In 2018, strain imaging with echocardiography has provided important pathophysiological insights in various cardiovascular diseases and the evidence demonstrating its incremental prognostic value over left ventricular ejection fraction is growing. Similarly, tissue characterization with cardiovascular magnetic resonance techniques (late gadolinium enhancement and T1-mapping) has become an important part in the diagnostic algorithms and risk stratification of patients with cardiomyopathies. In addition, assessment of coronary artery disease with computed tomography (CT) is changing from being exclusively an anatomical test to integrating anatomic (lesion severity and plaque characterization) with functional information (myocardial perfusion and coronary fractional flow reserve), whereas the prognostic implications of quantification of coronary flow reserve with positron emission tomography (PET) have been demonstrated in large scale studies. Technological advances in fusion imaging, such as PET/CT and PET/magnetic resonance, allow for relating anatomical tissue changes with functional alterations in the clinical and pre-clinical setting. Finally, the use of machine learning applied to imaging data to predict cardiovascular events is increasing. This Year in Cardiology review article provides an overview of the most relevant articles published in 2018 on cardiac imaging.