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Cardiac imaging as the gatekeeper for many cardiac diseases

After his graduation from La Sapienza University in Rome, Professor Salustri entered the Internal Medicine residency followed by the Cardiology fellowship at the University of Siena in Italy. Since the beginning of his career, he was attracted by cardiac imaging; the possibility of looking to the heart in terms of morphology and function in a non-invasive way was extremely appealing to him: “Cardiac imaging is the gatekeeper for the vast majority of cardiac diseases, and in most of the cases a proper   diagnosis is virtually impossible – or at least very challenging – without the support of the different imaging modalities.” Professor Salustri is particularly interested in the clinical application of the cardiac imaging modalities and has accordingly combined his clinical activities in busy non-academic hospitals with the cardiac imaging modalities – and echocardiography in particular – in order to get the most relevant clinical information and to provide the best care for his patients.

At the forefront of 3-dimensional echocardiography

As Professor Salustri was also interested in research, he spent four years at the Thoraxcenter in Rotterdam in the Netherlands, where he obtained his PhD in stress echocardiography. At that time, Professor Salustri was also leading the research program on 3-dimensional echocardiography, providing the basis for the further development of this technique in the daily practice. This program was one of the first in the world combining both experimental laboratorium as well as clinical applications of
3-dimensional echocardiography. Thanks to the enthusiasm of his mentor Dutch Professor Jos Roelandt - who sadly passed away last year - he was stimulated to spend his energy in this exciting field, which resulted in numerous publications in ­international journals and a continuous exchange of experience with other centers. As is well known, this particular technique has since evolved and Professor Salustri is to this day amazed to ­realize that the current 3-dimensional echocardiography would have not been possible without those pioneering experiences in which he played a crucial part.

Education and research

Specific lines of interest that Professor Salustri feels very strongly about are education, quality control and the application of cardiac imaging modalities in the clinical arena. Teaching and education are of paramount importance, because they provide the technical skills and are the prerequisite for obtaining reliable clinical information. In addition, as the interpretation of cardiac imaging is predominantly subjective in nature, quality control program are mandatory to ensure a high reproducibility and a low inter- and intra-observer variability. Finally, the very best imaging modalities for individual patients (i.e., the ideal test for a given patient) need to be selected in order to answer a specific clinical question. With this regard, Professor Salustri is convinced that the integration of different specialties such as cardiology, radiology and nuclear medicine, is still a challenge which needs to be addressed. At this aim the EACVI is playing an active role, with the concept of the patient (and not the test) at the center of our interest, and the different imaging modalities integrated in the specific diagnostic pathway. Finally, research programs on new techniques are very much needed. In fact, the research of today will be the routine of tomorrow, as the development of new techniques expands the horizons of our knowledge.

Structured programs on cardiac imaging needed for training

Young doctors with a special interest in cardiac imaging are strongly suggested by Professor Salustri to undergo a specific training in a center with high reputation in this field. There are few centers at the moment with a structured program on cardiac imaging. These programs should include a solid background on cardiac anatomy, physiology, and flow dynamics, followed by a dedicated training on the different imaging modalities, including physics properties and the specific applications in the different clinical setting.

What the future brings …

Apart from taking some steps back into history to learn where we are today and how we got there, Professor Salustri is also very forward looking with high hopes for the future of cardiac imaging. He sincerely hopes that cardiac imaging will become an established subspecialty with standardized teaching programs as this will guarantee and enhance its overall quality and even further improve outcomes for patients. For the same reasons, the integration of cardiac imaging with other subspecialties like interventional and electrophysiology would also be highly desirable.