Journal: J Cardiovasc Magn Reson

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<div><h4>Relationship between coronary high-intensity plaques on T1-weighted imaging by cardiovascular magnetic resonance and vulnerable plaque features by near-infrared spectroscopy and intravascular ultrasound: a prospective cohort study.</h4><i>Fukase T, Dohi T, Fujimoto S, Nishio R, ... Xie Y, Minamino T</i><br /><b>Background</b><br />This study aimed to compare the coronary plaque characterization by cardiovascular magnetic resonance (CMR) and near-infrared spectroscopy (NIRS)-intravascular ultrasound (IVUS) (NIRS-IVUS), and to determine whether pre-percutaneous coronary intervention (PCI) evaluation using CMR identifies high-intensity plaques (HIPs) at risk of peri-procedural myocardial infarction (pMI). Although there is little evidence in comparison with NIRS-IVUS findings, which have recently been shown to identify vulnerable plaques, we inferred that CMR-derived HIPs would be associated with vulnerable plaque features identified on NIRS-IVUS.<br /><b>Methods</b><br />52 patients with stable coronary artery disease who underwent CMR with non-contrast T1-weighted imaging and PCI using NIRS-IVUS were studied. HIP was defined as a signal intensity of the coronary plaque-to-myocardial signal intensity ratio (PMR) ≥ 1.4, which was measured from the data of CMR images. We evaluated whether HIPs were associated with the NIRS-derived maximum 4-mm lipid-core burden index (maxLCBI<sub>4mm</sub>) and plaque morphology on IVUS, and assessed the incidence and predictor of pMI defined by the current Universal Definition using high-sensitive cardiac troponin-T.<br /><b>Results</b><br />Of 62 lesions, HIPs were observed in 30 lesions (48%). The HIP group had a significantly higher remodeling index, plaque burden, and proportion of echo-lucent plaque and maxLCBI<sub>4mm</sub> ≥ 400 (known as large lipid-rich plaque [LRP]) than the non-HIP group. The correlation between the maxLCBI<sub>4mm</sub> and PMR was significantly positive (r = 0.51). In multivariable logistic regression analysis for prediction of HIP, NIRS-derived large LRP (odds ratio [OR] = 5.41; 95% confidence intervals [CIs] 1.65-17.8, p = 0.005) and IVUS-derived echo-lucent plaque (OR = 5.12; 95% CIs 1.11-23.6, p = 0.036) were strong independent predictors. Furthermore, pMI occurred in 14 of 30 lesions (47%) with HIP, compared to only 5 of 32 lesions (16%) without HIP (p = 0.005). In multivariable logistic regression analysis for prediction of incidence of pMI, CMR-derived HIP (OR = 5.68; 95% CIs 1.53-21.1, p = 0.009) was a strong independent predictor, but not NIRS-derived large LRP and IVUS-derived echo-lucent plaque.<br /><b>Conclusions</b><br />There is an important relationship between CMR-derived HIP and NIRS-derived large LRP. We also confirmed that non-contrast T1-weighted CMR imaging is useful for characterization of vulnerable plaque features as well as for pre-PCI risk stratification. Trial registration The ethics committee of Juntendo Clinical Research and Trial Center approved this study on January 26, 2021 (Reference Number 20-313).<br /><br />© 2023. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 30 Jan 2023; 25:4</small></div>
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<div><h4>Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects.</h4><i>Weiss EK, Jarvis K, Maroun A, Malaisrie SC, ... Rigsby CK, Markl M</i><br /><b>Background</b><br />Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole.<br /><b>Methods</b><br />510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole.<br /><b>Results</b><br />BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1).<br /><b>Conclusion</b><br />4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.<br /><br />© 2023. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 26 Jan 2023; 25:3</small></div>
Abstract
<div><h4>Myocardial late gadolinium enhancement using delayed 3D IR-FLASH in the pediatric population: feasibility and diagnostic performance compared to single-shot PSIR-bSSFP.</h4><i>Saprungruang A, Aguet J, Gill N, Tassos VP, ... Yoo SJ, Lam CZ</i><br /><b>Background</b><br />This study compares three-dimensional (3D) high-resolution (HR) late gadolinium enhancement (LGE; 3D HR-LGE) imaging using a respiratory navigated, electrocardiographically-gated inversion recovery gradient echo sequence with conventional LGE imaging using a single-shot phase-sensitive inversion recovery (PSIR) balanced steady-state free precession (bSSFP; PSIR-bSSFP) sequence for routine clinical use in the pediatric population.<br /><b>Methods</b><br />Pediatric patients (0-18 years) who underwent clinical cardiovascular magnetic resonance (CMR) with both 3D HR-LGE and single-shot PSIR-bSSFP LGE between January 2018 and June 2020 were included. Image quality (0-4) and detection of LGE in the left ventricle (LV) (per 17 segments), in the right ventricle (RV) (per 3 segments), as endocardial fibroelastosis (EFE), at the hinge points, and at the papillary muscles was analyzed by two blinded readers for each sequence. Ratios of the mean signal intensity of LGE to normal myocardium (LGE:Myo) and to LV blood pool (LGE:Blood) were recorded. Data is presented as median (1st-3rd quartiles). Wilcoxon signed rank test and chi-square analyses were used as appropriate. Inter-rater agreement was analyzed using weighted κ-statistics.<br /><b>Results</b><br />102 patients were included with median age at CMR of 8 (1-13) years-old and 44% of exams performed under general anesthesia. LGE was detected in 55% of cases. 3D HR LGE compared to single-shot PSIR-bSSFP had longer scan time [4:30 (3:35-5:34) vs 1:11 (0:47-1:32) minutes, p < 0.001], higher image quality ratings [3 (3-4) vs 2 (2-3), p < 0.001], higher LGE:Myo [23.7 (16.9-31.2) vs 5.0 (2.9-9.0), p < 0.001], detected more segments of LGE in both the LV [4 (2-8) vs 3 (1-7), p = 0.045] and RV [1 (1-1) vs 1 (0-1), p < 0.001], and also detected more cases of LGE with 13/56 (23%) of patients with LGE only detectable by 3D HR LGE (p < 0.001). 3D HR LGE specifically detected a greater proportion of RV LGE (27/27 vs 17/27, p < 0.001), EFE (11/11 vs 5/11, p = 0.004), and papillary muscle LGE (14/15 vs 4/15, p < 0.001). Inter-rater agreement for the recorded variables ranged from 0.42 to 1.00.<br /><b>Conclusions</b><br />3D HR LGE achieves greater image quality and detects more LGE than conventional single-shot PSIR-bSSFP LGE imaging, and should be considered an alternative to conventional LGE sequences for routine clinical use in the pediatric population.<br /><br />© 2023. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 23 Jan 2023; 25:2</small></div>
Saprungruang A, Aguet J, Gill N, Tassos VP, ... Yoo SJ, Lam CZ
J Cardiovasc Magn Reson: 23 Jan 2023; 25:2 | PMID: 36683053
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<div><h4>Dynamic pressure-volume loop analysis by simultaneous real-time cardiovascular magnetic resonance and left heart catheterization.</h4><i>Seemann F, Bruce CG, Khan JM, Ramasawmy R, ... Lederman RJ, Campbell-Washburn AE</i><br /><b>Background</b><br />Left ventricular (LV) contractility and compliance are derived from pressure-volume (PV) loops during dynamic preload reduction, but reliable simultaneous measurements of pressure and volume are challenging with current technologies. We have developed a method to quantify contractility and compliance from PV loops during a dynamic preload reduction using simultaneous measurements of volume from real-time cardiovascular magnetic resonance (CMR) and invasive LV pressures with CMR-specific signal conditioning.<br /><b>Methods</b><br />Dynamic PV loops were derived in 16 swine (n = 7 naïve, n = 6 with aortic banding to increase afterload, n = 3 with ischemic cardiomyopathy) while occluding the inferior vena cava (IVC). Occlusion was performed simultaneously with the acquisition of dynamic LV volume from long-axis real-time CMR at 0.55 T, and recordings of invasive LV and aortic pressures, electrocardiogram, and CMR gradient waveforms. PV loops were derived by synchronizing pressure and volume measurements. Linear regression of end-systolic- and end-diastolic- pressure-volume relationships enabled calculation of contractility. PV loops measurements in the CMR environment were compared to conductance PV loop catheter measurements in 5 animals. Long-axis 2D LV volumes were validated with short-axis-stack images.<br /><b>Results</b><br />Simultaneous PV acquisition during IVC-occlusion was feasible. The cardiomyopathy model measured lower contractility (0.2 ± 0.1 mmHg/ml vs 0.6 ± 0.2 mmHg/ml) and increased compliance (12.0 ± 2.1 ml/mmHg vs 4.9 ± 1.1 ml/mmHg) compared to naïve animals. The pressure gradient across the aortic band was not clinically significant (10 ± 6 mmHg). Correspondingly, no differences were found between the naïve and banded pigs. Long-axis and short-axis LV volumes agreed well (difference 8.2 ± 14.5 ml at end-diastole, -2.8 ± 6.5 ml at end-systole). Agreement in contractility and compliance derived from conductance PV loop catheters and in the CMR environment was modest (intraclass correlation coefficient 0.56 and 0.44, respectively).<br /><b>Conclusions</b><br />Dynamic PV loops during a real-time CMR-guided preload reduction can be used to derive quantitative metrics of contractility and compliance, and provided more reliable volumetric measurements than conductance PV loop catheters.<br /><br />© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.<br /><br /><small>J Cardiovasc Magn Reson: 16 Jan 2023; 25:1</small></div>
Seemann F, Bruce CG, Khan JM, Ramasawmy R, ... Lederman RJ, Campbell-Washburn AE
J Cardiovasc Magn Reson: 16 Jan 2023; 25:1 | PMID: 36642713
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<div><h4>2021-2022 state of our JCMR.</h4><i>Manning WJ</i><br /><AbstractText>In 2021, there were 136 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR), including 122 original research papers, six reviews, four technical notes, one Society for Cardiovascular Magnetic Resonance (SCMR) guideline, one SCMR position paper, one study protocol, and one obituary (Nathaniel Reichek). The volume was up 53% from 2020 (n = 89) with a corresponding 21% decrease in manuscript submissions from 435 to 345. This led to an increase in the acceptance rate from 24 to 32%. The quality of the submissions continues to be high. The 2021 JCMR Impact Factor (which is released in June 2022) markedly increased from 5.41 to 6.90 placing us in the top quartile of Society and cardiac imaging journals. Our 5 year impact factor similarly increased from 6.52 to 7.25. Fifteen years ago, the JCMR was at the forefront of medical and medical society journal migration to the Open-Access format. The Open-Access system has dramatically increased the availability and JCMR citation. Full-text article requests in 2021 approached 1.5 M!. As I have mentioned, it takes a village to run a journal. JCMR is very fortunate to have a group of very dedicated Associate Editors, Guest Editors, Journal Club Editors, and Reviewers. I thank each of them for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. My role, and the entire editorial process would not be possible without the ongoing high dedication and efforts of our managing editor, Jennifer Rodriguez. Her premier organizational skills have allowed for streamlining of the review process and marked improvement in our time-to-decision (see later). As I conclude my 6th and final year as your editor-in-chief, I thank you for entrusting me with the JCMR editorship and appreciate the time I have had at the helm. I am very confident that our Journal will reach new heights under the stewardship of Dr. Tim Leiner, currently at the Mayo Clinic with a seamless transition occurring as I write this in late November. I hope that you will continue to send your very best, high quality CMR manuscripts to JCMR, and that our readers will continue to look to JCMR for the very best/state-of-the-art CMR publications.</AbstractText><br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 31 Dec 2022; 24:75</small></div>
Manning WJ
J Cardiovasc Magn Reson: 31 Dec 2022; 24:75 | PMID: 36587219
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<div><h4>Lipid and smooth muscle architectural pathology in the rabbit atherosclerotic vessel wall using Q-space cardiovascular magnetic resonance.</h4><i>Taylor EN, Huang N, Lin S, Mortazavi F, ... Gilbert RJ, Hamilton JA</i><br /><b>Background</b><br />Atherosclerosis is an arterial vessel wall disease characterized by slow, progressive lipid accumulation, smooth muscle disorganization, and inflammatory infiltration. Atherosclerosis often remains subclinical until extensive inflammatory injury promotes vulnerability of the atherosclerotic plaque to rupture with luminal thrombosis, which can cause the acute event of myocardial infarction or stroke. Current bioimaging techniques are unable to capture the pathognomonic distribution of cellular elements of the plaque and thus cannot accurately define its structural disorganization.<br /><b>Methods</b><br />We applied cardiovascular magnetic resonance spectroscopy (CMRS) and diffusion weighted CMR (DWI) with generalized Q-space imaging (GQI) analysis to architecturally define features of atheroma and correlated these to the microscopic distribution of vascular smooth muscle cells (SMC), immune cells, extracellular matrix (ECM) fibers, thrombus, and cholesteryl esters (CE). We compared rabbits with normal chow diet and cholesterol-fed rabbits with endothelial balloon injury, which accelerates atherosclerosis and produces advanced rupture-prone plaques, in a well-validated rabbit model of human atherosclerosis.<br /><b>Results</b><br />Our methods revealed new structural properties of advanced atherosclerosis incorporating SMC and lipid distributions. GQI with tractography portrayed the locations of these components across the atherosclerotic vessel wall and differentiated multi-level organization of normal, pro-inflammatory cellular phenotypes, or thrombus. Moreover, the locations of CE were differentiated from cellular constituents by their higher restrictive diffusion properties, which permitted chemical confirmation of CE by high field voxel-guided CMRS.<br /><b>Conclusions</b><br />GQI with tractography is a new method for atherosclerosis imaging that defines a pathological architectural signature for the atheromatous plaque composed of distributed SMC, ECM, inflammatory cells, and thrombus and lipid. This provides a detailed transmural map of normal and inflamed vessel walls in the setting of atherosclerosis that has not been previously achieved using traditional CMR techniques. Although this is an ex-vivo study, detection of micro and mesoscale level vascular destabilization as enabled by GQI with tractography could increase the accuracy of diagnosis and assessment of treatment outcomes in individuals with atherosclerosis.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 22 Dec 2022; 24:74</small></div>
Taylor EN, Huang N, Lin S, Mortazavi F, ... Gilbert RJ, Hamilton JA
J Cardiovasc Magn Reson: 22 Dec 2022; 24:74 | PMID: 36544161
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<div><h4>Utilization of cardiovascular magnetic resonance (CMR) imaging for resumption of athletic activities following COVID-19 infection: an expert consensus document on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention (CVRI) Leadership and endorsed by the Society for Cardiovascular Magnetic Resonance (SCMR).</h4><i>Ruberg FL, Baggish AL, Hays AG, Jerosch-Herold M, ... Weinsaft JW, Woodard PK</i><br /><AbstractText>The global pandemic of coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory suyndrome coronavirus 2 (SARS-CoV-2) is now entering its 4th year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. While pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play, RTP) following resolution of infection. A variety of different testing combinations that leverage the electrocardiogram, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance (CMR) imaging have been proposed and implemented to mitigate risk. CMR in particular affords high sensitivity for myocarditis but has been employed and interpreted non-uniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to RTP. This consensus document synthesizes available evidence to contextualize the appropriate utilization of CMR in the RTP assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.</AbstractText><br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 21 Dec 2022; 24:73</small></div>
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<div><h4>Evolution of myocardial oedema and fibrosis in HIV infected persons after the initiation of antiretroviral therapy: a prospective cardiovascular magnetic resonance study.</h4><i>Robbertse PS, Doubell AF, Lombard CJ, Talle MA, Herbst PG</i><br /><b>Background</b><br />Human immunodeficiency virus (HIV) infected persons on antiretroviral therapy (ART) have been shown to have functionally and structurally altered ventricles and may be related to cardiovascular inflammation. Mounting evidence suggests that the myocardium of HIV infected individuals may be abnormal before ART is initiated and may represent subclinical HIV-associated cardiomyopathy (HIVAC). The influence of ART on subclinical HIVAC is not known.<br /><b>Methods</b><br />Newly diagnosed, ART naïve persons with HIV infection were enrolled along with HIV uninfected, age- and sex-matched controls. All participants underwent comprehensive cardiovascular assessment, including contrasted cardiovascular magnetic resonance (CMR) with multiparametric mapping on a 1.5T CMR system. The HIV group was started on ART (tenofovir/lamivudine/dolutegravir) and prospectively evaluated 9 months later. Cardiac tissue characterisation was compared in, and between groups using the appropriate statistical tests for the cross sectional data and the paired, prospective data respectively.<br /><b>Results</b><br />Seventy-three ART naïve HIV infected individuals (32 ± 7 years, 45% female) and 22 healthy non-HIV subjects (33 ± 7 years, 50% female) were enrolled. Compared with non-HIV healthy subjects, the global native T1 (1008 ± 31 ms vs 1032 ± 44 ms, p = 0.02), global T2 (46 ± 2 vs 48 ± 3 ms, p = 0.006), and the prevalence of pericardial effusion (18% vs 67%, p < 0.001) were significantly higher in the HIV infected group at diagnosis. Global native T1 (1032 ± 44 to 1014 ± 34 ms, p < 0.001) and extracellular volume (ECV) (26 ± 4% to 25 ± 3%, p = 0.001) decreased significantly after 9 months on ART and were significantly associated with a decrease in the HIV viral load, decreased high sensitivity C-reactive protein, and improvement in the CD4 count (p < 0.001). Replacement fibrosis was significantly higher in the HIV infected group than controls (49% vs 10%, p = 0.02). The prevalence of late gadolinium enhancement did not change significantly over the 9-month study period (49% vs 55%, p = 0.4).<br /><b>Conclusion</b><br />Subclinical HIVAC may already be present at the time of HIV diagnosis, as suggested by the combination of subclinical myocardial oedema and fibrosis found to be present before administration of ART. Markers of myocardial oedema on tissue characterization improved on ART in the short term, however, it is unclear if the underlying pathological mechanism is halted, or merely slowed by ART. Mid- to long term prospective studies are needed to evaluate subtle myocardial changes over time and to assess the significance of subclinical myocardial fibrosis.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 19 Dec 2022; 24:72</small></div>
Robbertse PS, Doubell AF, Lombard CJ, Talle MA, Herbst PG
J Cardiovasc Magn Reson: 19 Dec 2022; 24:72 | PMID: 36529806
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<div><h4>3D black blood cardiovascular magnetic resonance atlases of congenital aortic arch anomalies and the normal fetal heart: application to automated multi-label segmentation.</h4><i>Uus AU, van Poppel MPM, Steinweg JK, Grigorescu I, ... Pushparajah K, Deprez M</i><br /><b>Background</b><br />Image-domain motion correction of black-blood contrast T2-weighted fetal cardiovascular magnetic resonance imaging (CMR) using slice-to-volume registration (SVR) provides high-resolution three-dimensional (3D) images of the fetal heart providing excellent 3D visualisation of vascular anomalies [1]. However, 3D segmentation of these datasets, important for both clinical reporting and the application of advanced analysis techniques is currently a time-consuming process requiring manual input with potential for inter-user variability.<br /><b>Methods</b><br />In this work, we present novel 3D fetal CMR population-averaged atlases of normal and abnormal fetal cardiovascular anatomy. The atlases are created using motion-corrected 3D reconstructed volumes of 86 third trimester fetuses (gestational age range 29-34 weeks) including: 28 healthy controls, 20 cases with postnatally confirmed neonatal coarctation of the aorta (CoA) and 38 vascular rings (21 right aortic arch (RAA), 17 double aortic arch (DAA)). We used only high image quality datasets with isolated anomalies and without any other deviations in the cardiovascular anatomy.In addition, we implemented and evaluated atlas-guided registration and deep learning (UNETR) methods for automated 3D multi-label segmentation of fetal cardiac vessels. We used images from CoA, RAA and DAA cohorts including: 42 cases for training (14 from each cohort), 3 for validation and 6 for testing. In addition, the potential limitations of the network were investigated on unseen datasets including 3 early gestational age (22 weeks) and 3 low SNR cases.<br /><b>Results</b><br />We created four atlases representing the average anatomy of the normal fetal heart, postnatally confirmed neonatal CoA, RAA and DAA. Visual inspection was undertaken to verify expected anatomy per subgroup. The results of the multi-label cardiac vessel UNETR segmentation showed 100[Formula: see text] per-vessel detection rate for both normal and abnormal aortic arch anatomy.<br /><b>Conclusions</b><br />This work introduces the first set of 3D black-blood T2-weighted CMR atlases of normal and abnormal fetal cardiovascular anatomy including detailed segmentation of the major cardiovascular structures. Additionally, we demonstrated the general feasibility of using deep learning for multi-label vessel segmentation of 3D fetal CMR images.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 15 Dec 2022; 24:71</small></div>
Uus AU, van Poppel MPM, Steinweg JK, Grigorescu I, ... Pushparajah K, Deprez M
J Cardiovasc Magn Reson: 15 Dec 2022; 24:71 | PMID: 36517850
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<div><h4>Cardiovascular magnetic resonance pulmonary perfusion for guidance of interventional treatment of pulmonary vein stenosis.</h4><i>Jahnke C, Bollmann A, Oebel S, Lindemann F, ... Hindricks G, Paetsch I</i><br /><b>Background</b><br />Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment.<br /><b>Methods</b><br />CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up. Degree of PV stenosis was visually determined on CMR angiography; visual and quantitative analysis of pulmonary perfusion imaging was done for all five lung lobes.<br /><b>Results</b><br />Interventional treatment of PV stenosis achieved an acute procedural success rate of 90%. Agreement between visually evaluated pulmonary perfusion imaging and the presence or absence of a ≥ 70% PV stenosis was nearly perfect (Cohen\'s kappa, 0.96). ROC analysis demonstrated high discriminatory power of quantitative pulmonary perfusion measurements for the detection of ≥ 70% PV stenosis (AUC for time-to-peak enhancement, 0.96; wash-in rate, 0.93; maximum enhancement, 0.90). Quantitative pulmonary perfusion analysis proved a very large treatment effect attributable to successful PV revascularization already after 1 day.<br /><b>Conclusion</b><br />Integration of CMR pulmonary perfusion imaging into the clinical work-up of patients with PV stenosis allowed for efficient peri-procedural stratification and follow-up evaluation of revascularization success.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 12 Dec 2022; 24:70</small></div>
Jahnke C, Bollmann A, Oebel S, Lindemann F, ... Hindricks G, Paetsch I
J Cardiovasc Magn Reson: 12 Dec 2022; 24:70 | PMID: 36503589
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<div><h4>Comparing the findings and diagnostic sensitivity of cardiovascular magnetic resonance in biopsy confirmed acute myocarditis with infarct-like vs. heart failure presentation.</h4><i>Hassan K, Doubell A, Kyriakakis C, Joubert L, ... Zaharie D, Herbst P</i><br /><b>Background</b><br />Cardiovascular magnetic resonance (CMR) is considered the reference imaging modality in providing a non-invasive diagnosis of acute myocarditis (AM), as it allows for the detection of myocardial injury associated with AM. However, the diagnostic sensitivity and pattern of CMR findings appear to differ according to clinical presentation.<br /><b>Methods</b><br />This is a retrospective cross-sectional study. Consecutive adult patients presenting to a single tertiary centre in South Africa between August 2017 and January 2022 with AM confirmed on endomyocardial biopsy (EMB) were enrolled. Patients with infarct-like symptoms, defined as those presenting primarily with chest pain syndrome with associated ST-T wave changes on electrocardiogram, or heart failure (HF) symptoms, defined as clinical signs and symptoms of HF without significant chest discomfort, were compared using contrasted CMR and parametric techniques with EMB confirmation of AM as diagnostic gold standard.<br /><b>Results</b><br />Forty-one patients were identified including 23 (56%) with infarct-like symptoms and 18 (44%) with HF symptoms. On CMR, the infarct-like group had significantly higher ejection fractions of both ventricles (LVEF 55.3 ± 15.3% vs. 34.4 ± 13.5%, p < 0.001; RVEF 57.3 ± 10.9% vs. 42.9 ± 18.2%, p = 0.008), without significant differences in end diastolic volumes (LVEDVI 82.7 ± 30.3 ml/m<sup>2</sup> vs. 103.4 ± 35.9 ml/m<sup>2</sup>, p = 0.06; RVEDVI 73.7 ± 22.1 ml/m<sup>2</sup> vs. 83.9 ± 29.9 ml/m<sup>2</sup>, p = 0.25). Myocardial oedema was detected more frequently on T2-weighted imaging (91.3% vs. 61.1%, p = 0.03) and in more myocardial segments [3.0 (IQR 2.0-4.0) vs. 1.0 (IQR 0-1.0), p = 0.003] in the infarct-like group. Despite the absence of a significant statistical difference in the prevalence of late gadolinium enhancement (LGE) between the two groups (95.7% vs. 72.2%, p = 0.07), the infarct-like group had LGE detectable in significantly more ventricular segments [4.5 (IQR 2.3-6.0) vs. 2.0 (IQR 0-3.3), p = 0.02] and in a different distribution. The sensitivity of the original Lake Louise Criteria (LLC) was 91.3% in infarct-like patients and 55.6% in HF patients. When the updated LLC, which included the use of parametric myocardial mapping techniques, were applied, the sensitivity improved to 95.7% and 72.2% respectively.<br /><b>Conclusion</b><br />The pattern of CMR findings and its diagnostic sensitivity appears to differ in AM patients presenting with infarct-like and HF symptoms. Although the sensitivity of the LLC improved with the addition of parametric mapping in the HF group, it remained lower than that of the infarct-like group, and suggests that EMB should be considered earlier in the course of patients with clinically suspected AM presenting with HF.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 07 Dec 2022; 24:69</small></div>
Hassan K, Doubell A, Kyriakakis C, Joubert L, ... Zaharie D, Herbst P
J Cardiovasc Magn Reson: 07 Dec 2022; 24:69 | PMID: 36476480
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<div><h4>Society for cardiovascular magnetic resonance recommendations for training and competency of CMR technologists.</h4><i>Darty S, Jenista E, Kim RJ, Dyke C, ... Plein S, Elliott MD</i><br /><AbstractText>The Society for Cardiovascular Magnetic Resonance (SCMR) recommendations for training and competency of cardiovascular magnetic resonance (CMR) technologists document will define the knowledge, experiences and skills required for a technologist to be competent in CMR imaging. By providing a framework for CMR training and competency the overarching goal is to promote the performance of high-quality CMR and to foster the increased adoption of CMR into clinical care.</AbstractText><br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 05 Dec 2022; 24:68</small></div>
Darty S, Jenista E, Kim RJ, Dyke C, ... Plein S, Elliott MD
J Cardiovasc Magn Reson: 05 Dec 2022; 24:68 | PMID: 36464719
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<div><h4>Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension.</h4><i>Zhao X, Leng S, Tan RS, Chai P, ... Tan JL, Zhong L</i><br /><b>Background</b><br />Cardiovascular magnetic resonance (CMR) offers comprehensive right ventricular (RV) evaluation in pulmonary arterial hypertension (PAH). Emerging four-dimensional (4D) flow CMR allows visualization and quantification of intracardiac flow components and calculation of phasic blood kinetic energy (KE) parameters but it is unknown whether these parameters are associated with cardiopulmonary exercise test (CPET)-assessed exercise capacity, which is a surrogate measure of survival in PAH. We compared 4D flow CMR parameters in PAH with healthy controls, and investigated the association of these parameters with RV remodelling, RV functional and CPET outcomes.<br /><b>Methods</b><br />PAH patients and healthy controls from two centers were prospectively enrolled to undergo on-site cine and 4D flow CMR, and CPET within one week. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes (EDV). Phasic (peak systolic, average systolic, and peak E-wave) LV and RV blood flow KE indexed to EDV (KEI<sub>EDV</sub>) and ventricular LV and RV flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) were calculated. Oxygen uptake (VO<sub>2</sub>), carbon dioxide production (VCO<sub>2</sub>) and minute ventilation (VE) were measured and recorded.<br /><b>Results</b><br />45 PAH patients (46 ± 11 years; 7 M) and 51 healthy subjects (46 ± 14 years; 17 M) with no significant differences in age and gender were analyzed. Compared with healthy controls, PAH had significantly lower median RV direct flow, RV delayed ejection flow, RV peak E-wave KEI<sub>EDV</sub>, peak VO<sub>2</sub>, and percentage (%) predicted peak VO<sub>2</sub>, while significantly higher median RV residual volume and VE/VCO<sub>2</sub> slope. RV direct flow and RV residual volume were significantly associated with RV remodelling, function, peak VO<sub>2</sub>, % predicted peak VO<sub>2</sub> and VE/VCO<sub>2</sub> slope (all P < 0.01). Multiple linear regression analyses showed RV direct flow to be an independent marker of RV function, remodelling and exercise capacity.<br /><b>Conclusion</b><br />In this 4D flow CMR and CPET study, RV direct flow provided incremental value over RVEF for discriminating adverse RV remodelling, impaired exercise capacity, and PAH with intermediate and high risk based on risk score. These data suggest that CMR with 4D flow CMR can provide comprehensive assessment of PAH severity, and may be used to monitor disease progression and therapeutic response.<br /><b>Trial registration number</b><br />  https://www.<br /><b>Clinicaltrials</b><br />gov . Unique identifier: NCT03217240.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 01 Dec 2022; 24:61</small></div>
Zhao X, Leng S, Tan RS, Chai P, ... Tan JL, Zhong L
J Cardiovasc Magn Reson: 01 Dec 2022; 24:61 | PMID: 36451198
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<div><h4>Cardiovascular magnetic resonance imaging characteristics in patients with methamphetamine-associated cardiomyopathy.</h4><i>Stokes MB, Thoi F, Scherer DJ, Win KTH, ... Teo KS, Sanders P</i><br /><b>Background</b><br />Methamphetamine-associated cardiomyopathy (MA-CMP) is an increasingly recognised aetiology of cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a specialised cardiac imaging modality commonly used in assessment of cardiomyopathy. We aimed to identify specific CMR features associated with MA-CMP.<br /><b>Methods</b><br />A retrospective cohort study of CMR scans was performed in a single centre between January 2015 and December 2020. Thirty patients with MA-CMP who had undergone CMR were identified. MA-CMP was defined as those with a history of significant methamphetamine use hospitalised with acute decompensated heart failure (other causes of cardiomyopathy excluded). A retrospective analysis of index admission CMRs was performed. All studies were performed on a 1.5 T CMR scanner.<br /><b>Results</b><br />The mean age of MA-CMP patients was 43.7 ± 7.5 years, and 86.7% were male. The mean left ventricular (LV) volume obtained in this cohort was consistent with severe LV dilatation (LV end-diastolic volume (334 ± 99 ml); LV end-systolic volume: 269 ± 98 ml), whilst the right ventricular (RV) volume indicated moderate-to-severe dilatation (RV end-diastolic volume: 272 ± 91 ml; RV end-systolic volume: 173 ± 82 ml). Mean LV ejection fraction (20.9 ± 9.2%) indicated severe LV dysfunction, with moderate-to-severe RV dysfunction also detected (RV ejection fraction: 29.4 ± 13.4%). 22 patients (73.3%) had myocardial late gadolinium enhancement (LGE), of which 59.1% were located in the mid-wall, with all of these involving the interventricular septum. 22.7% displayed localised regions of sub-endocardial LGE in a variety of locations, and 18.2% had transmural regions of LGE that were located in the inferior and inferolateral segments. 6 patients (20%) had intracardiac thrombus (4 LV, 2 both LV and RV).<br /><b>Conclusion</b><br />MA-CMP was associated with severe biventricular dilatation and dysfunction, with a high prevalence of intraventricular thrombus. This cohort study highlights that MA-CMP patients have a high prevalence of CMR findings.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 01 Dec 2022; 24:67</small></div>
Stokes MB, Thoi F, Scherer DJ, Win KTH, ... Teo KS, Sanders P
J Cardiovasc Magn Reson: 01 Dec 2022; 24:67 | PMID: 36451214
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<div><h4>Cardiovascular magnetic resonance images with susceptibility artifacts: artificial intelligence with spatial-attention for ventricular volumes and mass assessment.</h4><i>Penso M, Babbaro M, Moccia S, Guglielmo M, ... Caiani EG, Pontone G</i><br /><b>Background</b><br />Segmentation of cardiovascular magnetic resonance (CMR) images is an essential step for evaluating dimensional and functional ventricular parameters as ejection fraction (EF) but may be limited by artifacts, which represent the major challenge to automatically derive clinical information. The aim of this study is to investigate the accuracy of a deep learning (DL) approach for automatic segmentation of cardiac structures from CMR images characterized by magnetic susceptibility artifact in patient with cardiac implanted electronic devices (CIED).<br /><b>Methods</b><br />In this retrospective study, 230 patients (100 with CIED) who underwent clinically indicated CMR were used to developed and test a DL model. A novel convolutional neural network was proposed to extract the left ventricle (LV) and right (RV) ventricle endocardium and LV epicardium. In order to perform a successful segmentation, it is important the network learns to identify salient image regions even during local magnetic field inhomogeneities. The proposed network takes advantage from a spatial attention module to selectively process the most relevant information and focus on the structures of interest. To improve segmentation, especially for images with artifacts, multiple loss functions were minimized in unison. Segmentation results were assessed against manual tracings and commercial CMR analysis software cvi<sup>42</sup>(Circle Cardiovascular Imaging, Calgary, Alberta, Canada). An external dataset of 56 patients with CIED was used to assess model generalizability.<br /><b>Results</b><br />In the internal datasets, on image with artifacts, the median Dice coefficients for end-diastolic LV cavity, LV myocardium and RV cavity, were 0.93, 0.77 and 0.87 and 0.91, 0.82, and 0.83 in end-systole, respectively. The proposed method reached higher segmentation accuracy than commercial software, with performance comparable to expert inter-observer variability (bias ± 95%LoA): LVEF 1 ± 8% vs 3 ± 9%, RVEF - 2 ± 15% vs 3 ± 21%. In the external cohort, EF well correlated with manual tracing (intraclass correlation coefficient: LVEF 0.98, RVEF 0.93). The automatic approach was significant faster than manual segmentation in providing cardiac parameters (approximately 1.5 s vs 450 s).<br /><b>Conclusions</b><br />Experimental results show that the proposed method reached promising performance in cardiac segmentation from CMR images with susceptibility artifacts and alleviates time consuming expert physician contour segmentation.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 28 Nov 2022; 24:62</small></div>
Penso M, Babbaro M, Moccia S, Guglielmo M, ... Caiani EG, Pontone G
J Cardiovasc Magn Reson: 28 Nov 2022; 24:62 | PMID: 36437452
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<div><h4>The relationship between myocardial microstructure and strain in chronic infarction using cardiovascular magnetic resonance diffusion tensor imaging and feature tracking.</h4><i>Sharrack N, Das A, Kelly C, Teh I, ... Schneider JE, Dall\'Armellina E</i><br /><b>Background</b><br />Cardiac diffusion tensor imaging (cDTI) using cardiovascular magnetic resonance (CMR) is a novel technique for the non-invasive assessment of myocardial microstructure. Previous studies have shown myocardial infarction to result in loss of sheetlet angularity, derived by reduced secondary eigenvector (E2A) and reduction in subendocardial cardiomyocytes, evidenced by loss of myocytes with right-handed orientation (RHM) on helix angle (HA) maps. Myocardial strain assessed using feature tracking-CMR (FT-CMR) is a sensitive marker of sub-clinical myocardial dysfunction. We sought to explore the relationship between these two techniques (strain and cDTI) in patients at 3 months following ST-elevation MI (STEMI).<br /><b>Methods</b><br />32 patients (F = 28, 60 ± 10 years) underwent 3T CMR three months after STEMI (mean interval 105 ± 17 days) with second order motion compensated (M2), free-breathing spin echo cDTI, cine gradient echo and late gadolinium enhancement (LGE) imaging. HA maps divided into left-handed HA (LHM, - 90 < HA < - 30), circumferential HA (CM, - 30° < HA < 30°), and right-handed HA (RHM, 30° < HA < 90°) were reported as relative proportions. Global and segmental analysis was undertaken.<br /><b>Results</b><br />Mean left ventricular ejection fraction (LVEF) was 44 ± 10% with a mean infarct size of 18 ± 12 g and a mean infarct segment LGE enhancement of 66 ± 21%. Mean global radial strain was 19 ± 6, mean global circumferential strain was - 13 ± - 3 and mean global longitudinal strain was - 10 ± - 3. Global and segmental radial strain correlated significantly with E2A in infarcted segments (p = 0.002, p = 0.011). Both global and segmental longitudinal strain correlated with RHM of infarcted segments on HA maps (p < 0.001, p = 0.003). Mean Diffusivity (MD) correlated significantly with the global infarct size (p < 0.008). When patients were categorised according to LVEF (reduced, mid-range and preserved), all cDTI parameters differed significantly between the three groups.<br /><b>Conclusion</b><br />Change in sheetlet orientation assessed using E2A from cDTI correlates with impaired radial strain. Segments with fewer subendocardial cardiomyocytes, evidenced by a lower proportion of myocytes with right-handed orientation on HA maps, show impaired longitudinal strain. Infarct segment enhancement correlates significantly with E2A and RHM. Our data has demonstrated a link between myocardial microstructure and contractility following myocardial infarction, suggesting a potential role for CMR cDTI to clinically relevant functional impact.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 24 Nov 2022; 24:66</small></div>
Sharrack N, Das A, Kelly C, Teh I, ... Schneider JE, Dall'Armellina E
J Cardiovasc Magn Reson: 24 Nov 2022; 24:66 | PMID: 36419059
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<div><h4>Age- and sex-specific reference values of biventricular strain and strain rate derived from a large cohort of healthy Chinese adults: a cardiovascular magnetic resonance feature tracking study.</h4><i>Li G, Zhang Z, Gao Y, Zhu C, ... Li K, Pohost GM</i><br /><b>Background</b><br />As a noninvasive tool, myocardial deformation imaging may facilitate the early detection of cardiac dysfunction. However, normal reference ranges of myocardial strain and strain rate (SR) based on large-scale East Asian populations are still lacking. This study aimed to provide reference values of left ventricular (LV) and right ventricular (RV) strain and SR based on a large cohort of healthy Chinese adults using cardiovascular magnetic resonance (CMR) feature tracking (FT).<br /><b>Methods</b><br />Five hundred and sixty-six healthy Chinese adults (55.1% men) free of hypertension, diabetes, and obesity were included. On cine CMR, biventricular global radial, circumferential, and longitudinal strain (GRS, GCS, and GLS), and the peak radial, circumferential, and longitudinal systolic, and diastolic SRs (PSSRR, PSSRC, PSSRL, PDSRR, PDSRC, and PDSRL), and regional radial and circumferential strain at the basal, mid-cavity, and apical levels were measured. Associations of global and regional biventricular deformation indices with age and sex were investigated.<br /><b>Results</b><br />Women demonstrated greater magnitudes of LV GRS (37.6 ± 6.1% vs. 32.1 ± 5.3%), GCS (- 20.7 ± 1.9% vs. - 18.8 ± 1.9%), GLS (- 17.8 ± 1.8% vs. - 15.6 ± 1.8%), RV GRS (25.1 ± 7.8% vs. 22.1 ± 6.7%), GCS (- 14.4 ± 3.6% vs. - 13.2 ± 3.2%), GLS (- 22.4 ± 5.2% vs. - 20.2 ± 4.6%), and biventricular peak systolic and diastolic SR in all three coordinate directions (all P < 0.05). For the LV, aging was associated with increasing amplitudes of GRS, GCS, and decreasing amplitudes of PDSRR, PDSRC, PDSRL (all P < 0.05). For the RV, aging was associated with an increase in the magnitudes of GRS, GCS, GLS, PSSRR, PSSRC, PSSRL, and a decrease in the magnitude of PDSRR, PDSRC (all P < 0.05). Biventricular radial and circumferential strain measurements at the basal, mid-cavity, and apical levels were all significantly related to age and sex in both sexes (all P < 0.05).<br /><b>Conclusions</b><br />We provide age- and sex-specific normal values of biventricular strain and SR based on a large sample of healthy Chinese adults with a broad age range. These results may be served as a reference standard for cardiac function assessment, especially for the Chinese population.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 21 Nov 2022; 24:63</small></div>
Abstract
<div><h4>Detection and evaluation of myocardial fibrosis in Eisenmenger syndrome using cardiovascular magnetic resonance late gadolinium enhancement and T1 mapping.</h4><i>Gong C, Guo J, Wan K, Wang L, ... Chen C, Chen Y</i><br /><b>Background</b><br />Myocardial fibrosis is a common pathophysiological process involved in many cardiovascular diseases. However, limited prior studies suggested no association between focal myocardial fibrosis detected by cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) and disease severity in Eisenmenger syndrome (ES). This study aimed to explore potential associations between myocardial fibrosis evaluated by the CMR LGE and T1 mapping and risk stratification profiles including exercise tolerance, serum biomarkers, hemodynamics, and right ventricular (RV) function in these patients.<br /><b>Methods</b><br />Forty-five adults with ES and 30 healthy subjects were included. All subjects underwent a contrast-enhanced 3T CMR. Focal replacement fibrosis was visualized on LGE images. The locations of LGE were recorded. After excluding LGE in ventricular insertion point (VIP), ES patients were divided into myocardial LGE-positive (LGE<sup>+</sup>) and LGE-negative (LGE<sup>-</sup>) subgroups. Regions of interest in the septal myocardium were manually contoured in the T1 mapping images to determine the diffuse myocardial fibrosis. The relationships between myocardial fibrosis and 6-min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-pro BNP), hematocrit, mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance index (PVRI), RV/left ventricular end-systolic volume (RV/LV ESV), RV ejection fraction (RVEF), and risk stratification were analyzed.<br /><b>Results</b><br />Myocardial LGE (excluding VIP) was common in ES (16/45, 35.6%), and often located in the septum (12/45, 26.7%). The clinical characteristics, hemodynamics, CMR morphology and function, and extracellular volume fraction (ECV) were similar in the LGE<sup>+</sup> and LGE<sup>-</sup> groups (all P > 0.05). ECV was significantly higher in ES patients (28.6 ± 5.9% vs. 25.6 ± 2.2%, P < 0.05) and those with LGE<sup>-</sup> ES (28.3 ± 5.9% vs. 25.6 ± 2.2%, P < 0.05) than healthy controls. We found significant correlations between ECV and log NT-pro BNP, hematocrit, mPAP, PVRI, RV/LV ESV, and RVEF (all P < 0.05), and correlations trends between ECV and 6MWT (P = 0.06) in ES patients. An ECV threshold of 29.0% performed well in differentiating patients with high-risk ES from those with intermediate or low risk (area under curve 0.857, P < 0.001).<br /><b>Conclusions</b><br />Myocardial fibrosis is a common feature of ES. ECV may serve as an important imaging marker for ES disease severity.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 21 Nov 2022; 24:60</small></div>
Gong C, Guo J, Wan K, Wang L, ... Chen C, Chen Y
J Cardiovasc Magn Reson: 21 Nov 2022; 24:60 | PMID: 36404313
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<div><h4>Acute intra-cavity 4D flow cardiovascular magnetic resonance predicts long-term adverse remodelling following ST-elevation myocardial infarction.</h4><i>Das A, Kelly C, Ben-Arzi H, van der Geest RJ, Plein S, Dall\'Armellina E</i><br /><b>Background</b><br />Despite advancements in percutaneous coronary intervention, a significant proportion of ST-elevation myocardial infarction (STEMI) survivors develop long-term adverse left ventricular (LV) remodelling, which is associated with poor prognosis. Adverse remodelling is difficult to predict, however four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) can measure various aspects of LV intra-cavity flow beyond LV ejection fraction and is well equipped for exploring the underlying mechanical processes driving remodelling. The aim for this study was to compare acute 4D flow CMR parameters between patients who develop adverse remodelling with patients who do not.<br /><b>Methods</b><br />Fifty prospective \'first-event\' STEMI patients underwent CMR 5 days post-reperfusion, which included cine-imaging, and 4D flow for assessing in-plane kinetic energy (KE), residual volume, peak-E and peak-A wave KE (indexed for LV end-diastolic volume [LVEDV]). All subjects underwent follow-up cine CMR imaging at 12 months to identify adverse remodelling (defined as 20% increase in LVEDV from baseline). Quantitative variables were compared using unpaired student\'s t-test. Tests were deemed statistically significant when p < 0.05.<br /><b>Results</b><br />Patients who developed adverse LV remodelling by 12 months had significantly higher in-plane KE (54 ± 12 vs 42 ± 10%, p = 0.02), decreased proportion of direct flow (27 ± 9% vs 11 ± 4%, p < 0.01), increased proportion of delayed ejection flow (22 ± 9% vs 12 ± 2, p < 0.01) and increased proportion of residual volume after 2 consecutive cardiac cycles (64 ± 14 vs 34 ± 14%, p < 0.01), in their acute scan.<br /><b>Conclusion</b><br />Following STEMI, increased in-plane KE, reduced direct flow and increased residual volume in the acute scan were all associated with adverse LV remodelling at 12 months. Our results highlight the clinical utility of acute 4D flow in prognostic stratification in patients following myocardial infarction.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 21 Nov 2022; 24:64</small></div>
Das A, Kelly C, Ben-Arzi H, van der Geest RJ, Plein S, Dall'Armellina E
J Cardiovasc Magn Reson: 21 Nov 2022; 24:64 | PMID: 36404326
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<div><h4>Utilization and impact of cardiovascular magnetic resonance on patient management in heart failure: insights from the SCMR Registry.</h4><i>Roifman I, Hammer M, Sparkes J, Dall\'Armellina E, Kwong RY, Wright G</i><br /><b>Background</b><br />Cardiovascular magnetic resonance (CMR) is an important diagnostic test used in the evaluation of patients with heart failure (HF). However, the demographics and clinical characteristics of those undergoing CMR for evaluation of HF are unknown. Further, the impact of CMR on subsequent HF patient care is unclear. The goal of this study was to describe the characteristics of patients undergoing CMR for HF and to determine the extent to which CMR leads to changes in downstream patient management by comparing pre-CMR indications and post-CMR diagnoses.<br /><b>Methods</b><br />We utilized the Society for Cardiovascular Magnetic Resonance (SCMR) Registry as our data source and abstracted data for patients undergoing CMR scanning for HF indications from 2013 to 2019. Descriptive statistics (percentages, proportions) were performed on key CMR and clinical variables of the patient population. The Fisher\'s exact test was used when comparing categorical variables. The Wilcoxon rank sum test was used to compare continuous variables.<br /><b>Results</b><br />3,837 patients were included in our study. 94% of the CMRs were performed in the United States with China, South Korea and India also contributing cases. Median age of HF patients was 59.3 years (IQR, 47.1, 68.3 years) with 67% of the scans occurring on women. Almost 2/3 of the patients were scanned on 3T CMR scanners. Overall, 49% of patients who underwent CMR scanning for HF had a change between the pre-test indication and post CMR diagnosis. 53% of patients undergoing scanning on 3T had a change between the pre-test indication and post CMR diagnosis when compared to 44% of patients who were scanned on 1.5T (p < 0.01).<br /><b>Conclusion</b><br />Our results suggest a potential impact of CMR scanning on downstream diagnosis of patients referred for CMR for HF, with a larger potential impact on those scanned on 3T CMR scanners.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 21 Nov 2022; 24:65</small></div>
Roifman I, Hammer M, Sparkes J, Dall'Armellina E, Kwong RY, Wright G
J Cardiovasc Magn Reson: 21 Nov 2022; 24:65 | PMID: 36404335
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<div><h4>Non-contrast free-breathing 3D cardiovascular magnetic resonance angiography using REACT (relaxation-enhanced angiography without contrast) compared to contrast-enhanced steady-state magnetic resonance angiography in complex pediatric congenital heart disease at 3T.</h4><i>Isaak A, Mesropyan N, Hart C, Zhang S, ... Dabir D, Luetkens JA</i><br /><b>Background</b><br />To evaluate the great vessels in young children with complex congenital heart disease (CHD) using non-contrast cardiovascular magnetic resonance angiography (CMRA) based on three-dimensional relaxation-enhanced angiography without contrast (REACT) in comparison to contrast-enhanced steady-state CMRA.<br /><b>Methods</b><br />In this retrospective study from April to July 2021, respiratory- and electrocardiogram-gated native REACT CMRA was compared to contrast-enhanced single-phase steady-state CMRA in children with CHD who underwent CMRA at 3T under deep sedation. Vascular assessment included image quality (1 = non-diagnostic, 5 = excellent), vessel diameter, and diagnostic findings. For statistical analysis, paired t-test, Pearson correlation, Bland-Altman analysis, Wilcoxon test, and intraclass correlation coefficients (ICC) were applied.<br /><b>Results</b><br />Thirty-six young children with complex CHD (median 4 years, interquartile range, 2-5; 20 males) were included. Native REACT CMRA was obtained successfully in all patients (mean scan time: 4:22 ± 1:44 min). For all vessels assessed, diameters correlated strongly between both methods (Pearson r = 0.99; bias = 0.04 ± 0.61 mm) with high interobserver reproducibility (ICC: 0.99 for both CMRAs). Native REACT CMRA demonstrated comparable overall image quality to contrast-enhanced CMRA (3.9 ± 1.0 vs. 3.8 ± 0.9, P = 0.018). With REACT CMRA, better image quality was obtained at the ascending aorta (4.8 ± 0.5 vs. 4.3 ± 0.8, P < 0.001), coronary roots (e.g., left: 4.1 ± 1.0 vs. 3.3 ± 1.1, P = 0.001), and inferior vena cava (4.6 ± 0.5 vs. 3.2 ± 0.8, P < 0.001). In all patients, additional vascular findings were assessed equally with native REACT CMRA and the contrast-enhanced reference standard (n = 6).<br /><b>Conclusion</b><br />In young children with complex CHD, REACT CMRA can provide gadolinium-free high image quality, accurate vascular measurements, and equivalent diagnostic quality compared to standard contrast-enhanced CMRA.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 17 Nov 2022; 24:55</small></div>
Abstract
<div><h4>4D flow cardiovascular magnetic resonance recovery profiles following pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension.</h4><i>Dong ML, Azarine A, Haddad F, Amsallem M, ... Mercier O, Marsden AL</i><br /><b>Background</b><br />Four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) allows comprehensive assessment of pulmonary artery (PA) flow dynamics. Few studies have characterized longitudinal changes in pulmonary flow dynamics and right ventricular (RV) recovery following a pulmonary endarterectomy (PEA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This can provide novel insights of RV and PA dynamics during recovery. We investigated the longitudinal trajectory of 4D flow metrics following a PEA including velocity, vorticity, helicity, and PA vessel wall stiffness.<br /><b>Methods</b><br />Twenty patients with CTEPH underwent pre-PEA and > 6 months post-PEA CMR imaging including 4D flow CMR; right heart catheter measurements were performed in 18 of these patients. We developed a semi-automated pipeline to extract integrated 4D flow-derived main, left, and right PA (MPA, LPA, RPA) volumes, velocity flow profiles, and secondary flow profiles. We focused on secondary flow metrics of vorticity, volume fraction of positive helicity (clockwise rotation), and the helical flow index (HFI) that measures helicity intensity.<br /><b>Results</b><br />Mean PA pressures (mPAP), total pulmonary resistance (TPR), and normalized RV end-systolic volume (RVESV) decreased significantly post-PEA (P < 0.002). 4D flow-derived PA volumes decreased (P < 0.001) and stiffness, velocity, and vorticity increased (P < 0.01) post-PEA. Longitudinal improvements from pre- to post-PEA in mPAP were associated with longitudinal decreases in MPA area (r = 0.68, P = 0.002). Longitudinal improvements in TPR were associated with longitudinal increases in the maximum RPA HFI (r=-0.85, P < 0.001). Longitudinal improvements in RVESV were associated with longitudinal decreases in MPA fraction of positive helicity (r = 0.75, P = 0.003) and minimum MPA HFI (r=-0.72, P = 0.005).<br /><b>Conclusion</b><br />We developed a semi-automated pipeline for analyzing 4D flow metrics of vessel stiffness and flow profiles. PEA was associated with changes in 4D flow metrics of PA flow profiles and vessel stiffness. Longitudinal analysis revealed that PA helicity was associated with pulmonary remodeling and RV reverse remodeling following a PEA.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 14 Nov 2022; 24:59</small></div>
Dong ML, Azarine A, Haddad F, Amsallem M, ... Mercier O, Marsden AL
J Cardiovasc Magn Reson: 14 Nov 2022; 24:59 | PMID: 36372884
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<div><h4>Longitudinal changes in ventricular size and function are associated with death and transplantation late after the Fontan operation.</h4><i>Ghelani SJ, Lu M, Sleeper LA, Prakash A, ... Powell AJ, Rathod RH</i><br /><b>Background</b><br />Cross-sectional studies have reported that ventricular dilation and dysfunction are associated with adverse clinical outcome in Fontan patients; however, longitudinal changes and their relationship with outcome are not known.<br /><b>Methods</b><br />This was a single-center retrospective analysis of Fontan patients with at least 2 cardiovascular magnetic resonance (CMR) scans without intervening interventions. Serial measures of end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), indexed mass (mass<sub>i</sub>), mass-to-volume ratio, and end-systolic wall stress (ESWS) were used to estimate within-patient change over time. Changes were compared for those with and without a composite outcome (death, heart transplant, or transplant listing) as well as between patients with left (LV) and right ventricular (RV) dominance.<br /><b>Results</b><br />Data from 156 patients were analyzed with a mean age at 1st CMR of 17.8 ± 9.6 years. 490 CMRs were included with median of 3 CMRs/patient (range 2-9). On regression analysis with mixed effects models, volumes and ESWS increased, while mass, mass-to-volume ratio, and EF decreased over time. With a median follow-up of 10.2 years, 14% met the composite outcome. Those with the composite outcome had a greater increase in EDVI compared to those without (4.7 vs. 0.8 ml/BSA<sup>1.3</sup>/year). Compared with LV dominance, RV dominance was associated with a greater increase in ESVI (1.4 vs. 0.5 ml/BSA<sup>1.3</sup>/year), a greater decrease in EF (- 0.61%/year vs. - 0.24%/year), and a higher rate of the composite outcome (21% vs. 8%).<br /><b>Conclusions</b><br />Ventricles in the Fontan circulation exhibit a steady decline in performance with an increase in EDVI, ESVI, and ESWS, and decrease in EF, mass index, and mass-to-volume ratio. Those with death or need for heart transplantation have a faster increase in EDVI. Patients with rapid increase in EDVI (> 5 ml/BSA<sup>1.3</sup>/year) may be at a higher risk of adverse outcomes and may benefit from closer surveillance. RV dominance is associated with worse clinical outcomes and remodeling compared to LV dominance.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 14 Nov 2022; 24:56</small></div>
Ghelani SJ, Lu M, Sleeper LA, Prakash A, ... Powell AJ, Rathod RH
J Cardiovasc Magn Reson: 14 Nov 2022; 24:56 | PMID: 36372887
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<div><h4>Prognostic value of right atrial strain derived from cardiovascular magnetic resonance in non-ischemic dilated cardiomyopathy.</h4><i>Li Y, Guo J, Li W, Xu Y, ... Sun J, Chen Y</i><br /><b>Background</b><br />The value of right atrial (RA) function in cardiovascular diseases is currently limited. This study was to explore the prognostic value of RA strain derived from fast long axis method by cardiovascular magnetic resonance (CMR) in patients with non-ischemic dilated cardiomyopathy (DCM).<br /><b>Methods</b><br />We prospectively enrolled patients with DCM who underwent CMR from June 2012 to March 2019 and 120 age- and sex-matched healthy subjects. Fast long-axis strain method was performed to assess the RA phasic function including RA reservoir strain, conduit strain, and booster strain. The predefined primary endpoint was all-cause mortality. The composite heart failure (HF) endpoint included HF death, HF readmission, and heart transplantation. Cox regression analysis and Kaplan-Meier survival curve were performed to describe the association between RA strain and outcomes.<br /><b>Results</b><br />A total of 624 patients (444 men, mean 48 years) were studied. After a median follow-up of 32.5 months, 116 patients (18.6%) experienced all-cause mortality and 205 patients (32.9%) reached composite HF endpoint. RA function was impaired in DCM patients compared with healthy subjects (all P < 0.001). After adjustment for covariates, RA reservoir strain [hazard ratio (HR) (per 5% decrease) 1.19, 95% confidence interval (CI) 1.03-1.37, P = 0.022] and conduit strain [HR (per 5% decrease) 1.37, 95% CI 1.03-1.84, P = 0.033] were independent predictors of all-cause mortality. Moreover, RA strain added incremental prognostic value for the prediction of adverse cardiac events over baseline clinical and CMR predictors (all P < 0.05).<br /><b>Conclusion</b><br />RA strain by fast long-axis analysis is independently associated with adverse clinical outcomes in patients with DCM.<br /><b>Trial registration</b><br />Trial registration number: ChiCTR1800017058; Date of registration: 2018-07-10 (Retrospective registration); URL: https://www.<br /><b>Clinicaltrials</b><br />gov.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 10 Nov 2022; 24:54</small></div>
Li Y, Guo J, Li W, Xu Y, ... Sun J, Chen Y
J Cardiovasc Magn Reson: 10 Nov 2022; 24:54 | PMID: 36352424
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<div><h4>Impact of ferumoxytol vs gadolinium on 4D flow cardiovascular magnetic resonance measurements in small children with congenital heart disease.</h4><i>Kollar SE, Udine ML, Mandell JG, Cross RR, Loke YH, Olivieri LJ</i><br /><b>Background</b><br />Cardiovascular magnetic resonance (CMR) allows for time-resolved three-dimensional phase-contrast (4D Flow) analysis of congenital heart disease (CHD). Higher spatial resolution in small infants requires thinner slices, which can degrade the signal. Particularly in infants, the choice of contrast agent (ferumoxytol vs. gadolinium) may influence 4D Flow CMR accuracy. Thus, we investigated the accuracy of 4D Flow CMR measurements compared to gold standard 2D flow phase contrast (PC) measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients with shunt lesions.<br /><b>Methods</b><br />This was a retrospective study consisting of CMR studies from complex CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D Flow and standard two-dimensional phase contrast (2D-PC) flow collected. 4D Flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins, and pulmonary veins. 4D Flow accuracy was defined as percent difference or correlation against conventional measurements (2D-PC) from the same vessels. Subgroup analysis was performed on two-ventricular vs single-ventricular CHD, arterial vs venous flow, as well as low flows (defined as < 1.5 L/min) in 1V CHD.<br /><b>Results</b><br />Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.6 vs. 2.3 ± 1.9 years, p = 0.70), patient body surface area (0.50 ± 0.2 vs. 0.52 ± 0.2 m<sup>2</sup>, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6 mm, p = 0.22). Ten CMR studies with single ventricular CHD were included. Overall, ferumoxytol-enhanced 4D flow CMR measurements demonstrated less percent difference to 2D-PC when compared to gadolinium-enhanced 4D Flow CMR studies. In subgroup analyses of arterial vs. venous flows (high velocity vs. low velocity) and low flow in single ventricle CHD, ferumoxytol-enhanced 4D Flow CMR measurements had stronger correlation to 2D-PC CMR. The contrast-to-noise ratio (CNR) in ferumoxytol-enhanced studies was higher than the CNR in gadolinium-enhanced studies.<br /><b>Conclusions</b><br />Ferumoxytol-enhanced 4D Flow CMR has improved accuracy when compared to gadolinium 4D Flow CMR, particularly for infants with small vessels in CHD.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 10 Nov 2022; 24:58</small></div>
Kollar SE, Udine ML, Mandell JG, Cross RR, Loke YH, Olivieri LJ
J Cardiovasc Magn Reson: 10 Nov 2022; 24:58 | PMID: 36352454
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<div><h4>Automatic segmentation of the great arteries for computational hemodynamic assessment.</h4><i>Montalt-Tordera J, Pajaziti E, Jones R, Sauvage E, ... Schievano S, Muthurangu V</i><br /><b>Background</b><br />Computational fluid dynamics (CFD) is increasingly used for the assessment of blood flow conditions in patients with congenital heart disease (CHD). This requires patient-specific anatomy, typically obtained from segmented 3D cardiovascular magnetic resonance (CMR) images. However, segmentation is time-consuming and requires expert input. This study aims to develop and validate a machine learning (ML) method for segmentation of the aorta and pulmonary arteries for CFD studies.<br /><b>Methods</b><br />90 CHD patients were retrospectively selected for this study. 3D CMR images were manually segmented to obtain ground-truth (GT) background, aorta and pulmonary artery labels. These were used to train and optimize a U-Net model, using a 70-10-10 train-validation-test split. Segmentation performance was primarily evaluated using Dice score. CFD simulations were set up from GT and ML segmentations using a semi-automatic meshing and simulation pipeline. Mean pressure and velocity fields across 99 planes along the vessel centrelines were extracted, and a mean average percentage error (MAPE) was calculated for each vessel pair (ML vs GT). A second observer (SO) segmented the test dataset for assessment of inter-observer variability. Friedman tests were used to compare ML vs GT, SO vs GT and ML vs SO metrics, and pressure/velocity field errors.<br /><b>Results</b><br />The network\'s Dice score (ML vs GT) was 0.945 (interquartile range: 0.929-0.955) for the aorta and 0.885 (0.851-0.899) for the pulmonary arteries. Differences with the inter-observer Dice score (SO vs GT) and ML vs SO Dice scores were not statistically significant for either aorta or pulmonary arteries (p = 0.741, p = 0.061). The ML vs GT MAPEs for pressure and velocity in the aorta were 10.1% (8.5-15.7%) and 4.1% (3.1-6.9%), respectively, and for the pulmonary arteries 14.6% (11.5-23.2%) and 6.3% (4.3-7.9%), respectively. Inter-observer (SO vs GT) and ML vs SO pressure and velocity MAPEs were of a similar magnitude to ML vs GT (p > 0.2).<br /><b>Conclusions</b><br />ML can successfully segment the great vessels for CFD, with errors similar to inter-observer variability. This fast, automatic method reduces the time and effort needed for CFD analysis, making it more attractive for routine clinical use.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 07 Nov 2022; 24:57</small></div>
Montalt-Tordera J, Pajaziti E, Jones R, Sauvage E, ... Schievano S, Muthurangu V
J Cardiovasc Magn Reson: 07 Nov 2022; 24:57 | PMID: 36336682
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<div><h4>Infarct quantification with cardiovascular magnetic resonance using \"standard deviation from remote\" is unreliable: validation in multi-centre multi-vendor data.</h4><i>Heiberg E, Engblom H, Carlsson M, Erlinge D, ... Aletras AH, Arheden H</i><br /><b>Background</b><br />The objective of the study was to investigate variability and agreement of the commonly used image processing method \"n-SD from remote\" and in particular for quantifying myocardial infarction by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). LGE-CMR in tandem with the analysis method \"n-SD from remote\" represents the current reference standard for infarct quantification. This analytic method utilizes regions of interest (ROIs) and defines infarct as the tissue with a set number of standard deviations (SD) above the signal intensity of remote nulled myocardium. There is no consensus on what the set number of SD is supposed to be. Little is known about how size and location of ROIs and underlying signal properties in the LGE images affect results. Furthermore, the method is frequently used elsewhere in medical imaging often without careful validation. Therefore, the usage of the \"n-SD\" method warrants a thorough validation.<br /><b>Methods</b><br />Data from 214 patients from two multi-center cardioprotection trials were included. Infarct size from different remote ROI positions, ROI size, and number of standard deviations (\"n-SD\") were compared with reference core lab delineations.<br /><b>Results</b><br />Variability in infarct size caused by varying ROI position, ROI size, and \"n-SD\" was 47%, 48%, and 40%, respectively. The agreement between the \"n-SD from remote\" method and the reference infarct size by core lab delineations was low. Optimal \"n-SD\" threshold computed on a slice-by-slice basis showed high variability, n = 5.3 ± 2.2.<br /><b>Conclusion</b><br />The \"n-SD from remote\" method is unreliable for infarct quantification due to high variability which depends on different placement and size of remote ROI, number \"n-SD\", and image signal properties related to the CMR-scanner and sequence used. Therefore, the \"n-SD from remote\" method should not be used, instead methods validated against an independent standard are recommended.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 07 Nov 2022; 24:53</small></div>
Heiberg E, Engblom H, Carlsson M, Erlinge D, ... Aletras AH, Arheden H
J Cardiovasc Magn Reson: 07 Nov 2022; 24:53 | PMID: 36336693
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<div><h4>Association of left ventricular abnormalities with incident cerebrovascular events and sources of thromboembolism in patients with chronic Chagas cardiomyopathy.</h4><i>Moreira HT, Volpe GJ, Mesquita GM, Braggion-Santos MF, ... Marin-Neto JA, Schmidt A</i><br /><b>Background</b><br />Although Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular events and sources of thromboembolism in patients with Chagas cardiomyopathy.<br /><b>Methods</b><br />This retrospective cohort included patients with chronic Chagas cardiomyopathy who underwent cardiovascular magnetic resonance (CMR). CMR was performed with a 1.5 T scanner to provide LV volumes, mass, ejection fraction (LVEF), and myocardial fibrosis. The primary outcome was a composite of incident ischemic cerebrovascular events (stroke or transient ischemic attack-TIA) and potential thromboembolic sources (atrial fibrillation (AF), atrial flutter, or intracavitary thrombus) during the follow-up.<br /><b>Results</b><br />A total of 113 patients were included. Median age was 56 years (IQR: 45-67), and 58 (51%) were women. The median LVEF was 53% (IQR: 41-62). LV aneurysms and LV fibrosis were present in 38 (34%) and 76 (67%) individuals, respectively. The median follow-up time was 6.9 years, with 29 events: 11 cerebrovascular events, 16 had AF or atrial flutter, and two had LV apical thrombosis. In the multivariable model, only lower LVEF remained significantly associated with the outcomes (HR: 0.96, 95% CI: 0.93-0.99). Patients with reduced LVEF lower than 40% had a much higher risk of cerebrovascular events and thromboembolic sources (HR: 3.16 95% CI: 1.38-7.25) than those with normal LVEF. The combined incidence rate of the combined events in chronic Chagas cardiomyopathy patients with reduced LVEF was 13.9 new cases per 100 persons-year.<br /><b>Conclusions</b><br />LV systolic dysfunction is an independent predictor of adverse cerebrovascular events and potential sources of thromboembolism in patients with chronic Chagas cardiomyopathy.<br /><br />© 2022. The Author(s).<br /><br /><small>J Cardiovasc Magn Reson: 03 Nov 2022; 24:52</small></div>
Moreira HT, Volpe GJ, Mesquita GM, Braggion-Santos MF, ... Marin-Neto JA, Schmidt A
J Cardiovasc Magn Reson: 03 Nov 2022; 24:52 | PMID: 36329520
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This program is still in alpha version.