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Cardiovascular Imaging

Imaging is central to nearly everything we do at Sanger Heart & Vascular Institute, and we embrace the most advanced imaging technologies to continuously improve our diagnostic and treatment capabilities.

Recent Highlights

Sanger was the first National Luminary Center of Excellence for training U.S. health care systems on building coronary computed tomography angiography programs and is one of only two such programs in the nation. In collaboration with Heartflow, we hold full-day symposia every one to two months, with attendees from throughout the U.S.

The Intersocietal Accreditation Commission has accredited our echocardiography and nuclear imaging labs. These labs are located throughout the Greater Charlotte region, bringing care to a large and growing number of patients. 

Siemens chose our cardiovascular magnetic resonance (CMR) program to be a show site for the Teamplay digital health platform. This system enables remote monitoring and performance of CMR studies.

We launched our inaugural Sanger Imaging Fellowship in 2022. Our first CMR fellow started in March, followed by an imaging fellow who began in July.

Providing echo quality assurance review for the National Basketball Association (NBA): Sanger’s Sports Cardiology Center, along with Sanger Cardiac Imaging, have newly partnered with the NBA to provide a quality assurance review process of all echocardiograms completed during the screening of NBA and WNBA players league-wide. This includes almost 900 players. The goal is to ensure echocardiograms meet appropriate standards and protocols.

Improving cardiac imaging for hypertrophic cardiomyopathy (HCM): We co-chaired the guideline recommendations for patients with HCM.


  • Intersocietal Accreditation Commission Accredited Facility - Vascular Testing.
  • Intersocietal Accreditation Commission Accredited Facility - Nuclear Cardiology.
  • Intersocietal Accreditation Commission Accredited Facility - Echocardiography.

Cardiovascular Imaging Research and Clinical Trials

We continue to expand our structural heart research portfolio and are involved in multiple clinical trials utilizing cardiac CT and echo imaging.

TRISCEND: A trial of the Edwards EVOQUE tricuspid valve replacement system

SUMMIT: A study of the Tendyne mitral valve replacement system

TRILUMINATE: A study of the Abbott transcatheter clip repair system in patients with moderate or greater tricuspid regurgitation

AltaValve Early Feasibility Study: A study of the AltaValve system for transcatheter mitral valve replacement

Cephea Early Feasibility Study: A study of a novel transseptal approach to transcatheter mitral valve replacement

CLASP: A trial of the PASCAL system for transcatheter mitral edge-to-edge repair

ACURATE IDE: A study of the ACURATE valve for TAVR

  • Chart showing an increase in Echocardiograms (Hospital & Ambulatory) from 64,372 in 2015, to 89,606 in 2022.
  • Chart showing an increase in Cardiac MRI Scans, from 642 in 2015, to 4,830 in 2022.
  • Chart showing a decrease in Nuclear Imaging Scans (Hospital & Ambulatory), from 14,694 in 2015, to 10,983 in 2022.
  • Chart showing an increase in Fractional Flow Reserve CT (FFRCT) Scans, from 40 in 2016 to 1,703 in 2021.
  • Chart showing an increase in Cardiac CT Scans Yearly Volume (Hospital & Ambulatory).
Provider looking at a computer screen.

MRI Registries

COVID-19: Society for Cardiovascular Magnetic Resonance COVID-19 registry.

Aortic insufficiency (AI): Investigating gender-based differences in left ventricular remodeling in patients with chronic AI.

Aortic regurgitation and scarring: Using CMR to assess the impact of AI and myocardial scarring on clinical outcomes.

Amyloidosis: Using neural networking to develop a novel CMR-based model to predict cardiac amyloid subtype.

Pulmonary hypertension: Utilizing an outcomes and risk assessment imaging model.

Process Improvements

Sanger was an initial testing site and early adopter of Collaboration Live. This new virtual platform, developed by Philips, allows the physician to directly connect to the ultrasound machine and the sonographer performing the examination. The physician can provide real-time guidance to ensure any clinical questions are answered.

Sanger implemented a cardiac CT-first strategy for evaluating chest pain in the emergency room. This improves patient care, shortens length of stay, and reduces redundant and unnecessary testing. It also improves cath lab utilization for and reduces diagnostic catheterization by identifying patients with disease that requires intervention versus medical therapy.

We continue developing and improving our advanced cardiovascular imaging infrastructure. This includes adding two additional cardiac-capable CT scanners that expand our ability to provide exceptional care across Greater Charlotte. All of these studies are read by board-certified cardiologists using remote reading software.

Our cardiac MR program continues expanding with four cardiac-capable CMR scanners across Greater Charlotte. All studies are read remotely from our Kenilworth location by board-certified cardiologists who specialize in CMR. The remote reading technology allows physicians to interact with staff and MR scanners across the system.

National Leadership Positions

National Leadership Positions

Our team continues to be appointed to leadership positions on key national bodies, including:

  • Council on Cardiovascular Sonography Steering Committee for American Society of Echocardiography (ASE)
  • ASE Advocacy Committee
  • ASE Intracardiac Echocardiography Task Force
  • American College of Radiology Cardiac CT Appropriate Use Committee
  • American College of Cardiology Partners in Quality Subcommittee
  • Journal of the American Society of Echocardiography
  • National Board of Echocardiography Examination of Special Competence in Adult Echocardiography (ASCeXam) Writing Committee

Sanger is now one of the nation's largest cardiac CT programs, on track to perform more than 10,000 cardiac CT studies annually.


Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy: An Update from the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance, and the Society of Cardiovascular Computed Tomography. Nagueh SF, Phelan D, Abraham T, Armour A, Desai MY, Dragulescu A, Gilliland Y, Lester SJ, Maldonado Y, Mohiddin S, Nieman K, Sperry BW, Woo A J Am Soc Echocardiogr. 2022 Jun;35(6):533-569. PMID: 35659037.

Myocarditis in the Athlete: A focus on COVID-19 Sequelae. Symanski, JD, Tso JV, Phelan DM, Kim JH. Clin Sports Med. 2022 Jul;41(3):455-472. PMID: 35710272. 

ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play: A Report of the American College of Cardiology Solution Set Oversight Committee. Writing Committee, Gluckman TJ, Bhave NM, Allen LA, Chung EH, Spatz ES, Ammirati E, Baggish AL, Bozkurt B, Cornwell WK 3rd, Harmon KG, Kim JH, Lala A, Levine BD, Martinez MW, Onuma O, Phelan D, Puntmann VO, Rajpal S, Taub PR, Verma AK. 2022 J Am Coll Cardiol 2022 Mar 14;S0735-1097(22)00306-0. PMID: 35307156.

Sex-based Differences in Left Ventricular Remodeling in Patients with Chronic Aortic Regurgitation: A Multi-modality Study. Tower-Rader A, Mathias IS, Obuchowski NA, Kocyigit D, Kumar Y, Donnellan E, Bolen M, Phelan D, Flamm S, Griffin B, Cho L, Svensson LG, Pettersson G, Popovic Z, Kwon D. J Cardiovasc Magn Reason 2022 Feb 22;24(1):12. PMID: 3519358.

When to Consider Cardiac MRI in the Evaluation of the Competitive Athlete After SARS-CoV-2 Infection. Phelan D, Kim JH, Drezner JA, Elliott MD, Martinez MW, Chung EH, Krishan S, Levine BD, Baggish AL. Br J Sports Med. 2022 Jan 27:bjsports-2021-104750. doi: 10.1136/bjsports-2021-104750. PMID: 35086807. 

Point-of-Care Ultrasonography. Phelan DM, Mayer SA, Stainback RF. N Engl J Med. 2022 Jan 13;386(2):196. doi: 10.1056/NEJMc2118252. PMID: 35020996.

Findings From Implementation of a Remote Collaboration Solution to Perform Echocardiograms During the COVID-19 Pandemic. Kelly NP, Scherer E, Johnson K, Boyle A, Rose GA, Phelan DM. J Am Soc Echocardiogr 2022 Feb;35(2):242-243. PMID: 34627974.

Left Ventricular Ejection Fraction in Athletes Compared to the World Alliance Societies of Echocardiography Normal Values. Parizher G, Phelan D, Emery MS. J Am Soc Echocardiogr 2022 Feb;35(2):234-235. PMID: 34627972.

Cardiac Computed Tomography and Magnetic Resonance Imaging of the Tricuspid Valve: Preprocedural Planning and Postprocedural Follow-up. Lopes B, Hashimoto G, Bapat V, Sorajja P, Scherer M, Cavalcante J. Intervent Cardiol Clin 11 (2022) 27-40.