The unimaginable evolution of interventional cardiology from imagination to imaging

The virtual imaging of our imagination has been transformed into the direct visualization of reality

Faith is to believe what you do not see; the reward of this faith is to see what you believe¹. Most of what we know about and what we do today on the heart and vessels is indicated, guided and controlled by imaging. But it was imagination that would drive the future of modern cardiology, as was written long ago: “on ne voit bien qu’avec le coeur, l’essentiel est invisible pour les yeux”². Indeed, laying the heart deep in the cage of the chest, meant that cardiology was initially based on “imagination” rather than on the reality of what could be seen.

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Translating imagination into imaging

Surgeons could see the heart beating in the opened chest and could even hold it and feel the thrill of the warm circulating blood and contracting cells transmitting the sense of life to their hands. Cardiologists instead, have always “imagined” the heart, and such imagination was translated into images… the electrocardiogram, the design of the electric activity of the heart; the vectocardiogram, the most creative form of imagination running after the sequence of electrically induced movements in the three dimensions within the chest; the angiogram, a two-dimensional profile of the coronary arteries that revolutionized medicine posing indication to life-saving treatments like coronary surgery or angioplasty based on the “imagination” of what atherosclerotic disease could be.

From ultrasounds to artificial intelligence

But that was only the beginning, ultrasounds, the m-mode echo recording… an endless black and white strip “imaging” the movements of the heart. Then, the modern echocardiogram as we know it today, a window opened to the real heart with all the physiological understanding behind imaging; the evolution of nuclear cardiology, CT scans, MR, 3D-echo and algorithms of artificial intelligence to decipher the mysteries of the engine of life.

All these without ever having neither seen it nor ever held it in our hands, all our knowledge and progress are based on imagination fed by imaging… quoting Saint Thomas: Our faith has led us to see what we believed, and the virtual imaging of our imagination has now been transformed into the direct visualization of reality...

Monitoring the efficacy of therapies and predicting the future

Indeed, by means of imaging cardiologists can reveal the most complex abnormalities of nature, predict and prevent serious clinical events, implant larger valves than the surgeons that can actually see the heart, treat vessels that look anatomically impossible thanks to adequate and sophisticated imaging, close holes and cavities without opening the chest or burn arrhythmic foci guided by images and imagining the result. Furthermore, based on images, they can monitor the efficacy of therapies and predict the future, by detecting myocardial viability and assessing remodelling.

Imagination has always surpassed reality but cannot replace it

Democritus 400 years A.C. understood the existence of the atom, Nikolaus Kopernikus made the first correct description of the solar system in 1543 with more imagination than images, but based on images astronomer Giovanni V. Schiaparelli described inexistent channels of water on planet Mars in 1877, speculating possible forms of “Martian life, just because of an exaggerated interpretation of poor quality images. Today excessive interpretation of still rudimentary images may also drive to wrong decisions (think about the analysis of “vulnerable plaques” by CT scan…), although most of modern medicine relies on instrumental imaging.

The patient as a human being remains the most delicate and artistic aspect of medicine

In cardiovascular medicine, this journey started more with imagination than with actual elements, and now it is unimaginable without imaging, although the clinical judgment that centres our knowledge on the patient as a human being remains the most delicate and artistic aspect of medicine, well beyond imagination and imaging.

Imaging resources