leads to user independent high image quality. Furthermore, with single-shot PSIR, even patients with arrhythmia can undergo DE CMR imaging. (Assessment of Late Gadolinium Enhancement in Nonischemic Cardiomyopathy […] 5).
Cardiovascular MR

Echocardiography
Echocardiography is a valuable tool for evaluation of myocardial viability. Wall thickness and myocardial contractility can easily be evaluated by 2D echocardiography. Low dose Dobutamine stress echocardiography and MCE perfusion studies enhance the determination of myocardial viability. New technologies including instantaneous full volume echo imaging will further improve global assessment of the heart and improve the diagnostic accuracy while reducing examination time.
Echocardiography

Cardiac CT
In chronic myocardial infarction the so-called late enhancement phenomen, as described in the Cardiovascular MR chapter, may also be demonstrated in CT. The accuracy of CT late enhancement compares favorable to CMR late enhancement as some initial studies could demonstrate (6). Furthermore CT can be used for assessment of wall thickness and function at rest, which are parameters of myocardial viability. With the Dual Source CT for instance, one scan can give you the coronary status as well as the iodine distribution in the myocardium to answer perfusion questions such as myocardial infarctions and infarct size.
Cardiovascular CT

Cardiac Molecular Imaging: Overview
Cardiac Molecular Imaging using either SPECT or PET techniques is established since decades for myocardial perfusion diagnosis. Its clinical value is well evaluated. Cardiac stress myocardial perfusion SPECT or PET is indicated in symptomatic patients with at least an intermediate likelihood of CAD, for preoperative evaluation of patients with high risk for CAD and for follow-up of known CAD.
Cardiac Molecular Imaging

Cardiac Molecular Imaging: Myocardial perfusion studies
MPS with SPECT (gated or ungated) are the commonly used and well evaluated non-invasive imaging method for analysis of myocardial perfusion. The prognostic significance of MPS is well studied and documented. Different agents may be used: thallium, Tc-99m sestamibi or tetrofosmin. Innovations like IQ·SPECT drastically reduce exam time while increasing diagnostic accuracy. PET uses NH3 or rubidium as imaging agents for assessment of myocardial perfusion. In contrast to SPECT, PET allows absolute quantification of myocardial perfusion.
Cardiac Molecular Imaging

Cardiac Molecular Imaging: Diagnostic accuracy
The diagnostic accuracy of MPS stress testing relates to the detection of significant CAD and depends on the stressor used. Sensitivity varies between 85 and 90 % and specificity ranges from 66 to 85 %. Adenosine offers high sensitivity (90%) and specificity (85%) and is therefore the preferred stressor. Alternatives are dipyridamole, dobutamine or exercise (Myocardial perfusion scintigraphy: the evidence 1). Incremental diagnostic value is added to nuclear studies when combined with functional assessments of LV ejection fraction and EDV from gated SPECT or gated PET measurements. The latest generation SPECT·CT systems make it possible to combine CT calcium scoring and myocardial perfusion SPECT for enhanced risk stratification and higher specifity.
Cardiac Molecular Imaging

Cardiovascular MR: Overview
Over the last years cardiovascular MR (CMR) has proven, in many clinical studies, that it may be a valuable alternative in the evaluation of myocardial perfusion2. In Stress Perfusion MRI, exam protocols are mostly identical to the ones used in nuclear cardiology, i.e. adenosine and dipyridamole are used as vasodilators. Images are acquired during the injection of the vasodilator and myocardial first-pass of a Gadolinium MR contrast agent. The diagnosis can be made either by visual assessment of the perfusion images or by a semi-quantitative analysis using post-processing tools such as ARGUS Dynamic Signal. The diagnostic accuracy of CMR compares to that of nuclear imaging.3 Additional viability imaging is performed to detect scar tissue and to increase the diagnostic performance of the exam.
Case Study: Perfusion in a Case of HOCM

Cardiovascular MR: Diagnostic accuracy
For high diagnostic accuracy high temporal resolution of CMR perfusion imaging is essential. Siemens’ Tim technology offers high iPAT factors in all 3 dimensions together with 32 channel architecture for the best possible image resolution, either spatial or temporal, or a mix of both. In the time of increasing obesity MAGNETOM Espree‘s wide bore design (ca. 70 cm) in combination with a short magnet (ca. 125 cm) makes Cardiovascular MRI also accessible for obese patients and patients feeling discomfort in normal bore scanners.
Cardiovascular MR

Echocardiography: VVI
Wall thickness and myocardial contractility are routinely evaluated in echo examinations of the left ventricle. Stress echo both with physical exercise or pharmacological exercise provide resting and stress induced wall motion information. Wall segments that demonstrate contraction are viable. Contrast agents and syngo VVI can aid in improving echo visualization and diagnosis in the technically difficult to image patient.

Echocardiography: MCI
Myocardial contrast echocardiography (MCE) utilizes contrast agent in order to assess myocardial perfusion in real time. MCE’s portability, rapid acquisition and interpretation of image data combined with the absence of radiation exposure make it an ideal bedside technique4. Myocardial perfusion quantitative analysis is an emerging application within echocardiography.
Echocardiography

Cardiovascular CT
Cardiovascular CT may add additional information besides evaluation of coronary status and cardiac function: Assessment of myocardial perfusion by means of CT is based on the kinetics of iodinated contrast agent. Similar to MRI, CT data are acquired after iv administration of the contrast agent. As a result, hypoperfused myocardial regions are identified as areas displaying hypoattenuation. Continuous measurement of attenuation values allows differentiation between infarcted and viable myocardium. Further advancements may be demonstrated when using Dual Source CT with Dual Energy for diagnosing coronary artery stenosis and myocardial ischemia.
Cardiovascular CT

Electrophysiology Laboratory (EP Lab)
Siemens is offering one of the most forward-oriented portfolios for electrophysiology, an integrated solution for enhanced patient care. Covering everything from advanced imaging, IECG recording, fusion of electroanatomic maps with individual patient anatomy to sophisticated 3D guidance. All designed to set new standards of efficiency in the EP laboratory.
Electrophysiology

Hemodynamic recording
AXIOM Sensis XP is the integrated solution for hemodynamic recording in the cathlab. It is process oriented and supports the complete workflow from patient registration, diagnosis and report generation.
Hemodynamic recording

syngo Dynamics
Evidence-based reporting and integration for efficiency of clinical procedures in cardiology and pediatric cardiology.
syngo Dynamics

3D Rotational Angiography
3D images of the heart structure and the pulmonary vessels can be generated directly in the cathlab with syngo DynaCT Cardiac.
3D Rotational Angiography

Radiation Dose Reduction
Our CARE package reduces the radiation dose for patients and the clinical team, while still providing high image quality and diagnostic confidence.
Radiation Dose Reduction

Imaging IT
With syngo Dynamics, our solution for Cardiovascular PACS (Picture Archiving and Communications System), imaging workflow in cardiology and vascular ultrasound can achieve a new level of excellence. syngo Dynamics is a comprehensive multi-modality diagnostic image review and evidence-based reporting system, incorporating decades of Siemens experience in both clinical and administrative workflows. The solution focuses on dynamic image clip review and reporting for ultrasound and cardiovascular imaging modalities. It represents a breakthrough in product design by integrating image and data management, post-processing and reporting while eliminating the need to have a different workplace, and even different staff, for each of these tasks. Pre-configured templates are used to make images and measurements available on demand. What’s more, these images can be displayed with worksheets or reports – without having to change to a different view. syngo Dynamics is based on IHE profiles and DICOM, and supports HL-7 via interface engines, thus providing open connectivity and allowing healthcare facilities to create a filmless and paperless environment. Supporting enterprise-wide solutions, syngo Dynamics can be easily integrated into hospital information systems. This includes modality worklisting, study transfer, and report upload functions which are supported by a powerful interface engine.

syngo Portfolio Overview
syngo Dynamics

CardioPhase® hsCRP
Siemens was the first company to offer a high sensitivity C-reactive protein (hsCRP) assay with a cardiac-specific claim.
CardioPhase® hsCRP

Natriuretic Peptides
Siemens is the only company that offers a choice in natriuretic peptide testing across multiple instrument platforms.
Natriuretic Peptides

Troponin
Siemens is the only company offering multiple solutions for high-sensitivity troponin I* testing that meets the current guidelines for MI diagnosis.
Troponin

Myeloperoxidase
Siemens offers MPO testing across multiple instrument solutions to help provide a more complete clinical picture of the CVD patient.
Myeloperoxidase