Multimodality imagers play a critical role in modern heart teams
The heart team approach in cardiology has evolved from a regulatory mandate during the early days of transcatheter aortic valve replacement (TAVR) into a foundational model for delivering care across nearly all cardiovascular specialties. In a session at the 2025 American Society of Nuclear Cardiology (ASNC) annual meeting, Wael Jaber, MD, director of nuclear cardiology and professor of medicine at Cleveland Clinic, emphasized that cardiac imagers—especially those who work in multiple modalities—are essential members of that team.
“Patients don’t ask to see a nuclear cardiologist or a heart failure doctor,” Jaber said. “They come with a problem, and it’s the team that solves it. The team is here to stay—and I can’t see us going back to fragmentation. Very rarely right now do you get admitted to the hospital with a heart problem and you only have one doctor taking care of you."
He said a patient with shortness of breath and weak left ventricular function will have an echocardiogram with an echocardiographer. Then an interventional cardiologist may get involved to figure out if the arteries are open. If there are blockages and it needs to be figured out if they should fix them or not, the patient is sent for a PET scan to figure out myocardial viability. Then the electrophysiology team might get involved to figure out if the patient needs a an ICD to prevent tachycardia and sudden death.
Imaging beyond silos for the entire cardiac care team
Jaber highlighted that cardiac imagers are increasingly being trained across multiple modalities, including echo, nuclear, cardiac MRI and CT, to provide a more complete diagnostic picture.
“We don’t have a monopoly on disease,” he said. “The goal is not to prove that nuclear, echo, or CT is the best. The goal is to use the right tool to arrive at the most accurate diagnosis. That’s why multimodality imagers are so valuable on the heart team—they can help navigate which test provides the clearest answer for the patient.”
ASNC’s program reflected that philosophy. While there were sessions dedicated to advancing nuclear cardiology, such as image processing, new tracers and reporting standards, the meeting also included experts from across imaging and the cardiac subspecialties fields. Jaber said ACC President Chris Kramer, MD, joined discussions to emphasize how nuclear cardiology fits within the broader “house of cardiology.”
The heart team is becoming a standard of care
While the heart team concept was initially formalized in the United States by the FDA during early TAVR device approvals, it is now embraced at many centers because it offers a more comprehensive way to care for patients and improve outcomes. Jaber said the model has spread far beyond valve disease into heart failure, cardio-oncology, amyloidosis and other specialized clinics.
“At Cleveland Clinic, this was organic. We’ve always practiced this way,” Jaber explained. “But nationally, TAVR really accelerated the acceptance of heart teams. Today, knowledge is so specialized and diffused that you need your colleagues’ input. Even within electrophysiology, you now have people focusing just on atrial fibrillation, others on ventricular arrhythmias, others on devices. It’s impossible for one person to manage all of this.”
The team can support living with disease, not dying from it
The growth of effective therapies has also reinforced the need for team-based care. Heart failure patients, for example, are living longer with disease due to advanced medications, devices and preventive strategies. That requires coordinated care among imagers, heart failure specialists, electrophysiologists, preventive cardiologists and rehabilitation teams.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]