Journal: J Cardiovasc Magn Reson

Sorted by: date / impact
Abstract

Supine, prone, right and left gravitational effects on human pulmonary circulation.

Wieslander B, Ramos JG, Ax M, Petersson J, Ugander M
Background
Body position can be optimized for pulmonary ventilation/perfusion matching during surgery and intensive care. However, positional effects upon distribution of pulmonary blood flow and vascular distensibility measured as the pulmonary blood volume variation have not been quantitatively characterized. In order to explore the potential clinical utility of body position as a modulator of pulmonary hemodynamics, we aimed to characterize gravitational effects upon distribution of pulmonary blood flow, pulmonary vascular distension, and pulmonary vascular distensibility.
Methods
Healthy subjects (n = 10) underwent phase contrast cardiovascular magnetic resonance (CMR) pulmonary artery and vein flow measurements in the supine, prone, and right/left lateral decubitus positions. For each lung, blood volume variation was calculated by subtracting venous from arterial flow per time frame.
Results
Body position did not change cardiac output (p = 0.84). There was no difference in blood flow between the superior and inferior pulmonary veins in the supine (p = 0.92) or prone body positions (p = 0.43). Compared to supine, pulmonary blood flow increased to the dependent lung in the lateral positions (16-33%, p = 0.002 for both). Venous but not arterial cross-sectional vessel area increased in both lungs when dependent compared to when non-dependent in the lateral positions (22-27%, p ≤ 0.01 for both). In contrast, compared to supine, distensibility increased in the non-dependent lung in the lateral positions (68-113%, p = 0.002 for both).
Conclusions
CMR demonstrates that in the lateral position, there is a shift in blood flow distribution, and venous but not arterial blood volume, from the non-dependent to the dependent lung. The non-dependent lung has a sizable pulmonary vascular distensibility reserve, possibly related to left atrial pressure. These results support the physiological basis for positioning patients with unilateral pulmonary pathology with the \"good lung down\" in the context of intensive care. Future studies are warranted to evaluate the diagnostic potential of these physiological insights into pulmonary hemodynamics, particularly in the context of non-invasively characterizing pulmonary hypertension.



J Cardiovasc Magn Reson: 10 Nov 2019; 21:69
Wieslander B, Ramos JG, Ax M, Petersson J, Ugander M
J Cardiovasc Magn Reson: 10 Nov 2019; 21:69 | PMID: 31707989
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Repaired coarctation of the aorta, persistent arterial hypertension and the selfish brain.

Rodrigues JCL, Jaring MFR, Werndle MC, Mitrousi K, ... Paton JFR, Hart EC
Background
It has been estimated that 20-30% of repaired aortic coarctation (CoA) patients develop hypertension, with significant cardiovascular morbidity and mortality. Vertebral artery hypoplasia (VAH) with an incomplete posterior circle of Willis (ipCoW; VAH + ipCoW) is associated with increased cerebrovascular resistance before the onset of increased sympathetic nerve activity in borderline hypertensive humans, suggesting brainstem hypoperfusion may evoke hypertension to maintain cerebral blood flow: the \"selfish brain\" hypothesis. We now assess the \"selfish brain\" in hypertension post-CoA repair.
Methods
Time-of-flight cardiovascular magnetic resonance angiography from 127 repaired CoA patients (34 ± 14 years, 61% male, systolic blood pressure (SBP) 138 ± 19 mmHg, diastolic blood pressure (DBP) 76 ± 11 mmHg) was compared with 33 normotensive controls (42 ± 14 years, 48% male, SBP 124 ± 10 mmHg, DBP 76 ± 8 mmHg). VAH was defined as < 2 mm and ipCoW as hypoplasia of one or both posterior communicating arteries.
Results
VAH + ipCoW was more prevalent in repaired CoA than controls (odds ratio: 5.8 [1.6-20.8], p = 0.007), after controlling for age, sex and body mass index (BMI). VAH + ipCoW was an independent predictor of hypertension (odds ratio: 2.5 [1.2-5.2], p = 0.017), after controlling for age, gender and BMI. Repaired CoA subjects with VAH + ipCoW were more likely to have difficult to treat hypertension (odds ratio: 3.3 [1.01-10.7], p = 0.049). Neither age at time of CoA repair nor any specific repair type were significant predictors of VAH + ipCoW in univariate regression analysis.
Conclusions
VAH + ipCoW predicts arterial hypertension and difficult to treat hypertension in repaired CoA. It is unrelated to age at time of repair or repair type. CoA appears to be a marker of wider congenital cerebrovascular problems. Understanding the \"selfish brain\" in post-CoA repair may help guide management.
Journal subject codes
High Blood Pressure; Hypertension; Magnetic Resonance Imaging (MRI); Cardiovascular Surgery; Cerebrovascular Malformations.



J Cardiovasc Magn Reson: 06 Nov 2019; 21:68
Rodrigues JCL, Jaring MFR, Werndle MC, Mitrousi K, ... Paton JFR, Hart EC
J Cardiovasc Magn Reson: 06 Nov 2019; 21:68 | PMID: 31703697
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy.

Abou Zahr R, Gooty V, Tandon A, Greil G, ... Ramaciotti C, Hussain T
Background
Injury to vital structures posterior to the sternum is a complication associated with redo sternotomy in congenital cardiac surgery. The goal of our study was a novel evaluation of real-time cine cardiovascular magnetic resonance (CMR) to predict the presence of significant retrosternal adhesions of cardiac and vascular structures prior to redo sternotomy in patients with congenital heart disease.
Methods
Twenty-three patients who had prior congenital heart surgery via median sternotomy had comprehensive CMR studies prior to redo sternotomy. The real time cine (RTC) sequence that was used is an ungated balanced steady-state free precession (bSSFP) sequence using SENSitivity Encoding for acceleration with real-time reconstruction. Spontaneously breathing patients were instructed to take deep breaths during the acquisition whilst increased tidal volumes were delivered to mechanically ventilated patients. All patients underwent redo cardiac surgery subsequently and the presence and severity of retrosternal adhesions were noted at the time of the redo sternotomies.
Results
Median age at the time of CMR and operation were 5.5 years (range, 0.2-18.4y) and 6.1 years (range, 0.3-18.8y) respectively. There were 15 males and 8 females in the study group. Preoperative retrosternal adhesions were identified on RTC in 13 patients and confirmed in 11 (85%) at the time of surgery. In only 2 patients, no adhesions were identified on CMR but were found to have significant retrosternal adhesions at surgery; false positive rate 15% (CI 0.4-29.6%), false negative rate 20% (CI 3.7-36.4%). The total classification error of the real time cine sequence was 17% (CI 1.7-32.4%) with an overall accuracy of 83% (CI 67.7-98.4%). Standard breath-hold cine images correlated poorly with surgical findings and did not increase the diagnostic yield.
Conclusions
RTC imaging can predict the presence of significant retrosternal adhesions and thus help in risk assessment prior to redo sternotomy. These findings complement the surgical planning and potentially reduce surgical complications .



J Cardiovasc Magn Reson: 30 Oct 2019; 21:67
Abou Zahr R, Gooty V, Tandon A, Greil G, ... Ramaciotti C, Hussain T
J Cardiovasc Magn Reson: 30 Oct 2019; 21:67 | PMID: 31672164
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Surveillance of abdominal aortic aneurysm using accelerated 3D non-contrast black-blood cardiovascular magnetic resonance with compressed sensing (CS-DANTE-SPACE).

Zhu C, Cao L, Wen Z, Ahn S, ... Hope M, Saloner D
Background
3D non-contrast high-resolution black-blood cardiovascular magnetic resonance (CMR) (DANTE-SPACE) has been used for surveillance of abdominal aortic aneurysm (AAA) and validated against computed tomography (CT) angiography. However, it requires a long scan time of more than 7 min. We sought to develop an accelerated sequence applying compressed sensing (CS-DANTE-SPACE) and validate it in AAA patients undergoing surveillance.
Methods
Thirty-eight AAA patients (all males, 73 ± 6 years) under clinical surveillance were recruited for this study. All patients were scanned with DANTE-SPACE (scan time 7:10 min) and CS-DANTE-SPACE (scan time 4:12 min, a reduction of 41.4%). Nine 9 patients were scanned more than 2 times. In total, 50 pairs of images were available for comparison. Two radiologists independently evaluated the image quality on a 1-4 scale, and measured the maximal diameter of AAA, the intra-luminal thrombus (ILT) and lumen area, ILT-to-muscle signal intensity ratio, and the ILT-to-lumen contrast ratio. The sharpness of the aneurysm inner/outer boundaries was quantified.
Results
CS-DANTE-SPACE achieved comparable image quality compared with DANTE-SPACE (3.15 ± 0.67 vs. 3.03 ± 0.64, p = 0.06). There was excellent agreement between results from the two sequences for diameter/area and ILT ratio measurements (ICCs> 0.85), and for quantifying growth rate (3.3 ± 3.1 vs. 3.3 ± 3.4 mm/year, ICC = 0.95.) CS-DANTE-SPACE showed a higher ILT-to-lumen contrast ratio (p = 0.01) and higher sharpness than DANTE-SPACE (p = 0.002). Both sequences had excellent inter-reader reproducibility for quantitative measurements (ICC > 0.88).
Conclusion
CS-DANTE-SPACE can reduce scan time while maintaining image quality for AAA imaging. It is a promising tool for the surveillance of patients with AAA disease in the clinical setting.



J Cardiovasc Magn Reson: 27 Oct 2019; 21:66
Zhu C, Cao L, Wen Z, Ahn S, ... Hope M, Saloner D
J Cardiovasc Magn Reson: 27 Oct 2019; 21:66 | PMID: 31660983
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Accelerated aortic 4D flow cardiovascular magnetic resonance using compressed sensing: applicability, validation and clinical integration.

Neuhaus E, Weiss K, Bastkowski R, Koopmann J, Maintz D, Giese D
Background
Three-dimensional time-resolved phase-contrast cardiovascular magnetic resonance (4D flow CMR) enables the quantification and visualisation of blood flow, but its clinical applicability remains hampered by its long scan time. The aim of this study was to evaluate the use of compressed sensing (CS) with on-line reconstruction to accelerate the acquisition and reconstruction of 4D flow CMR of the thoracic aorta.
Methods
4D flow CMR of the thoracic aorta was acquired in 20 healthy subjects using CS with acceleration factors ranging from 4 to 10. As a reference, conventional parallel imaging (SENSE) with acceleration factor 2 was used. Flow curves, net flows, peak flows and peak velocities were extracted from six contours along the aorta. To measure internal data consistency, a quantitative particle trace analysis was performed. Additionally, scan-rescan, inter- and intraobserver reproducibility were assessed. Subsequently, 4D flow CMR with CS factor 6 was acquired in 3 patients with differing aortopathies. The flow patterns resulting from particle trace visualisation were qualitatively analysed.
Results
All collected data were successfully acquired and reconstructed on-line. The average acquisition time including respiratory navigator efficiency with CS factor 6 was 5:02 ± 2:23 min while reconstruction took approximately 9 min. For CS factors of 8 or less, mean differences in net flow, peak flow and peak velocity as compared to SENSE were below 2.2 ± 7.8 ml/cycle, 4.6 ± 25.2 ml/s and - 7.9 ± 13.0 cm/s, respectively. For a CS factor of 10 differences reached 5.4 ± 8.0 ml/cycle, 14.4 ± 28.3 ml/s and - 4.0 ± 12.2 cm/s. Scan-rescan analysis yielded mean differences in net flow of - 0.7 ± 4.9 ml/cycle for SENSE and - 0.2 ± 8.5 ml/cycle for CS factor of 6.
Conclusions
A six- to eightfold acceleration of 4D flow CMR using CS is feasible. Up to a CS acceleration rate of 6, no statistically significant differences in measured flow parameters could be observed with respect to the reference technique. Acquisitions in patients with aortopathies confirm the potential to integrate the proposed method in a clinical routine setting, whereby its main benefits are scan-time savings and direct on-line reconstruction.



J Cardiovasc Magn Reson: 20 Oct 2019; 21:65
Neuhaus E, Weiss K, Bastkowski R, Koopmann J, Maintz D, Giese D
J Cardiovasc Magn Reson: 20 Oct 2019; 21:65 | PMID: 31638997
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Improved co-registration of ex-vivo and in-vivo cardiovascular magnetic resonance images using heart-specific flexible 3D printed acrylic scaffold combined with non-rigid registration.

Whitaker J, Neji R, Byrne N, Puyol-Antón E, ... Razavi R, Roujol S
Background
Ex-vivo cardiovascular magnetic resonance (CMR) imaging has played an important role in the validation of in-vivo CMR characterization of pathological processes. However, comparison between in-vivo and ex-vivo imaging remains challenging due to shape changes occurring between the two states, which may be non-uniform across the diseased heart. A novel two-step process to facilitate registration between ex-vivo and in-vivo CMR was developed and evaluated in a porcine model of chronic myocardial infarction (MI).
Methods
Seven weeks after ischemia-reperfusion MI, 12 swine underwent in-vivo CMR imaging with late gadolinium enhancement followed by ex-vivo CMR 1 week later. Five animals comprised the control group, in which ex-vivo imaging was undertaken without any support in the LV cavity, 7 animals comprised the experimental group, in which a two-step registration optimization process was undertaken. The first step involved a heart specific flexible 3D printed scaffold generated from in-vivo CMR, which was used to maintain left ventricular (LV) shape during ex-vivo imaging. In the second step, a non-rigid co-registration algorithm was applied to align in-vivo and ex-vivo data. Tissue dimension changes between in-vivo and ex-vivo imaging were compared between the experimental and control group. In the experimental group, tissue compartment volumes and thickness were compared between in-vivo and ex-vivo data before and after non-rigid registration. The effectiveness of the alignment was assessed quantitatively using the DICE similarity coefficient.
Results
LV cavity volume changed more in the control group (ratio of cavity volume between ex-vivo and in-vivo imaging in control and experimental group 0.14 vs 0.56, p < 0.0001) and there was a significantly greater change in the short axis dimensions in the control group (ratio of short axis dimensions in control and experimental group 0.38 vs 0.79, p < 0.001). In the experimental group, prior to non-rigid co-registration the LV cavity contracted isotropically in the ex-vivo condition by less than 20% in each dimension. There was a significant proportional change in tissue thickness in the healthy myocardium (change = 29 ± 21%), but not in dense scar (change = - 2 ± 2%, p = 0.034). Following the non-rigid co-registration step of the process, the DICE similarity coefficients for the myocardium, LV cavity and scar were 0.93 (±0.02), 0.89 (±0.01) and 0.77 (±0.07) respectively and the myocardial tissue and LV cavity volumes had a ratio of 1.03 and 1.00 respectively.
Conclusions
The pattern of the morphological changes seen between the in-vivo and the ex-vivo LV differs between scar and healthy myocardium. A 3D printed flexible scaffold based on the in-vivo shape of the LV cavity is an effective strategy to minimize morphological changes in the ex-vivo LV. The subsequent non-rigid registration step further improved the co-registration and local comparison between in-vivo and ex-vivo data.



J Cardiovasc Magn Reson: 09 Oct 2019; 21:62
Whitaker J, Neji R, Byrne N, Puyol-Antón E, ... Razavi R, Roujol S
J Cardiovasc Magn Reson: 09 Oct 2019; 21:62 | PMID: 31597563
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging.

Thompson RB, Chow K, Pagano JJ, Sekowski V, ... Savu A, Paterson DI
Background
Pulmonary edema is a cardinal feature of heart failure but no quantitative tests are available in clinical practice. The goals of this study were to develop a simple cardiovascular magnetic resonance (CMR) approach for lung water quantification, to correlate CMR derived lung water with intra-cardiac pressures and to determine its prognostic significance.
Methods
Lung water density (LWD, %) was measured using a widely available single-shot fast spin-echo acquisition in two study cohorts. Validation Cohort: LWD was compared to left ventricular end-diastolic pressure or pulmonary capillary wedge pressure in 19 patients with heart failure undergoing cardiac catheterization. Prospective Cohort: LWD was measured in 256 subjects, including 121 with heart failure, 82 at-risk for heart failure and 53 healthy controls. Clinical outcomes were evaluated up to 1 year.
Results
Within the validation cohort, CMR LWD correlated to invasively measured left-sided filling pressures (R = 0.8, p < 0.05). In the prospective cohort, mean LWD was 16.6 ± 2.1% in controls, 17.9 ± 3.0% in patients at-risk and 19.3 ± 5.4% in patients with heart failure, p < 0.001. In patients with or at-risk for heart failure, LWD >  20.8% (mean + 2 standard deviations of healthy controls) was an independent predictor of death, hospitalization or emergency department visit within 1 year, hazard ratio 2.4 (1.1-5.1, p = 0.03).
Conclusions
In patients with heart failure, increased CMR-derived lung water is associated with increased intra-cardiac filling pressures, and predicts 1 year outcomes. LWD could be incorporated in standard CMR scans.



J Cardiovasc Magn Reson: 11 Sep 2019; 21:58
Thompson RB, Chow K, Pagano JJ, Sekowski V, ... Savu A, Paterson DI
J Cardiovasc Magn Reson: 11 Sep 2019; 21:58 | PMID: 31511018
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Free breathing three-dimensional cardiac quantitative susceptibility mapping for differential cardiac chamber blood oxygenation - initial validation in patients with cardiovascular disease inclusive of direct comparison to invasive catheterization.

Wen Y, Weinsaft JW, Nguyen TD, Liu Z, ... Wang Y, Spincemaille P
Background
Differential blood oxygenation between left (LV) and right ventricles (RV; ΔSaO) is a key index of cardiac performance; LV dysfunction yields increased RV blood pool deoxygenation. Deoxyhemoglobin increases blood magnetic susceptibility, which can be measured using an emerging cardiovascular magnetic resonance (CMR) technique, Quantitative Susceptibility Mapping (QSM) - a concept previously demonstrated in healthy subjects using a breath-hold 2D imaging approach (2DQSM). This study tested utility of a novel 3D free-breathing QSM approach (3DQSM) in normative controls, and validated 3DQSM for non-invasive ΔSaO quantification in patients undergoing invasive cardiac catheterization (cath).
Methods
Initial control (n = 10) testing compared 2DQSM (ECG-triggered 2D gradient echo acquired at end-expiration) and 3DQSM (ECG-triggered navigator gated gradient echo acquired in free breathing using a phase-ordered automatic window selection algorithm to partition data based on diaphragm position). Clinical testing was subsequently performed in patients being considered for cath, including 3DQSM comparison to cine-CMR quantified LV function (n = 39), and invasive-cath quantified ΔSaO (n = 15). QSM was acquired using 3 T scanners; analysis was blinded to comparator tests (cine-CMR, cath).
Results
3DQSM generated interpretable QSM in all controls; 2DQSM was successful in 6/10. Among controls in whom both pulse sequences were successful, RV/LV susceptibility difference (and ΔSaO) were not significantly different between 3DQSM and 2DQSM (252 ± 39 ppb [17.5 ± 3.1%] vs. 211 ± 29 ppb [14.7 ± 2.0%]; p = 0.39). Acquisition times were 30% lower with 3DQSM (4.7 ± 0.9 vs. 6.7 ± 0.5 min, p = 0.002), paralleling a trend towards lower LV mis-registration on 3DQSM (p = 0.14). Among cardiac patients (63 ± 10y, 56% CAD) 3DQSM was successful in 87% (34/39) and yielded higher ΔSaO (24.9 ± 6.1%) than in controls (p < 0.001). QSM-calculated ΔSaO was higher among patients with LV dysfunction as measured on cine-CMR based on left ventricular ejection fraction (29.4 ± 5.9% vs. 20.9 ± 5.7%, p < 0.001) or stroke volume (27.9 ± 7.5% vs. 22.4 ± 5.5%, p = 0.013). Cath measurements (n = 15) obtained within a mean interval of 4 ± 3 days from CMR demonstrated 3DQSM to yield high correlation (r = 0.87, p < 0.001), small bias (- 0.1%), and good limits of agreement (±8.6%) with invasively measured ΔSaO.
Conclusion
3DQSM provides a novel means of assessing cardiac performance. Differential susceptibility between the LV and RV is increased in patients with cine-CMR evidence of LV systolic dysfunction; QSM-quantified ΔSaO yields high correlation and good agreement with the reference of invasively-quantified ΔSaO.



J Cardiovasc Magn Reson: 17 Nov 2019; 21:70
Wen Y, Weinsaft JW, Nguyen TD, Liu Z, ... Wang Y, Spincemaille P
J Cardiovasc Magn Reson: 17 Nov 2019; 21:70 | PMID: 31735165
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Fast self-navigated wall shear stress measurements in the murine aortic arch using radial 4D-phase contrast cardiovascular magnetic resonance at 17.6 T.

Winter P, Andelovic K, Kampf T, Gutjahr FT, ... Jakob PM, Herold V
Purpose
4D flow cardiovascular magnetic resonance (CMR) and the assessment of wall shear stress (WSS) are non-invasive tools to study cardiovascular risks in vivo. Major limitations of conventional triggered methods are the long measurement times needed for high-resolution data sets and the necessity of stable electrocardiographic (ECG) triggering. In this work an ECG-free retrospectively synchronized method is presented that enables accelerated high-resolution measurements of 4D flow and WSS in the aortic arch of mice.
Methods
4D flow and WSS were measured in the aortic arch of 12-week-old wildtype C57BL/6 J mice (n = 7) with a radial 4D-phase-contrast (PC)-CMR sequence, which was validated in a flow phantom. Cardiac and respiratory motion signals were extracted from the radial CMR signal and were used for the reconstruction of 4D-flow data. Rigid motion correction and a first order B correction was used to improve the robustness of magnitude and velocity data. The aortic lumen was segmented semi-automatically. Temporally averaged and time-resolved WSS and oscillatory shear index (OSI) were calculated from the spatial velocity gradients at the lumen surface at 14 locations along the aortic arch. Reproducibility was tested in 3 animals and the influence of subsampling was investigated.
Results
Volume flow, cross-sectional areas, WSS and the OSI were determined in a measurement time of only 32 min. Longitudinal and circumferential WSS and radial stress were assessed at 14 analysis planes along the aortic arch. The average longitudinal, circumferential and radial stress values were 1.52 ± 0.29 N/m, 0.28 ± 0.24 N/m and - 0.21 ± 0.19 N/m, respectively. Good reproducibility of WSS values was observed.
Conclusion
This work presents a robust measurement of 4D flow and WSS in mice without the need of ECG trigger signals. The retrospective approach provides fast flow quantification within 35 min and a flexible reconstruction framework.



J Cardiovasc Magn Reson: 13 Oct 2019; 21:64
Winter P, Andelovic K, Kampf T, Gutjahr FT, ... Jakob PM, Herold V
J Cardiovasc Magn Reson: 13 Oct 2019; 21:64 | PMID: 31610777
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study.

Guala A, Teixido-Tura G, Dux-Santoy L, Granato C, ... Evangelista A, Rodriguez-Palomares J
Background
Diseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined.
Methods
Seventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed.
Results
In-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter.
Conclusions
Reduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients.



J Cardiovasc Magn Reson: 13 Oct 2019; 21:63
Guala A, Teixido-Tura G, Dux-Santoy L, Granato C, ... Evangelista A, Rodriguez-Palomares J
J Cardiovasc Magn Reson: 13 Oct 2019; 21:63 | PMID: 31607265
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Model-based myocardial T1 mapping with sparsity constraints using single-shot inversion-recovery radial FLASH cardiovascular magnetic resonance.

Wang X, Kohler F, Unterberg-Buchwald C, Lotz J, Frahm J, Uecker M
Background
This study develops a model-based myocardial T1 mapping technique with sparsity constraints which employs a single-shot inversion-recovery (IR) radial fast low angle shot (FLASH) cardiovascular magnetic resonance (CMR) acquisition. The method should offer high resolution, accuracy, precision and reproducibility.
Methods
The proposed reconstruction estimates myocardial parameter maps directly from undersampled k-space which is continuously measured by IR radial FLASH with a 4 s breathhold and retrospectively sorted based on a cardiac trigger signal. Joint sparsity constraints are imposed on the parameter maps to further improve T1 precision. Validations involved studies of an experimental phantom and 8 healthy adult subjects.
Results
In comparison to an IR spin-echo reference method, phantom experiments with T1 values ranging from 300 to 1500 ms revealed good accuracy and precision at simulated heart rates between 40 and 100 bpm. In vivo T1 maps achieved better precision and qualitatively better preservation of image features for the proposed method than a real-time CMR approach followed by pixelwise fitting. Apart from good inter-observer reproducibility (0.6% of the mean), in vivo results confirmed good intra-subject reproducibility (1.05% of the mean for intra-scan and 1.17, 1.51% of the means for the two inter-scans, respectively) of the proposed method.
Conclusion
Model-based reconstructions with sparsity constraints allow for single-shot myocardial T1 maps with high spatial resolution, accuracy, precision and reproducibility within a 4 s breathhold. Clinical trials are warranted.



J Cardiovasc Magn Reson: 18 Sep 2019; 21:60
Wang X, Kohler F, Unterberg-Buchwald C, Lotz J, Frahm J, Uecker M
J Cardiovasc Magn Reson: 18 Sep 2019; 21:60 | PMID: 31533736
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Machine learning in cardiovascular magnetic resonance: basic concepts and applications.

Leiner T, Rueckert D, Suinesiaputra A, Baeßler B, ... Išgum I, Young AA

Machine learning (ML) is making a dramatic impact on cardiovascular magnetic resonance (CMR) in many ways. This review seeks to highlight the major areas in CMR where ML, and deep learning in particular, can assist clinicians and engineers in improving imaging efficiency, quality, image analysis and interpretation, as well as patient evaluation. We discuss recent developments in the field of ML relevant to CMR in the areas of image acquisition & reconstruction, image analysis, diagnostic evaluation and derivation of prognostic information. To date, the main impact of ML in CMR has been to significantly reduce the time required for image segmentation and analysis. Accurate and reproducible fully automated quantification of left and right ventricular mass and volume is now available in commercial products. Active research areas include reduction of image acquisition and reconstruction time, improving spatial and temporal resolution, and analysis of perfusion and myocardial mapping. Although large cohort studies are providing valuable data sets for ML training, care must be taken in extending applications to specific patient groups. Since ML algorithms can fail in unpredictable ways, it is important to mitigate this by open source publication of computational processes and datasets. Furthermore, controlled trials are needed to evaluate methods across multiple centers and patient groups.



J Cardiovasc Magn Reson: 06 Oct 2019; 21:61
Leiner T, Rueckert D, Suinesiaputra A, Baeßler B, ... Išgum I, Young AA
J Cardiovasc Magn Reson: 06 Oct 2019; 21:61 | PMID: 31590664
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Assessment of the regional distribution of normalized circumferential strain in the thoracic and abdominal aorta using DENSE cardiovascular magnetic resonance.

Wilson JS, Taylor WR, Oshinski J
Background
Displacement Encoding with Stimulated Echoes (DENSE) cardiovascular magnetic resonance (CMR) of the aortic wall offers the potential to improve patient-specific diagnostics and prognostics of diverse aortopathies by quantifying regionally heterogeneous aortic wall strain in vivo. However, before regional mapping of strain can be used to clinically assess aortic pathology, an evaluation of the natural variation of normal regional aortic kinematics is required.
Method
Aortic spiral cine DENSE CMR was performed at 3 T in 30 healthy adult subjects (range 18 to 65 years) at one or more axial locations that are at high risk for aortic aneurysm or dissection: the infrarenal abdominal aorta (IAA, n = 11), mid-descending thoracic aorta (DTA, n = 17), and/or distal aortic arch (DAA, n = 11). After implementing custom noise-reduction techniques, regional circumferential Green strain of the aortic wall was calculated across 16 sectors around the aortic circumference at each location and normalized by the mean circumferential strain for comparison between individuals.
Results
The distribution of normalized circumferential strain (NCS) was heterogeneous for all locations evaluated. Despite large differences in mean strain between subjects, comparisons of NCS revealed consistent patterns of strain distribution for similar groupings of patients by axial location, age, and/or mean displacement angle. NCS at local systole was greatest in the lateral/posterolateral walls in the IAAs (1.47 ± 0.27), medial wall in anteriorly displacing DTAs (1.28 ± 0.20), lateral wall in posteriorly displacing DTAs (1.29 ± 0.29), superior curvature in DAAs < 50 years-old (1.93 ± 0.22), and medial wall in DAAs > 50 years (2.29 ± 0.58). The distribution of strain was strongly influenced by the location of the vertebra and other surrounding structures unique to each location.
Conclusions
Regional in vivo circumferential strain in the adult aorta is unique to each axial location and heterogeneous around its circumference, but can be grouped into consistent patterns defined by basic patient-specific metrics following normalization. The heterogeneous strain distributions unique to each group may be due to local peri-aortic constraints (particularly at the aorto-vertebral interface), heterogeneous material properties, and/or heterogeneous flow patterns. These results must be carefully considered in future studies seeking to clinically interpret or computationally model patient-specific aortic kinematics.



J Cardiovasc Magn Reson: 15 Sep 2019; 21:59
Wilson JS, Taylor WR, Oshinski J
J Cardiovasc Magn Reson: 15 Sep 2019; 21:59 | PMID: 31522679
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance-guided right heart catheterization in a conventional CMR environment - predictors of procedure success and duration in pulmonary artery hypertension.

Knight DS, Kotecha T, Martinez-Naharro A, Brown JT, ... Muthurangu V, Coghlan JG
Background
Cardiovascular magnetic resonance imaging (CMR) is valuable for the investigation and management of pulmonary artery hypertension (PAH), but the direct measurement of pulmonary hemodynamics by right heart catheterization is still necessary. CMR-guided right heart catheterization (CMR-RHC) combines the benefits of CMR and invasive cardiac catheterization, but its feasibility in patients with acquired PAH has not been established. The aims of this study are to: (1) demonstrate the feasibility of CMR-RHC in patients being assessed for PAH in a conventional diagnostic CMR scanner room; (2) determine the predictors of (i) procedure duration, and (ii) procedural failure or technical difficulty as determined by the adjunctive need for a guidewire.
Methods
Fifty patients investigated for suspected or known PH underwent CMR-RHC. Durations of separate procedural components were recorded, including time taken to pass the catheter from the femoral vein to a stable wedge position (procedure time) and total time the patient spent in the CMR department (department time). Associations between procedural failure/guidewire usage and hemodynamic/CMR measures were assessed using logistic regression. Relationships between procedure times and hemodynamic/CMR measures were evaluated using Spearman\'s correlation coefficient.
Results
A full CMR-RHC study was successfully completed in 47 (94%) patients. CMR-conditional guidewires were used in 6 (12%) patients. Metrics associated with guidewire use/procedural failure were higher mean pulmonary artery (PA) pressures (mPAP: OR = 1.125, p = 0.018), right heart dilatation (right ventricular (RV) end-systolic volume (RVESV): OR = 1.028, p = 0.018), RV hypertrophy (OR = 1.050, p = 0.0067) and RV ejection fraction (EF) (OR = 0.914, p = 0.014). Median catheter and department times were 3.6 (2.0-7.7) minutes and 60.0 (54.0-68.5) minutes, respectively. All procedure times became significantly shorter with increasing procedural experience (p < 0.05). Catheterization time was also associated with PH severity (RV systolic pressure: rho = 0.46, p = 0.0013) and increasing RV end-systolic volume (RVESV: rho = 0.41, p = 0.0043), hypertrophy (rho = 0.43, p = 0.0025) and dysfunction (RVEF: rho = - 0.32, p = 0.031).
Conclusions
This study demonstrates that CMR-RHC using standard technology can be incorporated into routine clinical practice for the investigation of PAH. Procedural failure was rare but more likely in patients with severe PAH. Procedure time is clinically acceptable and increases with worsening PAH severity.



J Cardiovasc Magn Reson: 08 Sep 2019; 21:57
Knight DS, Kotecha T, Martinez-Naharro A, Brown JT, ... Muthurangu V, Coghlan JG
J Cardiovasc Magn Reson: 08 Sep 2019; 21:57 | PMID: 31495338
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Dynamic quantitative nonenhanced magnetic resonance angiography of the abdominal aorta and lower extremities using cine fast interrupted steady-state in combination with arterial spin labeling: a feasibility study.

Aherne EA, Koktzoglou I, Lind BB, Edelman RR
Background
Cine fast interrupted steady-state in combination with arterial spin labeling is a recently described nonenhanced magnetic resonance angiography (MRA) technique that relies on bolus tracking for time-resolved digital subtraction angiography-like displays of blood flow patterns. We evaluated the feasibility of applying this technique to display in-plane flow patterns in two regions: the abdominal aorta and lower extremity peripheral arteries.
Methods
We performed an institutional review board-approved study in healthy subjects and patients. In 7 healthy subjects, in-plane flow was imaged at 4 stations ranging from the lower legs to the aorto-iliac bifurcation (junction of the distal thigh and upper calf, mid-thigh, junction of the upper thigh and pelvis, upper pelvis). In 5 healthy subjects and 6 patients without abdominal aortopathy, images were acquired through the suprarenal abdominal aorta. Ten patients with known peripheral arterial disease and two patients with stable disease of the abdominal aorta were also evaluated. Peak velocity was compared at each of the 4 stations for cine fast interrupted steady-state in combination with arterial spin labeling and two-dimensional cine phase contrast in patients with normal vessels.
Results
In-plane flow patterns were well visualized in all peripheral arterial stations and in the abdominal aorta, providing a high quality display of hemodynamic patterns along extensive lengths of the vessels. There was very strong positive correlation (r = 0.952, P < 0.05) and excellent agreement (intraclass correlation coefficient, 0.935; 95% confidence interval, 0.812-0.972) between peak flow velocities measured by cine fast interrupted steady-state in combination with arterial spin labeling and two-dimensional cine phase contrast. In 10 patients with peripheral artery disease and 2 patients with aortic pathology, cine fast interrupted steady-state in combination with arterial spin labeling provided a visual demonstration of abnormal hemodynamics.
Conclusion
This feasibility study suggests that cine fast interrupted steady-state in combination with arterial spin labeling provides an efficient, high quality and physiologically accurate display of in-plane flow patterns over extensive lengths of the lower extremity peripheral arteries, which can be difficult to achieve using other MRA techniques.



J Cardiovasc Magn Reson: 01 Sep 2019; 21:55
Aherne EA, Koktzoglou I, Lind BB, Edelman RR
J Cardiovasc Magn Reson: 01 Sep 2019; 21:55 | PMID: 31474219
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging.

Gotschy A, von Deuster C, van Gorkum RJH, Gastl M, ... Stoeck CT, Kozerke S
Background
In-vivo cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) allows imaging of alterations of cardiac fiber architecture in diseased hearts. Cardiac amyloidosis (CA) causes myocardial infiltration of misfolded proteins with unknown consequences for myocardial microstructure. This study applied CMR DTI in CA to assess microstructural alterations and their consequences for myocardial function compared to healthy controls.
Methods
Ten patients with CA (8 AL, 2 ATTR) and ten healthy controls were studied using a diffusion-weighed second-order motion-compensated spin-echo sequence at 1.5 T. Additionally, left ventricular morphology, ejection fraction, strain and native T1 values were obtained in all subjects. In CA patients, T1 mapping was repeated after the administration of gadolinium for extracellular volume fraction (ECV) calculation. CMR DTI analysis was performed to yield the scalar diffusion metrics mean diffusivity (MD) and fractional anisotropy (FA) as well as the characteristics of myofiber orientation including helix, transverse and E2A sheet angle (HA, TA, E2A).
Results
MD and FA were found to be significantly different between CA patients and healthy controls (MD 1.77 ± 0.17 10 vs 1.41 ± 0.07 10 mm/s, p <  0.001; FA 0.25 ± 0.04 vs 0.35 ± 0.03, p <  0.001). MD demonstrated an excellent correlation with native T1 (r = 0.908, p <  0.001) while FA showed a significant correlation with ECV in the CA population (r = - 0.851, p <  0.002). HA exhibited a more circumferential orientation of myofibers in CA patients, in conjunction with a higher TA standard deviation and a higher absolute E2A sheet angle. The transmural HA slope was found to be strongly correlated with the global longitudinal strain (r = 0.921, p < 0.001).
Conclusion
CMR DTI reveals significant alterations of scalar diffusion metrics in CA patients versus healthy controls. Elevated MD and lower FA values indicate myocardial disarray with higher diffusion in CA that correlates well with native T1 and ECV measures. In CA patients, CMR DTI showed pronounced circumferential orientation of the myofibers, which may provide the rationale for the reduction of global longitudinal strain that occurs in amyloidosis patients. Accordingly, CMR DTI captures specific features of amyloid infiltration, which provides a deeper understanding of the microstructural consequences of CA.



J Cardiovasc Magn Reson: 04 Sep 2019; 21:56
Gotschy A, von Deuster C, van Gorkum RJH, Gastl M, ... Stoeck CT, Kozerke S
J Cardiovasc Magn Reson: 04 Sep 2019; 21:56 | PMID: 31484544
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Multiparametric cardiovascular magnetic resonance imaging in acute myocarditis: a comparison of different measurement approaches.

Dabir D, Vollbrecht TM, Luetkens JA, Kuetting DLR, ... Schild HH, Thomas D
Background
Myocardial T1 and T2 mapping are reliable diagnostic markers for the detection and follow up of acute myocarditis. The aim of this study was to compare the diagnostic performance of current mapping measurement approaches to differentiate between myocarditis patients and healthy individuals.
Methods
Fifty patients with clinically defined acute myocarditis and 30 healthy controls underwent cardiovascular magnetic resonance (CMR). Myocardial T1 relaxation times, T2 relaxation times, left ventricular (LV) function, T2 ratio, early gadolinium enhancement ratio, and presence of late gadolinium enhancement (LGE) were analysed. Native T1 and T2 relaxation times, as well as extracellular volume fraction (ECV) were measured for the entire LV myocardium (global), within the midventricular short axis slice (mSAX), within the midventricular septal wall (ConSept), and within the remote myocardium (remote). Receiver operating characteristics analysis was performed to compare diagnostic performance.
Results
All measurement approaches revealed significantly higher native T1 and T2 relaxation times as well as ECV values in patients compared to healthy controls (p < 0.05 for all parameters). The global measurement approach showed highest diagnostic performance regarding all mapping parameters (AUCs, native T1: 0.903, T2: 0.847, ECV: 0.731). Direct comparison of the different measurement approaches revealed significant differences in diagnostic performance between the global and the remote approach regarding T1 relaxation times and ECV (p = 0.001 and p = 0.002 respectively). Further, the global measurement approach revealed significantly higher T1 relaxation times compared to the ConSept approach (AUCs: 0.903 vs. 0.783; p = 0.003) and nearly significant differences compared to the mSAX approach (AUC: 0.850; p = 0.051). T2 relaxation times showed no significant differences between all measurement approaches (p > 0.050 for all parameters).
Conclusions
Native T1 and T2 mapping allow for accurate detection of acute myocarditis irrespective of the measurement approach used. Even measurements performed exclusively within remote myocardium allow for reliable detection of acute myocarditis, demonstrating diffuse involvement of disease despite a mostly regional or patchy distribution pattern of visible pathologies. The global measurement approach provides the overall best diagnostic performance in acute myocarditis for both T1 and T2 mapping.



J Cardiovasc Magn Reson: 28 Aug 2019; 21:54
Dabir D, Vollbrecht TM, Luetkens JA, Kuetting DLR, ... Schild HH, Thomas D
J Cardiovasc Magn Reson: 28 Aug 2019; 21:54 | PMID: 31462282
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic value of novel imaging parameters derived from standard cardiovascular magnetic resonance in high risk patients with systemic light chain amyloidosis.

Arenja N, Andre F, Riffel JH, Siepen FAD, ... Katus HA, Buss SJ
Background
The differentiated assessment of functional parameters besides morphological changes is essential for the evaluation of prognosis in systemic immunoglobulin light chain (AL) amyloidosis.
Methods
Seventy-four subjects with AL amyloidosis and presence of late gadolinium enhancement (LGE) pattern typical for cardiac amyloidosis were analyzed. Long axis strain (LAS) and myocardial contraction fraction (MCF), as well as morphological and functional markers, were measured. The primary endpoint was death, while death and heart transplantation served as a composite secondary endpoint.
Results
After a median follow-up of 41 months, 29 out of 74 patients died and 10 received a heart transplant. Left ventricular (LV) functional parameters were reduced in patients, who met the composite endpoint (LV ejection fraction 51% vs. 61%, LAS - 6.9% vs - 10%, GLS - 12% vs - 15% and MCF 42% vs. 69%; p <  0.001 for all). In unadjusted univariate analysis, LAS (HR = 1.05, p <  0.001) and MCF (HR = 0.96, p <  0.001) were associated with reduced transplant-free survival. Kaplan-Meier analyses showed a significantly lower event-free survival in patients with reduced MCF. MCF and LAS performed best to identify high risk patients for secondary endpoint (Log-rank test p <  0.001) in a combined model. Using sequential Cox regression analysis, the addition of LAS and MCF to LV ejection fraction led to a significant increase in the predictive power of the model (χ (df = 1) = 28.2, p <  0.001).
Conclusions
LAS and MCF as routinely available and robust CMR-derived parameters predict outcome in LGE positive AL amyloidosis. Patients with impaired LV function in combination with reduced LAS and MCF are at the highest risk for death and heart transplantation.



J Cardiovasc Magn Reson: 21 Aug 2019; 21:53
Arenja N, Andre F, Riffel JH, Siepen FAD, ... Katus HA, Buss SJ
J Cardiovasc Magn Reson: 21 Aug 2019; 21:53 | PMID: 31434577
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Size of carotid artery intraplaque hemorrhage and acute ischemic stroke: a cardiovascular magnetic resonance Chinese atherosclerosis risk evaluation study.

Liu Y, Wang M, Zhang B, Wang W, ... Yuan C, Zhao X
Background
To determine the usefulness of the size of carotid artery intraplaque hemorrhage (IPH) in discriminating the risk of acute ischemic stroke using cardiovascular magnetic resonance (CMR) vessel wall imaging.
Methods
Symptomatic patients with carotid atherosclerotic plaque who participated in a cross-sectional, multicenter study of CARE-II (NCT02017756) were included. All patients underwent carotid and brain CMR imaging. Carotid plaque burden and the size of plaque compositions including calcification, lipid-rich necrotic core (LRNC), and IPH were measured. Presence of acute cerebral infarct (ACI) in ipsilateral hemisphere of carotid plaque was determined. The relationship between carotid plaque features and presence of ipsilateral ACI was then analyzed.
Results
Of 687 recruited patients (62.7 ± 10.1 years; 69.4% males) with carotid plaque, 28.5% had ACI in ipsilateral hemispheres. Logistic regression revealed that carotid plaque burden was significantly associated with the presence of ACI before and after adjusted for clinical confounding factors. The volume of LRNC, %LRNC volume, volume of IPH, and %IPH volume were significantly associated with ACI before (volume of LRNC: OR = 1.297, p = 0.005; %LRNC volume: OR = 1.119, p = 0.018; volume of IPH: OR = 2.514, p = 0.003; %IPH volume: OR = 2.202, p = 0.003) and after (volume of LRNC: OR = 1.312, p = 0.006; %LRNC volume: OR = 1.90, p = 0.034; volume of IPH: OR = 2.907, p = 0.007; % IPH volume: OR = 2.374, p = 0.004) adjusted for clinical confounding factors. The association between volume of IPH and ACI remained statistically significant after further adjusted for plaque volume (OR = 2.813, p = 0.016) or both plaque volume and volume of LRNC (OR = 4.044, p = 0.024).
Conclusions
In symptomatic patients with carotid atherosclerotic plaques, the size of IPH is independently associated with ipsilateral ACI, suggesting the size of IPH might be a useful indicator for the risk of ACI.
Trial registration
Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02017756.



J Cardiovasc Magn Reson: 30 Jun 2019; 21:36
Liu Y, Wang M, Zhang B, Wang W, ... Yuan C, Zhao X
J Cardiovasc Magn Reson: 30 Jun 2019; 21:36 | PMID: 31262337
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

mDixon ECG-gated 3-dimensional cardiovascular magnetic resonance angiography in patients with congenital cardiovascular disease.

Kourtidou S, Jones MR, Moore RA, Tretter JT, ... Fleck RJ, Taylor MD
Background
Cardiovascular magnetic resonance (CMR) angiography (CMRA) is an important non-invasive imaging tool for congenital heart disease (CHD) and aortopathy patients. The conventional 3D balanced steady-state free precession (bSSFP) sequence is often confounded by imaging artifacts. We sought to compare the respiratory navigated and electrocardiogram (ECG) gated modified Dixon (mDixon) CMRA sequence to conventional non-gated dynamic multi-phase contrast enhanced CMRA (CE-CMRA) and bSSFP across a variety of diagnoses.
Methods
We included 24 patients with CHD or aortopathy with CMR performed between September 2017 to December 2017. Each patient had undergone CE-CMRA, followed by a bSSFP and mDixon angiogram. Patients with CMR-incompatible implants or contraindications to contrast were excluded. The studies were rated according to image quality at a scale from 1 (poor) to 4 (excellent) based on diagnostic adequacy, artifact burden, vascular border delineation, myocardium-blood pool contrast, and visualization of pulmonary and systemic veins and coronaries. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and quantitative vascular measurements were compared between the two gated sequences. Bland-Altman plots were generated to compare paired measures.
Results
All scans were diagnostically adequate. Mean (SD) quality scores were 3.4 (0.7) for the mDixon, 3.2 (0.5) for the bSSFP and 3.4 (0.5) for the CE-CMRA. Qualitatively, the intracardiac anatomy and myocardium-blood pool definition were better in the bSSFP; however, mDixon images showed enhanced vessel wall sharpness with less blurring surrounding the anatomical borders distally. Coronary origins were identified in all cases. Pulmonary veins were visualized in 92% of mDixon sequences, 75% of bSSFP and 96% of CE-CMRA. Similarly, neck veins were identified in 92, 83 and 96% respectively. Artifacts prevented vascular measurement in 6/192 (3%) and 4/192 (2%) of total vascular measurements for the mDixon and bSSFP, respectively. However, the size of signal void and field distortion were significantly worse in the latter, particularly for flow and metal induced artifacts.
Conclusion
In patients with congenital heart disease, ECG gated mDixon angiography yields high fidelity vascular images including better delineation of head and neck vasculature and pulmonary veins and fewer artifacts than the comparable bSSFP sequence. It should be considered as the preferred strategy for successful CHD imaging in patients with valve stenosis, vascular stents, or metallic implants.



J Cardiovasc Magn Reson: 07 Aug 2019; 21:52
Kourtidou S, Jones MR, Moore RA, Tretter JT, ... Fleck RJ, Taylor MD
J Cardiovasc Magn Reson: 07 Aug 2019; 21:52 | PMID: 31391061
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Echocardiography and cardiovascular magnetic resonance based evaluation of myocardial strain and relationship with late gadolinium enhancement.

Erley J, Genovese D, Tapaskar N, Alvi N, ... Mor-Avi V, Patel AR
Objectives
We sought to: (1) determine the agreement in cardiovascular magnetic resonance (CMR) and speckle tracking echocardiography (STE) derived strain measurements, (2) compare their reproducibility, (3) determine which approach is best related to CMR late gadolinium enhancement (LGE).
Background
While STE-derived strain is routinely used to assess left ventricular (LV) function, CMR strain measurements are not yet standardized. Strain can be measured using dedicated pulse sequences (strain-encoding, SENC), or post-processing of cine images (feature tracking, FT). It is unclear whether these measurements are interchangeable, and whether strain can be used as an alternative to LGE.
Methods
Fifty patients underwent 2D echocardiography and 1.5 T CMR. Global longitudinal strain (GLS) was measured by STE (Epsilon), FT (NeoSoft) and SENC (Myocardial Solutions) and circumferential strain (GCS) by FT and SENC.
Results
GLS showed good inter-modality agreement (r-values: 0.71-0.75), small biases (< 1%) but considerable limits of agreement (- 7 to 8%). The agreement between the CMR techniques was better for GLS than GCS (r = 0.81 vs 0.67; smaller bias). Repeated measurements showed low intra- and inter-observer variability for both GLS and GCS (intraclass correlations 0.86-0.99; coefficients of variation 3-13%). LGE was present in 22 (44%) of patients. Both SENC- and FT-derived GLS and GCS were associated with LGE, while STE-GLS was not. Irrespective of CMR technique, this association was stronger for GCS (AUC 0.77-0.78) than GLS (AUC 0.67-0.72) and STE-GLS (AUC = 0.58).
Conclusion
There is good inter-technique agreement in strain measurements, which were highly reproducible, irrespective of modality or analysis technique. GCS may better reflect the presence of underlying LGE than GLS.



J Cardiovasc Magn Reson: 07 Aug 2019; 21:46
Erley J, Genovese D, Tapaskar N, Alvi N, ... Mor-Avi V, Patel AR
J Cardiovasc Magn Reson: 07 Aug 2019; 21:46 | PMID: 31391036
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations.

Holdsworth DA, Parsons IT, Chamley R, Britton J, ... d\'Arcy J, Nicol ED
Background
The benefit of cardiovascular magnetic resonance Imaging (CMR) in assessing occupational risk is unknown. Pilots undergo frequent medical assessment for occult disease, which threatens incapacitation or distraction during flight. ECG and examination anomalies often lead to lengthy restriction, pending full investigation. CMR provides a sensitive, specific assessment of cardiac anatomy, tissue characterisation, perfusion defects and myocardial viability. We sought to determine if CMR, when added to standard care, would alter occupational outcome.
Methods
A retrospective review was conducted of all personnel attending the RAF Aviation Medicine Consultation Service (AMCS) for assessment of a cardiac anomaly, over a 2-year period. Those undergoing standard of care (history, examination, exercise ECG, 24 h-Holter and transthoracic echocardiography), and those undergoing a CMR in addition, were identified. The influence of CMR upon the final decision regarding flying restriction was determined by comparing the diagnosis reached with standard of care plus CMR vs. standard of care alone.
Results
Of the ~ 8000 UK military aircrew, 558 personnel were seen for cardiovascular assessment. Fifty-two underwent CMR. A normal TTE did not reliably exclude abnormalities subsequently detected by CMR. Addition of CMR resulted in an upgraded occupational status in 62% of those investigated, with 37% returning to unrestricted duties. Only 8% of referrals were undiagnosed following CMR. All these were cases of borderline chamber dilatation and reduction in systolic function in whom diagnostic uncertainty remained between physiological exercise adaptation and early cardiomyopathy.
Conclusions
CMR increases the likelihood of a definitive diagnosis and of return to flying. This study supports early use of CMR in occupational assessment for high-hazard occupations.



J Cardiovasc Magn Reson: 28 Jul 2019; 21:48
Holdsworth DA, Parsons IT, Chamley R, Britton J, ... d'Arcy J, Nicol ED
J Cardiovasc Magn Reson: 28 Jul 2019; 21:48 | PMID: 31352898
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Diffusion weighted cardiovascular magnetic resonance imaging for discriminating acute from non-acute deep venous Thrombus.

Wu G, Morelli J, Xiong Y, Liu X, Li X
Background
The importance of discriminating acute from non-acute thrombus is highlighted. The study aims to investigate the feasibility of readout-segmented diffusion weighted (DW) cardiovascular magnetic resonance (CMR) for discrimination of acute from non-acute deep venous thrombus (DVT).
Methods
For this prospective study from December 2015 to December 2017, 85 participants (mean age = 53 years, age range = 34~74) with DVT of lower extremities underwent readout-segmented DW CMR. DVT of ≤14 days were defined as acute (n = 55) and > 14 days as non-acute (n = 30). DVT visualization on b = 0, b = 800, and apparent diffusion coefficient (ADC) images were assessed using a 4-point scale (0~3, poor~excellent). DW CMR parameters were measured using region of interest (ROI). Relative signal intensity (rSI) and ADC were compared between acute and non-acute DVT using a Mann Whitney test. Sensitivity and specificity for ADC and rSI were calculated.
Results
ADC maps had higher visualization scores than b = 0 and b = 800 images (2.7 ± 0.5, 2.5 ± 0.6, and 2.4 ± 0.6 respectively, P<0.05). The mean ADC was higher in acute DVT than non-acute DVT (0.56 ± 0.17 × 10 vs. 0.22 ± 0.12 × 10 mm/s, P<0.001). Using 0.32 × 10 mm/s as the cutoff, sensitivity and specificity for ADC to discriminate acute from non-acute DVT were 93 and 90% respectively. Sensitivity and specificity were 73 and 60% for rSI on b = 0, and 75 and 63% for rSI on b = 800.
Conclusions
Readout segmented diffusion-weighted CMR derived ADC distinguishes acute from non-acute DVT.
Trial registration
This study is retrospectively registered.
Trial registration number
HUST-TJH-2015-146 .



J Cardiovasc Magn Reson: 07 Jul 2019; 21:37
Wu G, Morelli J, Xiong Y, Liu X, Li X
J Cardiovasc Magn Reson: 07 Jul 2019; 21:37 | PMID: 31286985
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Resolving the natural myocardial remodelling brought upon by cardiac contraction; a porcine ex-vivo cardiovascular magnetic resonance study of the left and right ventricle.

Omann C, Agger P, Bøgh N, Laustsen C, ... Hjortdal VE, Smerup M
Background
The three-dimensional rearrangement of the right ventricular (RV) myocardium during cardiac deformation is unknown. Previous in-vivo studies have shown that myocardial left ventricular (LV) deformation is driven by rearrangement of aggregations of cardiomyocytes that can be characterised by changes in the so-called E3-angle. Ex-vivo imaging offers superior spatial resolution compared with in-vivo measurements, and can thus provide novel insight into the deformation of the myocardial microstructure in both ventricles. This study sought to describe the dynamic changes of the orientations of the cardiomyocytes in both ventricles brought upon by cardiac contraction, with particular interest in the thin-walled RV, which has not previously been described in terms of its micro-architecture.
Methods
The hearts of 14 healthy 20 kg swine were excised and preserved in either a relaxed state or a contracted state. Myocardial architecture was assessed and compared between the two contractional states by quantification of the helical, transmural and E3-angles of the cardiomyocytes using high-resolution diffusion tensor imaging.
Results
The differences between the two states of contraction were most pronounced in the endocardium where the E3-angle decreased from 78.6° to 24.8° in the LV and from 82.6° to 68.6° in the RV. No significant change in neither the helical nor the transmural angle was found in the cardiomyocytes of the RV. In the endocardium of the LV, however, the helical angle increased from 35.4° to 47.8° and the transmural angle increased from 3.1° to 10.4°.
Conclusion
The entire myocardium rearranges through the cardiac cycle with the change in the orientation of the aggregations of cardiomyocytes being the predominant mediator of myocardial wall thickening. Interestingly, differences also exist between the RV and LV, which helps in the explanation of the different physiological capabilities of the ventricles.



J Cardiovasc Magn Reson: 30 Jun 2019; 21:35
Omann C, Agger P, Bøgh N, Laustsen C, ... Hjortdal VE, Smerup M
J Cardiovasc Magn Reson: 30 Jun 2019; 21:35 | PMID: 31256759
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Fetal XCMR: a numerical phantom for fetal cardiovascular magnetic resonance imaging.

Roy CW, Marini D, Segars WP, Seed M, Macgowan CK
Background
Validating new techniques for fetal cardiovascular magnetic resonance (CMR) is challenging due to random fetal movement that precludes repeat measurements. Consequently, fetal CMR development has been largely performed using physical phantoms or postnatal volunteers. In this work, we present an open-source simulation designed to aid in the development and validation of new approaches for fetal CMR. Our approach, fetal extended Cardiac-Torso cardiovascular magnetic resonance imaging (Fetal XCMR), builds on established methods for simulating CMR acquisitions but is tailored toward the dynamic physiology of the fetal heart and body. We present comparisons between the Fetal XCMR phantom and data acquired in utero, resulting in image quality, anatomy, tissue signals and contrast.
Methods
Existing extended Cardiac-Torso models are modified to create maternal and fetal anatomy, combined according to simulated motion, mapped to CMR contrast, and converted to CMR data. To provide a comparison between the proposed simulation and experimental fetal CMR images acquired in utero, images from a typical scan of a pregnant woman are included and simulated acquisitions were generated using matching CMR parameters, motion and noise levels. Three reconstruction (static, real-time, and CINE), and two motion estimation methods (translational motion, fetal heart rate) from data acquired in transverse, sagittal, coronal, and short-axis planes of the fetal heart were performed to compare to in utero acquisitions and demonstrate feasibility of the proposed simulation framework.
Results
Overall, CMR contrast, morphologies, and relative proportions of the maternal and fetal anatomy are well represented by the Fetal XCMR images when comparing the simulation to static images acquired in utero. Additionally, visualization of maternal respiratory and fetal cardiac motion is comparable between Fetal XCMR and in utero real-time images. Finally, high quality CINE image reconstructions provide excellent delineation of fetal cardiac anatomy and temporal dynamics for both data types.
Conclusion
The fetal CMR phantom provides a new method for evaluating fetal CMR acquisition and reconstruction methods by simulating the underlying anatomy and physiology. As the field of fetal CMR continues to grow, new methods will become available and require careful validation. The fetal CMR phantom is therefore a powerful and convenient tool in the continued development of fetal cardiac imaging.



J Cardiovasc Magn Reson: 22 May 2019; 21:29
Roy CW, Marini D, Segars WP, Seed M, Macgowan CK
J Cardiovasc Magn Reson: 22 May 2019; 21:29 | PMID: 31118056
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial fibrosis by late gadolinium enhancement cardiovascular magnetic resonance in myotonic muscular dystrophy type 1: highly prevalent but not associated with surface conduction abnormality.

Cardona A, Arnold WD, Kissel JT, Raman SV, Zareba KM
Background
Conduction disease and arrhythmias represent a major cause of mortality in myotonic muscular dystrophy type 1 (MMD1). Permanent pacemaker (PPM) implantation is the cornerstone of therapy to reduce cardiovascular mortality in MMD1. Cardiovascular magnetic resonance (CMR) studies demonstrate a high prevalence of myocardial fibrosis in MMD1, however the association between CMR myocardial fibrosis with late gadolinium enhancement (CMR-LGE) and surface conduction abnormality is not well established in MMD1. We investigated whether myocardial fibrosis by CMR-LGE is associated with surface conduction abnormalities meeting criteria for PPM implantation according to current guidelines in a cohort of patients with genetically confirmed MMD1.
Methods
Patients with genetically confirmed MMD1 were retrospectively evaluated. 12-lead electrocardiography (ECG) performed within 6 months of CMR was necessary for inclusion. The severity and extent of MMD1 was quantified using a validated Muscular Impairment Rating Scale (MIRS). Based on current guidelines for device-based therapy of cardiac rhythm abnormalities, we defined surface conduction abnormality as the presence of ECG alterations meeting criteria for PPM implant (class I or II indications): PR interval > 200 ms (type I atrioventricular (AV) block) and/or mono or bifascicular block (QRS > 120 ms), or evidence of advanced AV block. Balanced steady-state free precession sequences (bSSFP) were used for assessment of left ventricular (LV) volumes and ejection fraction. MOdified Look-Locker Inversion Recovery (MOLLI) acquisition schemes were used to acquire T1 maps. Patients\' charts were reviewed up to 12 months post-CMR for occurrence of PPM implantation.
Results
Fifty-two patients (38% male, 41 ± 14 years) were included. Overall, 31 (60%) patients had a surface conduction abnormality and 22 (42%) demonstrated midwall myocardial fibrosis by CMR-LGE. After a median of 57 days from CMR exam, 15 patients (29%) underwent PPM implantation. Subjects with vs. without surface conduction abnormality had significantly longer disease length (15.5 vs. 7.8 years, p = 0.015) and higher disease severity on the MIRS scale (p = 0.041). High prevalence of myocardial fibrosis by CMR-LGE was detected in subjects with and without surface conduction abnormality with no significant difference between the two cohorts (42% vs. 43%, p = 0.999). By multivariate logistic regression analysis, disease length was the only independent variable associated with surface conduction abnormality (OR 1.071, 95%CI 1.003-1.144, p = 0.040); while CMR-LGE was not associated with conduction abnormality (ρ = - 0.009, p = 0.949).
Conclusions
Myocardial fibrosis by CMR-LGE is highly prevalent in MMD1 but not related to surface conduction abnormality meeting current guideline criteria for PPM implantation .



J Cardiovasc Magn Reson: 01 May 2019; 21:26
Cardona A, Arnold WD, Kissel JT, Raman SV, Zareba KM
J Cardiovasc Magn Reson: 01 May 2019; 21:26 | PMID: 31046780
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Kidney transplantation is associated with reduced myocardial fibrosis. A cardiovascular magnetic resonance study with native T1 mapping.

Contti MM, Barbosa MF, Del Carmen Villanueva Mauricio A, Nga HS, ... Bravin AM, de Andrade LGM
Background
The measurement of native T1 through cardiovascular magnetic resonance (CMR) is a noninvasive method of assessing myocardial fibrosis without gadolinium contrast. No studies so far have evaluated native T1 after renal transplantation. The primary aim of the current study is to assess changes in the myocardium native T1 6 months after renal transplantation.
Methods
We prospectively evaluated 44 renal transplant patients with 3 T CMR exams: baseline at the beginning of transplantation and at 6 months after transplantation.
Results
The native T1 time was measured in the midventricular septum and decreased significantly from 1331 ± 52 ms at the baseline to 1298 ± 42 ms 6 months after transplantation (p = 0.001). The patients were split into two groups through a two-step cluster algorithm: In cluster-1 (n = 30) the left ventricular (LV) mass index and the prevalence of diabetes were lower. In cluster-2 (n = 14) the LV mass index and diabetes prevalence were higher. Decrease in native T1 values was significant only in the patients in cluster-1 (p = 0.001).
Conclusions
The native myocardial T1 time decreased significantly 6 months after renal transplant, which may be associated with the regression of the reactive fibrosis. The patients with greater baseline LV mass index and the diabetic group did not reach a significant decrease in T1.



J Cardiovasc Magn Reson: 26 Mar 2019; 21:21
Contti MM, Barbosa MF, Del Carmen Villanueva Mauricio A, Nga HS, ... Bravin AM, de Andrade LGM
J Cardiovasc Magn Reson: 26 Mar 2019; 21:21 | PMID: 30917836
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Measuring inorganic phosphate and intracellular pH in the healthy and hypertrophic cardiomyopathy hearts by in vivo 7T P-cardiovascular magnetic resonance spectroscopy.

Valkovič L, Clarke WT, Schmid AI, Raman B, ... Neubauer S, Rodgers CT
Background
Cardiovascular phosphorus MR spectroscopy (P-CMRS) is a powerful tool for probing energetics in the human heart, through quantification of phosphocreatine (PCr) to adenosine triphosphate (ATP) ratio. In principle, P-CMRS can also measure cardiac intracellular pH (pH) and the free energy of ATP hydrolysis (ΔG). However, these require determination of the inorganic phosphate (Pi) signal frequency and amplitude that are currently not robustly accessible because blood signals often obscure the Pi resonance. Typical cardiac P-CMRS protocols use low (e.g. 30°) flip-angles and short repetition time (TR) to maximise signal-to-noise ratio (SNR) within hardware limits. Unfortunately, this causes saturation of Pi with negligible saturation of the flowing blood pool. We aimed to show that an adiabatic 90° excitation, long-TR, 7T P-CMRS protocol will reverse this balance, allowing robust cardiac pH measurements in healthy subjects and patients with hypertrophic cardiomyopathy (HCM).
Methods
The cardiac Pi T was first measured by the dual TR technique in seven healthy subjects. Next, ten healthy subjects and three HCM patients were scanned with 7T P-MRS using long (6 s) TR protocol and adiabatic excitation. Spectra were fitted for cardiac metabolites including Pi.
Results
The measured Pi T was 5.0 ± 0.3 s in myocardium and 6.4 ± 0.6 s in skeletal muscle. Myocardial pH was 7.12 ± 0.04 and Pi/PCr ratio was 0.11 ± 0.02. The coefficients of repeatability were 0.052 for pH and 0.027 for Pi/PCr quantification. The pH in HCM patients did not differ (p = 0.508) from volunteers. However, Pi/PCr was higher (0.24 ± 0.09 vs. 0.11 ± 0.02; p = 0.001); Pi/ATP was higher (0.44 ± 0.14 vs. 0.24 ± 0.05; p = 0.002); and PCr/ATP was lower (1.78 ± 0.07 vs. 2.10 ± 0.20; p = 0.020), in HCM patients, which is in agreement with previous reports.
Conclusion
A 7T P-CMRS protocol with adiabatic 90° excitation and long (6 s) TR gives sufficient SNR for Pi and low enough blood signal to permit robust quantification of cardiac Pi and hence pH. Pi was detectable in every subject scanned for this study, both in healthy subjects and HCM patients. Cardiac pH was unchanged in HCM patients, but both Pi/PCr and Pi/ATP increased that indicate an energetic impairment in HCM. This work provides a robust technique to quantify cardiac Pi and pH.



J Cardiovasc Magn Reson: 13 Mar 2019; 21:19
Valkovič L, Clarke WT, Schmid AI, Raman B, ... Neubauer S, Rodgers CT
J Cardiovasc Magn Reson: 13 Mar 2019; 21:19 | PMID: 30871562
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

High resolution, 3-dimensional Ferumoxytol-enhanced cardiovascular magnetic resonance venography in central venous occlusion.

Shahrouki P, Moriarty JM, Khan SN, Bista B, ... Nguyen KL, Finn JP
Background
Although cardiovascular magnetic resonance venography (CMRV) is generally regarded as the technique of choice for imaging the central veins, conventional CMRV is not ideal. Gadolinium-based contrast agents (GBCA) are less suited to steady state venous imaging than to first pass arterial imaging and they may be contraindicated in patients with renal impairment where evaluation of venous anatomy is frequently required. We aim to evaluate the diagnostic performance of 3-dimensional (3D) ferumoxytol-enhanced CMRV (FE-CMRV) for suspected central venous occlusion in patients with renal failure and to assess its clinical impact on patient management.
Methods
In this IRB-approved and HIPAA-compliant study, 52 consecutive adult patients (47 years, IQR 32-61; 29 male) with renal impairment and suspected venous occlusion underwent FE-CMRV, following infusion of ferumoxytol. Breath-held, high resolution, 3D steady state FE-CMRV was performed through the chest, abdomen and pelvis. Two blinded reviewers independently scored twenty-one named venous segments for quality and patency. Correlative catheter venography in 14 patients was used as the reference standard for diagnostic accuracy. Retrospective chart review was conducted to determine clinical impact of FE-CMRV. Interobserver agreement was determined using Gwet\'s AC1 statistic.
Results
All patients underwent technically successful FE-CMRV without any adverse events. 99.5% (1033/1038) of venous segments were of diagnostic quality (score ≥ 2/4) with very good interobserver agreement (AC1 = 0.91). Interobserver agreement for venous occlusion was also very good (AC1 = 0.93). The overall accuracy of FE-CMRV compared to catheter venography was perfect (100.0%). No additional imaging was required prior to a clinical management decision in any of the 52 patients. Twenty-four successful and uncomplicated venous interventions were carried out following pre-procedural vascular mapping with FE-CMRV.
Conclusions
3D FE-CMRV is a practical, accurate and robust technique for high-resolution mapping of central thoracic, abdominal and pelvic veins and can be used to inform image-guided therapy. It may play a pivotal role in the care of patients in whom conventional contrast agents may be contraindicated or ineffective.



J Cardiovasc Magn Reson: 10 Mar 2019; 21:17
Shahrouki P, Moriarty JM, Khan SN, Bista B, ... Nguyen KL, Finn JP
J Cardiovasc Magn Reson: 10 Mar 2019; 21:17 | PMID: 30853026
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Microvasculature and intraplaque hemorrhage in atherosclerotic carotid lesions: a cardiovascular magnetic resonance imaging study.

Crombag GAJC, Schreuder FHBM, van Hoof RHM, Truijman MTB, ... van Oostenbrugge RJ, Kooi ME
Background
The presence of intraplaque haemorrhage (IPH) has been related to plaque rupture, is associated with plaque progression, and predicts cerebrovascular events. However, the mechanisms leading to IPH are not fully understood. The dominant view is that IPH is caused by leakage of erythrocytes from immature microvessels. The aim of the present study was to investigate whether there is an association between atherosclerotic plaque microvasculature and presence of IPH in a relatively large prospective cohort study of patients with symptomatic carotid plaque.
Methods
One hundred and thirty-two symptomatic patients with ≥2 mm carotid plaque underwent cardiovascular magnetic resonance (CMR) of the symptomatic carotid plaque for detection of IPH and dynamic contrast-enhanced (DCE)-CMR for assessment of plaque microvasculature. K, an indicator of microvascular flow, density and leakiness, was estimated using pharmacokinetic modelling in the vessel wall and adventitia. Statistical analysis was performed using an independent samples T-test and binary logistic regression, correcting for clinical risk factors.
Results
A decreased vessel wall K was found for IPH positive patients (0.051 ± 0.011 min versus 0.058 ± 0.017 min, p = 0.001). No significant difference in adventitial K was found in patients with and without IPH (0.057 ± 0.012 min and 0.057 ± 0.018 min, respectively). Histological analysis in a subgroup of patients that underwent carotid endarterectomy demonstrated no significant difference in relative microvessel density between plaques without IPH (n = 8) and plaques with IPH (n = 15) (0.000333 ± 0.0000707 vs. and 0.000289 ± 0.0000439, p = 0.585).
Conclusions
A reduced vessel wall K is found in the presence of IPH. Thus, we did not find a positive association between plaque microvasculature and IPH several weeks after a cerebrovascular event. Not only leaky plaque microvessels, but additional factors may contribute to IPH development.
Trial registration
NCT01208025 . Registration date September 23, 2010. Retrospectively registered (first inclusion September 21, 2010). NCT01709045 , date of registration October 17, 2012. Retrospectively registered (first inclusion August 23, 2011).



J Cardiovasc Magn Reson: 03 Mar 2019; 21:15
Crombag GAJC, Schreuder FHBM, van Hoof RHM, Truijman MTB, ... van Oostenbrugge RJ, Kooi ME
J Cardiovasc Magn Reson: 03 Mar 2019; 21:15 | PMID: 30832656
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis.

Gräni C, Eichhorn C, Bière L, Kaneko K, ... Jerosch-Herold M, Kwong RY
Background
Although the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method.
Methods
Six hundred seventy consecutive patients (48 ± 16 years, 59% male) with suspected myocarditis were enrolled between 2002 and 2015. We performed LGE quantitation using seven different signal intensity thresholding methods based either on 2, 3, 4, 5, 6, 7 standard deviations (SD) above remote myocardium or full width at half maximum (FWHM). In addition, a LGE visual presence score (LGE-VPS) (LGE present/absent in each segment) was assessed. For each of these methods, the strength of association of LGE results with major adverse cardiac events (MACE) was determined. Inter-and intra-rater variability using intraclass-correlation coefficient (ICC) was performed for all methods.
Results
Ninety-eight (15%) patients experienced a MACE at a medium follow-up of 4.7 years. LGE quantification by FWHM, 2- and 3-SD demonstrated univariable association with MACE (hazard ratio [HR] 1.05, 95% confidence interval [CI]:1.02-1.08, p = 0.001; HR 1.02, 95%CI:1.00-1.04; p = 0.001; HR 1.02, 95%CI: 1.00-1.05, p = 0.035, respectively), whereas 4-SD through 7-SD methods did not reach significant association. LGE-VPS also demonstrated association with MACE (HR 1.09, 95%CI: 1.04-1.15, p < 0.001). In the multivariable model, FWHM, 2-SD methods, and LGE-VPS each demonstrated significant association with MACE adjusted to age, sex, BMI and LVEF (adjusted HR of 1.04, 1.02, and 1.07; p = 0.009, p = 0.035; and p = 0.005, respectively). In these, FWHM and LGE-VPS had the highest degrees of inter and intra-rater reproducibility based on their high ICC values.
Conclusions
FWHM is the optimal semi-automated quantification method in risk-stratifying patients with suspected myocarditis, demonstrating the strongest association with MACE and the highest technical consistency. Visual LGE scoring is a reliable alternative method and is associated with a comparable association with MACE and reproducibility in these patients.
Trial registration number
NCT03470571 . Registered 13th March 2018. Retrospectively registered.



J Cardiovasc Magn Reson: 27 Feb 2019; 21:14
Gräni C, Eichhorn C, Bière L, Kaneko K, ... Jerosch-Herold M, Kwong RY
J Cardiovasc Magn Reson: 27 Feb 2019; 21:14 | PMID: 30813942
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Genetic variants of HIF1α are associated with right ventricular fibrotic load in repaired tetralogy of Fallot patients: a cardiovascular magnetic resonance study.

Hoang TT, Manso PH, Edman S, Mercer-Rosa L, ... Agopian AJ, Goldmuntz E
Background
Studies suggest that right ventricular (RV) fibrosis is associated with RV remodeling and long-term outcomes in patients with tetralogy of Fallot (TOF). Pre-operative hypoxia may increase expression of hypoxia inducible factor-1-alpha (HIF1α) and promote transforming growth factor β1 (TGFβ1)-mediated fibrosis. We hypothesized that there would be associations between: (1) RV fibrosis and RV function, (2) HIF1α variants and RV fibrosis, and (3) HIF1α variants and RV function among post-surgical TOF cases.
Methods
We retrospectively measured post-surgical fibrotic load (indexed volume and fibrotic score) from 237 TOF cases who had existing cardiovascular magnetic resonance imaging using late gadolinium enhancement (LGE), and indicators of RV remodeling (i.e., ejection fraction [RVEF] and end-diastolic volume indexed [RVEDVI]). Genetic data were available in 125 cases. Analyses were conducted using multivariable linear mixed-effects regression with a random intercept and multivariable generalized Poisson regression with a random intercept.
Results
Indexed fibrotic volume and fibrotic score significantly decreased RVEF by 1.6% (p = 0.04) and 0.9% (p = 0.03), respectively. Indexed fibrotic volume and score were not associated with RVEDVI. After adjusting for multiple comparisons, 6 of the 48 HIF1α polymorphisms (representing two unique signals) were associated with fibrotic score. None of the HIF1α polymorphisms were associated with indexed fibrotic volume, RVEDVI, or RVEF.
Conclusion
The association of some HIF1α polymorphisms and fibrotic score suggests that HIF1α may modulate the fibrotic response in TOF.



J Cardiovasc Magn Reson: 18 Aug 2019; 21:51
Hoang TT, Manso PH, Edman S, Mercer-Rosa L, ... Agopian AJ, Goldmuntz E
J Cardiovasc Magn Reson: 18 Aug 2019; 21:51 | PMID: 31422771
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The amount of late gadolinium enhancement outperforms current guideline-recommended criteria in the identification of patients with hypertrophic cardiomyopathy at risk of sudden cardiac death.

Freitas P, Ferreira AM, Arteaga-Fernández E, de Oliveira Antunes M, ... Mady C, Rochitte CE
Background
Identifying the patients with hypertrophic cardiomyopathy (HCM) in whom the risk of sudden cardiac death (SCD) justifies the implantation of a cardioverter-defibrillator (ICD) in primary prevention remains challenging. Different risk stratification and criteria are used by the European and American guidelines in this setting. We sought to evaluate the role of cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) in improving these risk stratification strategies.
Methods
We conducted a multicentric retrospective analysis of HCM patients who underwent CMR for diagnostic confirmation and/or risk stratification. Eligibility for ICD was assessed according to the HCM Risk-SCD score and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) algorithm. The amount of LGE was quantified (LGE%) and categorized as 0%, 0.1-10%, 10.1-19.9% and ≥ 20%. The primary endpoint was a composite of SCD, aborted SCD, sustained ventricular tachycardia (VT), or appropriate ICD discharge.
Results
A total of 493 patients were available for analysis (58% male, median age 46 years). LGE was present in 79% of patients, with a median LGE% of 2.9% (IQR 0.4-8.4%). The concordance between risk assessment by the HCM Risk-SCD, ACCF/AHA and LGE was relatively weak. During a median follow-up of 3.4 years (IQR 1.5-6.8 years), 23 patients experienced an event (12 SCDs, 6 appropriate ICD discharges and 5 sustained VTs). The amount of LGE was the only independent predictor of outcome (adjusted HR: 1.08; 95% CI: 1.04-1.12; p <  0.001) after adjustment for the HCM Risk-SCD and ACCF/AHA criteria. The amount of LGE showed greater discriminative power (C-statistic 0.84; 95% CI: 0.76-0.91) than the ACCF/AHA (C-statistic 0.61; 95% CI: 0.49-0.72; p for comparison < 0.001) and the HCM Risk-SCD (C-statistic 0.68; 95% CI: 0.59-0.78; p for comparison = 0.006). LGE was able to increase the discriminative power of the ACCF/AHA and HCM Risk-SCD criteria, with net reclassification improvements of 0.36 (p = 0.021) and 0.43 (p = 0.011), respectively.
Conclusions
The amount of LGE seems to outperform the HCM Risk-SCD score and the ACCF/AHA algorithm in the identification of HCM patients at increased risk of SCD and reclassifies a relevant proportion of patients.



J Cardiovasc Magn Reson: 14 Aug 2019; 21:50
Freitas P, Ferreira AM, Arteaga-Fernández E, de Oliveira Antunes M, ... Mady C, Rochitte CE
J Cardiovasc Magn Reson: 14 Aug 2019; 21:50 | PMID: 31412875
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

High-energy external defibrillation and transcutaneous pacing during MRI: feasibility and safety.

Shusterman V, Hodgson-Zingman D, Thedens D, Zhu X, ... Faranesh A, London B
Background
Rapid application of external defibrillation, a crucial first-line therapy for ventricular fibrillation and cardiac arrest, is currently unavailable in the setting of magnetic resonance imaging (MRI), raising concerns about patient safety during MRI tests and MRI-guided procedures, particularly in patients with cardiovascular diseases. The objective of this study was to examine the feasibility and safety of defibrillation/pacing for the entire range of clinically useful shock energies inside the MRI bore and during scans, using defibrillation/pacing outside the magnet as a control.
Methods
Experiments were conducted using a commercial defibrillator (LIFEPAK 20, Physio-Control, Redmond, Washington, USA) with a custom high-voltage, twisted-pair cable with two mounted resonant floating radiofrequency traps to reduce emission from the defibrillator and the MRI scanner. A total of 18 high-energy (200-360 J) defibrillation experiments were conducted in six swine on a 1.5 T MRI scanner outside the magnet bore, inside the bore, and during scanning, using adult and pediatric defibrillation pads. Defibrillation was followed by cardiac pacing (with capture) in a subset of two animals. Monitored signals included: high-fidelity temperature (0.01 °C, 10 samples/sec) under the pads and 12-lead electrocardiogram (ECG) using an MRI-compatible ECG system.
Results
Defibrillation/pacing was successful in all experiments. Temperature was higher during defibrillation inside the bore and during scanning compared with outside the bore, but the differences were small (ΔT: 0.5 and 0.7 °C, p = 0.01 and 0.04, respectively). During scans, temperature after defibrillation tended to be higher for pediatric vs. adult pads (p = 0.08). MR-image quality (signal-to-noise ratio) decreased by ~ 10% when the defibrillator was turned on.
Conclusions
Our study demonstrates the feasibility and safety of in-bore defibrillation for the full range of defibrillation energies used in clinical practice, as well as of transcutaneous cardiac pacing inside the MRI bore. Methods for Improving MR-image quality in the presence of a working defibrillator require further study.



J Cardiovasc Magn Reson: 04 Aug 2019; 21:47
Shusterman V, Hodgson-Zingman D, Thedens D, Zhu X, ... Faranesh A, London B
J Cardiovasc Magn Reson: 04 Aug 2019; 21:47 | PMID: 31378203
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Loss of base-to-apex circumferential strain gradient assessed by cardiovascular magnetic resonance in Fabry disease: relationship to T1 mapping, late gadolinium enhancement and hypertrophy.

Mathur S, Dreisbach JG, Karur GR, Iwanochko RM, ... Wintersperger BJ, Hanneman K
Background
Cardiac involvement is common and is the leading cause of mortality in Fabry disease (FD). We explored the association between cardiovascular magnetic resonance (CMR) myocardial strain, T1 mapping, late gadolinium enhancement (LGE) and left ventricular hypertrophy (LVH) in patients with FD.
Methods
In this prospective study, 38 FD patients (45.0 ± 14.5 years, 37% male) and 8 healthy controls (40.1 ± 13.7 years, 63% male) underwent 3 T CMR including cine balanced steady-state free precession (bSSFP), LGE and modified Look-Locker Inversion recovery (MOLLI) T1 mapping. Global longitudinal (GLS) and circumferential (GCS) strain and base-to-apex longitudinal strain (LS) and circumferential strain (CS) gradients were derived from cine bSSFP images using feature tracking analysis.
Results
Among FD patients, 8 had LVH (FD LVH+, 21%) and 17 had LGE (FD LGE+, 45%). Nineteen FD patients (50%) had neither LVH nor LGE (FD LVH- LGE-). None of the healthy controls had LVH or LGE. FD patients and healthy controls did not differ significantly with respect to GLS (- 15.3 ± 3.5% vs. - 16.3 ± 1.5%, p = 0.45), GCS (- 19.4 ± 3.0% vs. -19.5 ± 2.9%, p = 0.84) or base-to-apex LS gradient (7.5 ± 3.8% vs. 9.3 ± 3.5%, p = 0.24). FD patients had significantly lower base-to-apex CS gradient (2.1 ± 3.7% vs. 6.5 ± 2.2%, p = 0.002) and native T1 (1170.2 ± 37.5 ms vs. 1239.0 ± 18.0 ms, p < 0.001). Base-to-apex CS gradient differentiated FD LVH- LGE- patients from healthy controls (OR 0.42, 95% CI: 0.20 to 0.86, p = 0.019), even after controlling for native T1 (OR 0.24, 95% CI: 0.06 to 0.99, p = 0.049). In a nested logistic regression model with native T1, model fit was significantly improved by the addition of base-to-apex CS gradient (χ(df = 1) = 11.04, p < 0.001). Intra- and inter-observer agreement were moderate to good for myocardial strain parameters: GLS (ICC 0.849 and 0.774, respectively), GCS (ICC 0.831 and 0.833, respectively), and base-to-apex CS gradient (ICC 0.737 and 0.613, respectively).
Conclusions
CMR reproducibly identifies myocardial strain abnormalities in FD. Loss of base-to-apex CS gradient may be an early marker of cardiac involvement in FD, with independent and incremental value beyond native T1.



J Cardiovasc Magn Reson: 31 Jul 2019; 21:45
Mathur S, Dreisbach JG, Karur GR, Iwanochko RM, ... Wintersperger BJ, Hanneman K
J Cardiovasc Magn Reson: 31 Jul 2019; 21:45 | PMID: 31366357
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Stress increases intracardiac 4D flow cardiovascular magnetic resonance -derived energetics and vorticity and relates to VOmax in Fontan patients.

Kamphuis VP, Elbaz MSM, van den Boogaard PJ, Kroft LJM, ... Roest AAW, Westenberg JJM
Background
We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity.
Methods
Ten Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 μg/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_vol, KE EL). The relation to maximum oxygen uptake (VO max) from CPET was tested by Pearson\'s correlation or Spearman\'s rank correlation in case of non-normality of the data.
Results
Dobutamine stress caused a significant 88 ± 52% increase in KE (KE: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (EL: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_vol: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO max (KE: r = - 0.83, P = 0.003; EL: r = - 0.80, P = 0.006; vorticity_vol: r = - 0.64, P = 0.047).
Conclusions
4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO max.



J Cardiovasc Magn Reson: 24 Jul 2019; 21:43
Kamphuis VP, Elbaz MSM, van den Boogaard PJ, Kroft LJM, ... Roest AAW, Westenberg JJM
J Cardiovasc Magn Reson: 24 Jul 2019; 21:43 | PMID: 31340834
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Increased extracellular volume in the liver of pediatric Fontan patients.

de Lange C, Reichert MJE, Pagano JJ, Seed M, ... Lam CZ, Grosse-Wortmann L
Background
Patients with single ventricle physiology are at increased risk for developing liver fibrosis. Its extent and prevalence in children with bidirectional cavopulmonary connection (BCPC) and Fontan circulation are unclear. Extracellular volume fraction (ECV), derived from cardiovascular magnetic resonance (CMR) and T1 relaxometry, reflect fibrotic remodeling and/or congestion in the liver. The aim of this study was to investigate whether pediatric patients with single ventricle physiology experience increased native T1 and ECV as markers of liver fibrosis/congestion.
Methods
Hepatic native T1 times and ECV, using a cardiac short axis modified Look-Locker inversion recovery sequence displaying the liver, were measured retrospectively in children with BCPC- and Fontan circulations and compared to pediatric controls.
Results
Hepatic native T1 time were increased in Fontan patients (n = 62, 11.4 ± 4.4 years, T1 762 ± 64 ms) versus BCPC patients (n = 20, 2.8 ± 0.9 years, T1 645 ± 43 ms, p = 0.04). Both cohorts had higher T1 than controls (n = 44, 13.7 ± 2.9 years, T1 604 ± 54 ms, p < 0.001 for both). ECV was 41.4 ± 4.8% in Fontan and 36.4 ± 4.8% in BCPC patients, respectively (p = 0.02). In Fontan patients, T1 values correlated with exposure to cardiopulmonary bypass time (R = 0.3, p = 0.02), systolic and end diastolic volumes (R = 0.3, p = 0.04 for both) and inversely with oxygen saturations and body surface area (R = -0.3, p = 0.04 for both). There were no demonstrable associations of T1 or ECV with central venous pressure or age after Fontan.
Conclusion
Fontan and BCPC patients have elevated CMR markers suggestive of hepatic fibrosis and/or congestion, even at a young age. The tissue changes do not appear to be related to central venous pressures.
Trial registration
Retrospectively registered data.



J Cardiovasc Magn Reson: 14 Jul 2019; 21:39
de Lange C, Reichert MJE, Pagano JJ, Seed M, ... Lam CZ, Grosse-Wortmann L
J Cardiovasc Magn Reson: 14 Jul 2019; 21:39 | PMID: 31303178
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Impact of caffeine on myocardial perfusion reserve assessed by semiquantitative adenosine stress perfusion cardiovascular magnetic resonance.

Seitz A, Kaesemann P, Chatzitofi M, Löbig S, ... Mahrholdt H, Greulich S
Background
Adenosine is used in stress perfusion cardiac imaging to reveal myocardial ischemia by its vasodilator effects. Caffeine is a competitive antagonist of adenosine. However, previous studies reported inconsistent results about the influence of caffeine on adenosine\'s vasodilator effect. This study assessed the impact of caffeine on the myocardial perfusion reserve index (MPRI) using adenosine stress cardiovascular magnetic resonance imaging (CMR). Moreover, we sought to evaluate if the splenic switch-off sign might be indicative of prior caffeine consumption.
Methods
Semiquantitative perfusion analysis was performed in 25 patients who underwent: 1) caffeine-naïve adenosine stress CMR demonstrating myocardial ischemia and, 2) repeat adenosine stress CMR after intake of caffeine. MPRI (global; remote and ischemic segments), and splenic perfusion ratio (SPR) were assessed and compared between both exams.
Results
Global MPRI after caffeine was lower vs. caffeine-naïve conditions (1.09 ± 0.19 vs. 1.24 ± 0.19; p <  0.01). MPRI in remote myocardium decreased by caffeine (1.24 ± 0.19 vs. 1.49 ± 0.19; p <  0.001) whereas MPRI in ischemic segments (0.89 ± 0.18 vs. 0.95 ± 0.23; p = 0.23) was similar, resulting in a lower MPRI ratio (=remote/ischemic segments) after caffeine consumption vs. caffeine-naïve conditions (1.41 ± 0.19 vs. 1.64 ± 0.35, p = 0.01). The SPR was unaffected by caffeine (SPR 0.38 ± 0.19 vs. 0.38 ± 0.18; p = 0.92).
Conclusion
Caffeine consumption prior to adenosine stress CMR results in a lower global MPRI, which is driven by the decreased MPRI in remote myocardium and underlines the need of abstinence from caffeine. The splenic switch-off sign is not affected by prior caffeine intake.



J Cardiovasc Magn Reson: 23 Jun 2019; 21:33
Seitz A, Kaesemann P, Chatzitofi M, Löbig S, ... Mahrholdt H, Greulich S
J Cardiovasc Magn Reson: 23 Jun 2019; 21:33 | PMID: 31230593
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association of cardiovascular magnetic resonance-derived circumferential strain parameters with the risk of ventricular arrhythmia and all-cause mortality in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator.

Paiman EHM, Androulakis AFA, Shahzad R, Tao Q, ... Lamb HJ, van der Geest RJ
Background
Impaired left ventricular (LV) contraction and relaxation may further promote adverse remodeling and may increase the risk of ventricular arrhythmia (VA) in ischemic cardiomyopathy. We aimed to examine the association of cardiovascular magnetic resonance (CMR)-derived circumferential strain parameters for LV regional systolic function, LV diastolic function and mechanical dispersion with the risk of VA in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator (ICD).
Methods
Patients with an ischemic cardiomyopathy who underwent CMR prior to primary prevention ICD implantation, were retrospectively identified. LV segmental circumferential strain curves were extracted from short-axis cine CMR. For LV regional strain analysis, the extent of moderately and severely impaired strain (percentage of LV segments with strain between - 10% and - 5% and > - 5%, respectively) were calculated. LV diastolic function was quantified by the early and late diastolic strain rate. Mechanical dispersion was defined as the standard deviation in delay time between each strain curve and the patient-specific reference curve. Cox proportional hazard ratios (HR) (95%CI) were calculated to assess the association between LV strain parameters and appropriate ICD therapy.
Results
A total of 121 patients (63 ± 11 years, 84% men, LV ejection fraction (LVEF) 27 ± 9%) were included. During a median (interquartile range) follow-up of 47 (27;69) months, 30 (25%) patients received appropriate ICD therapy. The late diastolic strain rate (HR 1.1 (1.0;1.2) per - 0.25 1/s, P = 0.043) and the extent of moderately impaired strain (HR 1.5 (1.0;2.2) per + 10%, P = 0.048) but not the extent of severely impaired strain (HR 0.9 (0.6;1.4) per + 10%, P = 0.685) were associated with appropriate ICD therapy, independent of LVEF, late gadolinium enhancement (LGE) scar border size and acute revascularization. Mechanical dispersion was not related to appropriate ICD therapy (HR 1.1 (0.8;1.6) per + 25 ms, P = 0.464).
Conclusions
In an ischemic cardiomyopathy population referred for primary prevention ICD implantation, the extent of moderately impaired strain and late diastolic strain rate were associated with the risk of appropriate ICD therapy, independent of LVEF, scar border size and acute revascularization. These findings suggest that disturbed LV contraction and relaxation may contribute to an increased risk of VA after myocardial infarction.



J Cardiovasc Magn Reson: 15 May 2019; 21:28
Paiman EHM, Androulakis AFA, Shahzad R, Tao Q, ... Lamb HJ, van der Geest RJ
J Cardiovasc Magn Reson: 15 May 2019; 21:28 | PMID: 31096987
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Subclinical myocardial injury in patients with Facioscapulohumeral muscular dystrophy 1 and preserved ejection fraction - assessment by cardiovascular magnetic resonance.

Blaszczyk E, Grieben U, von Knobelsdorff-Brenkenhoff F, Kellman P, ... Spuler S, Schulz-Menger J
Background
Facioscapulohumeral muscular dystrophy type 1 (FSHD1) is an autosomal dominant and the third most common inherited muscle disease. Cardiac involvement is currently described in several muscular dystrophies (MD), but there are conflicting reports in FSHD1. Mostly, FSHD1 is recognized as MD with infrequent cardiac involvement, but sudden cardiac deaths are reported in single cases. The aim of this study is to investigate whether subclinical cardiac involvement in FSHD1 patients is detectable in preserved left ventricular systolic function applying cardiovascular magnetic resonance (CMR).
Methods
We prospectively included patients with genetically confirmed FSHD1 (n = 52, 48 ± 15 years) and compared them with 29 healthy age-matched controls using a 1.5 T CMR scanner. Myocardial tissue differentiation was performed qualitatively using focal fibrosis imaging (late gadolinium enhancement (LGE)), fat imaging (multi-echo sequence for fat/water-separation) and parametric T2- and T1-mapping for quantifying inflammation and diffuse fibrosis. Extracellular volume fraction was calculated. A 12-lead electrocardiogram and 24-h Holter were performed for the assessment of MD-specific Groh-criteria and arrhythmia.
Results
Focal fibrosis by LGE was present in 13 patients (25%,10 men), fat infiltration in 7 patients (13%,5 men). T2 values did not differ between FSHD1 and healthy controls. Native T1 mapping revealed significantly higher values in patients (global native myocardial T1 values basal: FSHD1: 1012 ± 26 ms vs. controls: 985 ± 28 ms, p < 0.01, medial FSHD1: 994 ± 37 ms vs. controls: 982 ± 28 ms, p = 0.028). This was also evident in regions adjacent to focal fibrosis, indicating diffuse fibrosis. Groh-criteria were positive in 1 patient. In Holter, arrhythmic events were recorded in 10/43 subjects (23%).
Conclusions
Patients with FSHD1 and preserved left ventricular ejection fraction present focal and diffuse myocardial injury. Longitudinal multi-center trials are needed to define the impact of myocardial changes as well as a relation between myocardial injury and arrhythmias on long-term prognosis and therapeutic decision-making.
Trial registration
ISRCTN registry with study ID ISRCTN13744381 .



J Cardiovasc Magn Reson: 28 Apr 2019; 21:25
Blaszczyk E, Grieben U, von Knobelsdorff-Brenkenhoff F, Kellman P, ... Spuler S, Schulz-Menger J
J Cardiovasc Magn Reson: 28 Apr 2019; 21:25 | PMID: 31030674
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Validation of aortic valve 4D flow analysis and myocardial deformation by cardiovascular magnetic resonance in patients after the arterial switch operation.

van Wijk WHS, Breur JMPJ, Westenberg JJM, Driessen MMP, ... Leiner T, Grotenhuis HB
Background
Aortic regurgitation (AR) and subclinical left ventricular (LV) dysfunction expressed by myocardial deformation imaging are common in patients with transposition of the great arteries after the arterial switch operation (ASO). Echocardiographic evaluation is often hampered by reduced acoustic window settings. Cardiovascular magnetic resonance (CMR) imaging provides a robust alternative as it allows for comprehensive assessment of degree of AR and LV function. The purpose of this study is to validate CMR based 4-dimensional flow quantification (4D flow) for degree of AR and feature tracking strain measurements for LV deformation assessment in ASO patients.
Methods
A total of 81 ASO patients (median 20.6 years, IQR 13.5-28.4) underwent CMR for 4D and 2D flow analysis. CMR global longitudinal strain (GLS) feature tracking was compared to echocardiographic (echo) speckle tracking. Agreements between and within tests were expressed as intra-class correlation coefficients (ICC).
Results
Eleven ASO patients (13.6%) showed AR > 5% by 4D flow, with good correlation to 2D flow assessment (ICC = 0.85). 4D flow stroke volume of the aortic valve demonstrated good agreement to 2D stroke volume over the mitral valve (internal validation, ICC = 0.85) and multi-slice planimetric LV stroke volume (external validation, ICC = 0.95). 2D flow stroke volume showed slightly less, though still good agreement with 4D flow (ICC = 0.78) and planimetric LV stroke volume (ICC = 0.87). GLS by CMR was normal (- 18.8 ± 4.4%) and demonstrated good agreement with GLS and segmental analysis by echocardiographic speckle tracking (GLS = - 17.3 ± 3.1%, ICC of 0.80).
Conclusions
Aortic 4D flow and CMR feature tracking GLS analysis demonstrate good to excellent agreement with 2D flow assessment and echocardiographic speckle tracking, respectively, and can therefore reliably be used for an integrated and comprehensive CMR analysis of aortic valve competence and LV deformation analysis in ASO patients.



J Cardiovasc Magn Reson: 17 Mar 2019; 21:20
van Wijk WHS, Breur JMPJ, Westenberg JJM, Driessen MMP, ... Leiner T, Grotenhuis HB
J Cardiovasc Magn Reson: 17 Mar 2019; 21:20 | PMID: 30879465
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A cardiovascular magnetic resonance (CMR) safe metal braided catheter design for interventional CMR at 1.5 T: freedom from radiofrequency induced heating and preserved mechanical performance.

Yildirim KD, Basar B, Campbell-Washburn AE, Herzka DA, Kocaturk O, Lederman RJ
Background
Catheter designs incorporating metallic braiding have high torque control and kink resistance compared with unbraided alternatives. However, metallic segments longer than a quarter wavelength (~ 12 cm for 1.5 T scanner) are prone to radiofrequency (RF) induced heating during cardiovascular magnetic resonance (CMR) catheterization. We designed a braid-reinforced catheter with interrupted metallic segments to mitigate RF-induced heating yet retain expected mechanical properties for CMR catheterization.
Methods
We constructed metal wire braided 6 Fr catheter shaft subassemblies using electrically insulated stainless-steel wires and off-the-shelf biocompatible polymers. The braiding was segmented, in-situ, using lasers to create non-resonant wire lengths. We compared the heating and mechanical performance of segmented- with un-segmented- metal braided catheter shaft subassemblies.
Results
The braiding segmentation procedure did not significantly alter the structural integrity of catheter subassemblies, torque response, push-ability, or kink resistance compared with non-segmented controls. Segmentation shortened the electrical length of individually insulated metallic braids, and therefore inhibited resonance during CMR RF excitation. RF-induced heating was reduced below 2 °C under expected use conditions in vitro.
Conclusion
We describe a simple modification to the manufacture of metallic braided catheters that will allow CMR catheterization without RF-induced heating under contemporary scanning conditions at 1.5 T. The proposed segmentation pattern largely preserves braid structure and mechanical integrity while interrupting electrical resonance. This inexpensive design may be applicable to both diagnostic and interventional catheters and will help to enable a range of interventional procedures using real time CMR.



J Cardiovasc Magn Reson: 06 Mar 2019; 21:16
Yildirim KD, Basar B, Campbell-Washburn AE, Herzka DA, Kocaturk O, Lederman RJ
J Cardiovasc Magn Reson: 06 Mar 2019; 21:16 | PMID: 30841903
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Visualization of coronary arteries in paediatric patients using whole-heart coronary magnetic resonance angiography: comparison of image-navigation and the standard approach for respiratory motion compensation.

Velasco Forte MN, Valverde I, Prabhu N, Correia T, ... Pushparajah K, Henningsson M
Aims
To investigate the use of respiratory motion compensation using image-based navigation (iNAV) with constant respiratory efficiency using single end-expiratory thresholding (CRUISE) for coronary magnetic resonance angiography (CMRA), and compare it to the conventional diaphragmatic navigator (dNAV) in paediatric patients with congenital or suspected heart disease.
Methods
iNAV allowed direct tracking of the respiratory heart motion and was generated using balanced steady state free precession startup echoes. Respiratory gating was achieved using CRUISE with a fixed 50% efficiency. Whole-heart CMRA was acquired with 1.3 mm isotropic resolution. For comparison, CMRA with identical imaging parameters were acquired using dNAV. Scan time, visualization of coronary artery origins and mid-course, imaging quality and sharpness was compared between the two sequences.
Results
Forty patients (13 females; median weight: 44 kg; median age: 12.6, range: 3 months-17 years) were enrolled. 25 scans were performed in awake patients. A contrast agent was used in 22 patients. The scan time was significantly reduced using iNAV for awake patients (iNAV 7:48 ± 1:26 vs dNAV 9:48 ± 3:11, P = 0.01) but not for patients under general anaesthesia (iNAV = 6:55 ± 1:50 versus dNAV = 6:32 ± 2:16; P = 0.32). In 98% of the cases, iNAV image quality had an equal or higher score than dNAV. The visual score analysis showed a clear difference, favouring iNAV (P = 0.002). The right coronary artery and the left anterior descending vessel sharpness was significantly improved (iNAV: 56.8% ± 10.1% vs dNAV: 53.7% ± 9.9%, P < 0.002 and iNAV: 55.8% ± 8.6% vs dNAV: 53% ± 9.2%, P = 0.001, respectively).
Conclusion
iNAV allows for a higher success-rate and clearer depiction of the mid-course of coronary arteries in paediatric patients. Its acquisition time is shorter in awake patients and image quality score is equal or superior to the conventional method in most cases.



J Cardiovasc Magn Reson: 24 Feb 2019; 21:13
Velasco Forte MN, Valverde I, Prabhu N, Correia T, ... Pushparajah K, Henningsson M
J Cardiovasc Magn Reson: 24 Feb 2019; 21:13 | PMID: 30798789
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Quantification in cardiovascular magnetic resonance: agreement of software from three different vendors on assessment of left ventricular function, 2D flow and parametric mapping.

Zange L, Muehlberg F, Blaszczyk E, Schwenke S, ... Funk S, Schulz-Menger J
Background
Quantitative results of cardiovascular magnetic resonance (CMR) image analysis influence clinical decision making. Image analysis is performed based on dedicated software. The manufacturers provide different analysis tools whose algorithms are often unknown. The aim of this study was to evaluate the impact of software on quantification of left ventricular (LV) assessment, 2D flow measurement and T1- and T2-parametric mapping.
Methods
Thirty-one data sets of patients who underwent a CMR Scan on 1.5 T were analyzed using three different software (Circle CVI: cvi, Siemens Healthineers: Argus, Medis: Qmass/Qflow) by one reader blinded to former results. Cine steady state free precession short axis images were analyzed regarding LV ejection fraction (EF), end-systolic and end-diastolic volume (ESV, EDV) and LV mass. Phase-contrast magnetic resonance images were evaluated for forward stroke volume (SV) and peak velocity (Vmax). Pixel-wise generated native T1- and T2-maps were used to assess T1- and T2-time. Forty-five data sets were evaluated twice (15 per software) for intraobserver analysis. Equivalence was considered if the confidence interval of a paired assessment of two sofware was within a tolerance interval defined by ±1.96 highest standard deviation obtained by intraobserver analysis.
Results
For each parameter, thirty data sets could be analyzed with all three software. All three software (A/B, A/C, B/C) were considered equivalent for LV EF, EDV, ESV, mass, 2D flow SV and T2-time. Differences between software were detected in flow measurement for Vmax and in parametric mapping for T1-time. For Vmax, equivalence was given between software A and C and for T1-time equivalence was given between software B and C.
Conclusion
Software had no impact on quantitative results of LV assessment, T2-time and SV based on 2D flow. In contrast to that, Vmax and T1-time may be influenced by software. CMR reports should contain the name and version of the software applied for image analysis to avoid misinterpretation upon follow-up and research examinations.
Trial registration
ISRCTN12210850 . Registered 14 July 2017, retrospectively registered.



J Cardiovasc Magn Reson: 20 Feb 2019; 21:12
Zange L, Muehlberg F, Blaszczyk E, Schwenke S, ... Funk S, Schulz-Menger J
J Cardiovasc Magn Reson: 20 Feb 2019; 21:12 | PMID: 30786898
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

In vitro optimization and comparison of CT angiography versus radial cardiovascular magnetic resonance for the quantification of cross-sectional areas and coronary endothelial function.

Yerly J, Becce F, van Heeswijk RB, Verdun FR, ... Meuli R, Stuber M
Background
Our objectives were first to determine the optimal coronary computed tomography angiography (CTA) protocol for the quantification and detection of simulated coronary artery cross-sectional area (CSA) differences in vitro, and secondly to quantitatively compare the performance of the optimized CTA protocol with a previously validated radial coronary cardiovascular magnetic resonance (CMR) technique.
Methods
256-multidetector CTA and radial coronary CMR were used to obtain images of a custom in vitro resolution phantom simulating a range of physiological responses of coronary arteries to stress. CSAs were automatically quantified and compared with known nominal values to determine the accuracy, precision, signal-to-noise ratio (SNR), and circularity of CSA measurements, as well as the limit of detection (LOD) of CSA differences. Various iodine concentrations, radiation dose levels, tube potentials, and iterative image reconstruction algorithms (ASiR-V) were investigated to determine the optimal CTA protocol. The performance of the optimized CTA protocol was then compared with a radial coronary CMR method previously developed for endothelial function assessment under both static and moving conditions.
Results
The iodine concentration, dose level, tube potential, and reconstruction algorithm all had significant effects (all p <  0.001) on the accuracy, precision, LOD, SNR, and circularity of CSA measurements with CTA. The best precision, LOD, SNR, and circularity with CTA were achieved with 6% iodine, 20 mGy, 100 kVp, and 90% ASiR-V. Compared with the optimized CTA protocol under static conditions, radial coronary CMR was less accurate (- 0.91 ± 0.13 mm vs. -0.35 ± 0.04 mm, p <  0.001), but more precise (0.08 ± 0.02 mm vs. 0.21 ± 0.02 mm, p <  0.001), and enabled the detection of significantly smaller CSA differences (0.16 ± 0.06 mm vs. 0.52 ± 0.04 mm; p <  0.001; corresponding to CSA percentage differences of 2.3 ± 0.8% vs. 7.4 ± 0.6% for a 3-mm baseline diameter). The same results held true under moving conditions as CSA measurements with CMR were less affected by motion.
Conclusions
Radial coronary CMR was more precise and outperformed CTA for the specific task of detecting small CSA differences in vitro, and was able to reliably identify CSA changes an order of magnitude smaller than those reported for healthy physiological vasomotor responses of proximal coronary arteries. However, CTA yielded more accurate CSA measurements, which may prove useful in other clinical scenarios, such as coronary artery stenosis assessment.



J Cardiovasc Magn Reson: 06 Feb 2019; 21:11
Yerly J, Becce F, van Heeswijk RB, Verdun FR, ... Meuli R, Stuber M
J Cardiovasc Magn Reson: 06 Feb 2019; 21:11 | PMID: 30728035
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Safety and prognostic value of regadenoson stress cardiovascular magnetic resonance imaging in heart transplant recipients.

Kazmirczak F, Nijjar PS, Zhang L, Hughes A, ... Farzaneh-Far A, Shenoy C
Background
There is a critical need for non-invasive methods to detect coronary allograft vasculopathy and to risk stratify heart transplant recipients. Vasodilator stress testing using cardiovascular magnetic resonance imaging (CMR) is a promising technique for this purpose. We aimed to evaluate the safety and the prognostic value of regadenoson stress CMR in heart transplant recipients.
Methods
To evaluate the safety, we assessed adverse effects in a retrospective matched cohort study of consecutive heart transplant recipients who underwent regadenoson stress CMR matched in a 2:1 ratio to age- and gender-matched non-heart transplant patients. To evaluate the prognostic value, we compared the outcomes of patients with abnormal vs. normal regadenoson stress CMRs using a composite endpoint of myocardial infarction, percutaneous intervention, cardiac hospitalization, retransplantation or death.
Results
For the safety analysis, 234 regadenoson stress CMR studies were included - 78 performed in 57 heart transplant recipients and 156 performed in non-heart transplant patients. Those in heart transplant recipients were performed at a median of 2.74 years after transplantation. Thirty-four (44%) CMR studies were performed in the first two years after heart transplantation. There were no differences in the rates of adverse effects between heart transplant recipients and non-heart transplant patients. To study the prognostic value of regadenoson stress CMRs, 20 heart transplant recipients with abnormal regadenoson stress CMRs were compared to 37 with normal regadenoson stress CMRs. An abnormal regadenoson stress CMR was associated with a significantly higher incidence of the composite endpoint compared with a normal regadenoson stress CMR (3-year cumulative incidence estimates of 32.1% vs. 12.7%, p = 0.034).
Conclusions
Regadenoson stress CMR is safe and well tolerated in heart transplant recipients, with no incidence of sinus node dysfunction or high-degree atrioventricular block, including in the first two years after heart transplantation. An abnormal regadenoson stress CMR identifies heart transplant recipients at a higher risk for major adverse cardiovascular events.



J Cardiovasc Magn Reson: 23 Jan 2019; 21:9
Kazmirczak F, Nijjar PS, Zhang L, Hughes A, ... Farzaneh-Far A, Shenoy C
J Cardiovasc Magn Reson: 23 Jan 2019; 21:9 | PMID: 30674318
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Automated analysis of cardiovascular magnetic resonance myocardial native T mapping images using fully convolutional neural networks.

Fahmy AS, El-Rewaidy H, Nezafat M, Nakamori S, Nezafat R
Background
Cardiovascular magnetic resonance (CMR) myocardial native T mapping allows assessment of interstitial diffuse fibrosis. In this technique, the global and regional T are measured manually by drawing region of interest in motion-corrected T maps. The manual analysis contributes to an already lengthy CMR analysis workflow and impacts measurements reproducibility. In this study, we propose an automated method for combined myocardium segmentation, alignment, and T calculation for myocardial T mapping.
Methods
A deep fully convolutional neural network (FCN) was used for myocardium segmentation in T weighted images. The segmented myocardium was then resampled on a polar grid, whose origin is located at the center-of-mass of the segmented myocardium. Myocardium T maps were reconstructed from the resampled T weighted images using curve fitting. The FCN was trained and tested using manually segmented images for 210 patients (5 slices, 11 inversion times per patient). An additional image dataset for 455 patients (5 slices and 11 inversion times per patient), analyzed by an expert reader using a semi-automatic tool, was used to validate the automatically calculated global and regional T values. Bland-Altman analysis, Pearson correlation coefficient, r, and the Dice similarity coefficient (DSC) were used to evaluate the performance of the FCN-based analysis on per-patient and per-slice basis. Inter-observer variability was assessed using intraclass correlation coefficient (ICC) of the T values calculated by the FCN-based automatic method and two readers.
Results
The FCN achieved fast segmentation (< 0.3 s/image) with high DSC (0.85 ± 0.07). The automatically and manually calculated T values (1091 ± 59 ms and 1089 ± 59 ms, respectively) were highly correlated in per-patient (r = 0.82; slope = 1.01; p < 0.0001) and per-slice (r = 0.72; slope = 1.01; p < 0.0001) analyses. Bland-Altman analysis showed good agreement between the automated and manual measurements with 95% of measurements within the limits-of-agreement in both per-patient and per-slice analyses. The intraclass correllation of the T calculations by the automatic method vs reader 1 and reader 2 was respectively 0.86/0.56 and 0.74/0.49 in the per-patient/per-slice analyses, which were comparable to that between two expert readers (=0.72/0.58 in per-patient/per-slice analyses).
Conclusion
The proposed FCN-based image processing platform allows fast and automatic analysis of myocardial native T mapping images mitigating the burden and observer-related variability of manual analysis.



J Cardiovasc Magn Reson: 13 Jan 2019; 21:7
Fahmy AS, El-Rewaidy H, Nezafat M, Nakamori S, Nezafat R
J Cardiovasc Magn Reson: 13 Jan 2019; 21:7 | PMID: 30636630
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Fetal hemodynamics and cardiac streaming assessed by 4D flow cardiovascular magnetic resonance in fetal sheep.

Schrauben EM, Saini BS, Darby JRT, Soo JY, ... Seed M, Macgowan CK
Background
To date it has not been possible to obtain a comprehensive 3D assessment of fetal hemodynamics because of the technical challenges inherent in imaging small cardiac structures, movement of the fetus during data acquisition, and the difficulty of fusing data from multiple cardiac cycles when a cardiac gating signal is absent. Here we propose the combination of volumetric velocity-sensitive cardiovascular magnetic resonance imaging (\"4D flow\" CMR) and a specialized animal preparation (catheters to monitor fetal heart rate, anesthesia to immobilize mother and fetus) to examine fetal sheep cardiac hemodynamics in utero.
Methods
Ten pregnant Merino sheep underwent surgery to implant arterial catheters in the target fetuses. Anesthetized ewes underwent 4D flow CMR with acquisition at 3 T for fetal whole-heart coverage with 1.2-1.5 mm spatial resolution and 45-62 ms temporal resolution. Flow was measured in the heart and major vessels, and particle traces were used to visualize circulatory patterns in fetal cardiovascular shunts. Conservation of mass was used to test internal 4D flow consistency, and comparison to standard 2D phase contrast (PC) CMR was performed for validation.
Results
Streaming of blood from the ductus venosus through the foramen ovale was visualized. Flow waveforms in the major thoracic vessels and shunts displayed normal arterial and venous patterns. Combined ventricular output (CVO) was 546 mL/min per kg, and the distribution of flows (%CVO) were comparable to values obtained using other methods. Internal 4D flow consistency across 23 measurement locations was established with differences of 14.2 ± 12.1%. Compared with 2D PC CMR, 4D flow showed a strong correlation (R = 0.85) but underestimated flow (bias = - 21.88 mL/min per kg, p < 0.05).
Conclusions
The combination of fetal surgical preparation and 4D flow CMR enables characterization and quantification of complex flow patterns in utero. Visualized streaming of blood through normal physiological shunts confirms the complex mechanism of substrate delivery to the fetal heart and brain. Besides offering insight into normal physiology, this technology has the potential to qualitatively characterize complex flow patterns in congenital heart disease phenotypes in a large animal model, which can support the development of new interventions to improve outcomes in this population.



J Cardiovasc Magn Reson: 20 Jan 2019; 21:8
Schrauben EM, Saini BS, Darby JRT, Soo JY, ... Seed M, Macgowan CK
J Cardiovasc Magn Reson: 20 Jan 2019; 21:8 | PMID: 30661506
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Late effects of pediatric hematopoietic stem cell transplantation on left ventricular function, aortic stiffness and myocardial tissue characteristics.

Paiman EHM, Louwerens M, Bresters D, Westenberg JJM, ... Roest AAW, Lamb HJ
Background
Pediatric hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of cardiovascular disease later in life. As HSCT survival has significantly improved, with a growing number of HSCT indications, tailored screening strategies for HSCT-related late effects are warranted. Little is known regarding the value of cardiovascular magnetic resonance (CMR) for early identification of high-risk patients after HSCT, before symptomatic cardiovascular disease manifests. This study aimed to assess CMR-derived left ventricular (LV) systolic and diastolic function, aortic stiffness and myocardial tissue characteristics in young adults who received HSCT during childhood.
Methods
Sixteen patients (22.1 ± 1.5 years) treated with HSCT during childhood and 16 healthy controls (22.1 ± 1.8 years) underwent 3 T CMR. LV systolic and diastolic function were measured as LV ejection fraction (LVEF), the ratio of transmitral early and late peak filling rate (E/A), the estimated LV filling pressure (E/Ea) and global longitudinal and circumferential systolic strain and diastolic strain rates, using balanced steady-state free precession cine CMR and 2D velocity-encoded CMR over the mitral valve. Aortic stiffness, myocardial fibrosis and steatosis were assessed with 2D velocity-encoded CMR, native T1 mapping and proton CMR spectroscopy (H-CMRS), respectively.
Results
In the patient compared to the control group, E/Ea (9.92 ± 3.42 vs. 7.24 ± 2.29, P = 0.004) was higher, LVEF (54 ± 6% vs. 58 ± 5%, P = 0.055) and global longitudinal strain (GLS) ( -20.7 ± 3.5% vs. -22.9 ± 3.0%, P = 0.063) tended to be lower, while aortic pulse wave velocity (4.40 ± 0.26 vs. 4.29 ± 0.29 m/s, P = 0.29), native T1 (1211 ± 36 vs. 1227 ± 28 ms, P = 0.16) and myocardial triglyceride content (0.47 ± 0.18 vs. 0.50 ± 0.13%, P = 0.202) were comparable. There were no differences between patients and controls in E/A (2.76 ± 0.92 vs. 2.97 ± 0.91, P = 0.60) and diastolic strain rates.
Conclusion
In young adults who received HSCT during childhood, LV diastolic function was decreased (higher estimated LV filling pressure) and LV systolic function (LVEF and GLS) tended to be reduced as compared to healthy controls, whereas no concomitant differences were found in aortic stiffness and myocardial tissue characteristics. When using CMR, assessment of LV diastolic function in particular is important for early detection of patients at risk of HSCT-related cardiovascular disease, which may warrant closer surveillance.



J Cardiovasc Magn Reson: 16 Jan 2019; 21:6
Paiman EHM, Louwerens M, Bresters D, Westenberg JJM, ... Roest AAW, Lamb HJ
J Cardiovasc Magn Reson: 16 Jan 2019; 21:6 | PMID: 30651110
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Neural-network classification of cardiac disease from P cardiovascular magnetic resonance spectroscopy measures of creatine kinase energy metabolism.

Solaiyappan M, Weiss RG, Bottomley PA
Background
The heart\'s energy demand per gram of tissue is the body\'s highest and creatine kinase (CK) metabolism, its primary energy reserve, is compromised in common heart diseases. Here, neural-network analysis is used to test whether noninvasive phosphorus (P) cardiovascular magnetic resonance spectroscopy (CMRS) measurements of cardiac adenosine triphosphate (ATP) energy, phosphocreatine (PCr), the first-order CK reaction rate k, and the rate of ATP synthesis through CK (CK flux), can predict specific human heart disease and clinical severity.
Methods
The data comprised the extant 178 complete sets of PCr and ATP concentrations, k, and CK flux data from human CMRS studies performed on clinical 1.5 and 3 Tesla scanners. Healthy subjects and patients with nonischemic cardiomyopathy, dilated (DCM) or hypertrophic disease, New York Heart Association (NYHA) class I-IV heart failure (HF), or with anterior myocardial infarction are included. Three-layer neural-networks were created to classify disease and to differentiate DCM, hypertrophy and clinical NYHA class in HF patients using leave-one-out training. Network performance was assessed using \'confusion matrices\' and \'area-under-the-curve\' (AUC) analyses of \'receiver operating curves\'. Possible methodological bias and network imbalance were tested by segregating 1.5 and 3 Tesla data, and by data augmentation by random interpolation of nearest neighbors, respectively.
Results
The network differentiated healthy, HF and non-HF cardiac disease with an overall accuracy of 84% and AUC > 90% for each category using the four CK metabolic parameters, alone. HF patients with DCM, hypertrophy, and different NYHA severity were differentiated with ~ 80% overall accuracy independent of CMRS methodology.
Conclusions
While sample-size was limited in some sub-classes, a neural network classifier applied to noninvasive cardiac P CMRS data, could serve as a metabolic biomarker for common disease types and HF severity with clinically-relevant accuracy. Moreover, the network\'s ability to individually classify disease and HF severity using CK metabolism alone, implies an intimate relationship between CK metabolism and disease, with subtle underlying phenotypic differences that enable their differentiation.
Trial registration
ClinicalTrials.gov Identifier: NCT00181259.



J Cardiovasc Magn Reson: 11 Aug 2019; 21:49
Solaiyappan M, Weiss RG, Bottomley PA
J Cardiovasc Magn Reson: 11 Aug 2019; 21:49 | PMID: 31401975
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Noncontrast free-breathing respiratory self-navigated coronary artery cardiovascular magnetic resonance angiography at 3 T using lipid insensitive binomial off-resonant excitation (LIBRE).

Bastiaansen JAM, van Heeswijk RB, Stuber M, Piccini D
Background
Robust and homogeneous lipid suppression is mandatory for coronary artery cardiovascular magnetic resonance (CMR) imaging since the coronary arteries are commonly embedded in epicardial fat. However, effective large volume lipid suppression becomes more challenging when performing radial whole-heart coronary artery CMR for respiratory self-navigation and the problem may even be exacerbated at increasing magnetic field strengths. Incomplete fat suppression not only hinders a correct visualization of the coronary vessels and generates image artifacts, but may also affect advanced motion correction methods. The aim of this study was to evaluate a recently reported lipid insensitive CMR method when applied to a noncontrast self-navigated coronary artery CMR acquisitions at 3 T, and to compare it to more conventional fat suppression techniques.
Methods
Lipid insensitive binomial off resonant excitation (LIBRE) radiofrequency excitation pulses were included into a self-navigated 3D radial GRE coronary artery CMR sequence at 3 T. LIBRE was compared against a conventional CHESS fat saturation (FS) and a binomial 1-180°-1 water excitation (WE) pulse. First, fat suppression of all techniques was numerically characterized using Matlab and experimentally validated in phantoms and in legs of human volunteers. Subsequently, free-breathing self-navigated coronary artery CMR was performed using the LIBRE pulse as well as FS and WE in ten healthy subjects. Myocardial, arterial and chest fat signal-to-noise ratios (SNR), as well as coronary vessel conspicuity were quantitatively compared among those scans.
Results
The results obtained in the simulations were confirmed by the experimental validations as LIBRE enabled near complete fat suppression for 3D radial imaging in vitro and in vivo. For self-navigated whole-heart coronary artery CMR at 3 T, fat SNR was significantly attenuated using LIBRE compared with conventional FS. LIBRE increased the right coronary artery (RCA) vessel sharpness significantly (37 ± 9% (LIBRE) vs. 29 ± 8% (FS) and 30 ± 8% (WE), both p < 0.05) and led to a significant increase in the measured RCA vessel length to (83 ± 31 mm (LIBRE) vs. 56 ± 12 mm (FS) and 59 ± 27 (WE) p < 0.05).
Conclusions
Applied to a respiratory self-navigated noncontrast 3D radial whole-heart sequence, LIBRE enables robust large volume fat suppression and significantly improves coronary artery image quality at 3 T compared to the use of conventional FS and WE.



J Cardiovasc Magn Reson: 10 Jul 2019; 21:38
Bastiaansen JAM, van Heeswijk RB, Stuber M, Piccini D
J Cardiovasc Magn Reson: 10 Jul 2019; 21:38 | PMID: 31291957
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinical value of dark-blood late gadolinium enhancement cardiovascular magnetic resonance without additional magnetization preparation.

Holtackers RJ, Van De Heyning CM, Nazir MS, Rashid I, ... Botnar RM, Chiribiri A
Background
For two decades, bright-blood late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been considered the reference standard for the non-invasive assessment of myocardial viability. While bright-blood LGE can clearly distinguish areas of myocardial infarction from viable myocardium, it often suffers from poor scar-to-blood contrast, making subendocardial scar difficult to detect. Recently, we proposed a novel dark-blood LGE approach that increases scar-to-blood contrast and thereby improves subendocardial scar conspicuity. In the present study we sought to assess the clinical value of this novel approach in a large patient cohort with various non-congenital ischemic and non-ischemic cardiomyopathies on both 1.5 T and 3 T CMR scanners of different vendors.
Methods
Three hundred consecutive patients referred for clinical CMR were randomly assigned to a 1.5 T or 3 T scanner. An entire short-axis stack and multiple long-axis views were acquired using conventional phase sensitive inversion recovery (PSIR) LGE with TI set to null myocardium (bright-blood) and proposed PSIR LGE with TI set to null blood (dark-blood), in a randomized order. The bright-blood LGE and dark-blood LGE images were separated, anonymized, and interpreted in a random order at different time points by one of five independent observers. Each case was analyzed for the type of scar, per-segment transmurality, papillary muscle enhancement, overall image quality, observer confidence, and presence of right ventricular scar and intraventricular thrombus.
Results
Dark-blood LGE detected significantly more cases with ischemic scar compared to conventional bright-blood LGE (97 vs 89, p = 0.008), on both 1.5 T and 3 T, and led to a significantly increased total scar burden (3.3 ± 2.4 vs 3.0 ± 2.3 standard AHA segments, p = 0.015). Overall image quality significantly improved using dark-blood LGE compared to bright-blood LGE (81.3% vs 74.0% of all segments were of highest diagnostic quality, p = 0.006). Furthermore, dark-blood LGE led to significantly higher observer confidence (confident in 84.2% vs 78.4%, p = 0.033).
Conclusions
The improved detection of ischemic scar makes the proposed dark-blood LGE method a valuable diagnostic tool in the non-invasive assessment of myocardial scar. The applicability in routine clinical practice is further strengthened, as the present approach, in contrast to other recently proposed dark- and black-blood LGE techniques, is readily available without the need for scanner adjustments, extensive optimizations, or additional training.



J Cardiovasc Magn Reson: 28 Jul 2019; 21:44
Holtackers RJ, Van De Heyning CM, Nazir MS, Rashid I, ... Botnar RM, Chiribiri A
J Cardiovasc Magn Reson: 28 Jul 2019; 21:44 | PMID: 31352900
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Right ventricular shape and function: cardiovascular magnetic resonance reference morphology and biventricular risk factor morphometrics in UK Biobank.

Mauger C, Gilbert K, Lee AM, Sanghvi MM, ... Suinesiaputra A, Young AA
Background
The associations between cardiovascular disease (CVD) risk factors and the biventricular geometry of the right ventricle (RV) and left ventricle (LV) have been difficult to assess, due to subtle and complex shape changes. We sought to quantify reference RV morphology as well as biventricular variations associated with common cardiovascular risk factors.
Methods
A biventricular shape atlas was automatically constructed using contours and landmarks from 4329 UK Biobank cardiovascular magnetic resonance (CMR) studies. A subdivision surface geometric mesh was customized to the contours using a diffeomorphic registration algorithm, with automatic correction of slice shifts due to differences in breath-hold position. A reference sub-cohort was identified consisting of 630 participants with no CVD risk factors. Morphometric scores were computed using linear regression to quantify shape variations associated with four risk factors (high cholesterol, high blood pressure, obesity and smoking) and three disease factors (diabetes, previous myocardial infarction and angina).
Results
The atlas construction led to an accurate representation of 3D shapes at end-diastole and end-systole, with acceptable fitting errors between surfaces and contours (average error less than 1.5 mm). Atlas shape features had stronger associations than traditional mass and volume measures for all factors (p < 0.005 for each). High blood pressure was associated with outward displacement of the LV free walls, but inward displacement of the RV free wall and thickening of the septum. Smoking was associated with a rounder RV with inward displacement of the RV free wall and increased relative wall thickness.
Conclusion
Morphometric relationships between biventricular shape and cardiovascular risk factors in a large cohort show complex interactions between RV and LV morphology. These can be quantified by z-scores, which can be used to study the morphological correlates of disease.



J Cardiovasc Magn Reson: 17 Jul 2019; 21:41
Mauger C, Gilbert K, Lee AM, Sanghvi MM, ... Suinesiaputra A, Young AA
J Cardiovasc Magn Reson: 17 Jul 2019; 21:41 | PMID: 31315625
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Diagnostic performance of cardiovascular magnetic resonance native T1 and T2 mapping in pediatric patients with acute myocarditis.

Cornicelli MD, Rigsby CK, Rychlik K, Pahl E, Robinson JD
Background
Multiple studies in adult patients suggest that tissue mapping performed by cardiovascular magnetic resonance (CMR) has excellent diagnostic accuracy in acute myocarditis, however, these techniques have not been studied in depth in children.
Methods
CMR data on 23 consecutive pediatric patients from 2014 to 2017 with a clinical diagnosis of acute myocarditis were retrospectively analyzed and compared to 39 healthy controls. The CMR protocol included native T1, T2, and extracellular volume fraction (ECV) in addition to standard Lake Louise Criteria (LLC) parameters on a 1.5 T scanner.
Results
Mean global values for novel mapping parameters were significantly elevated in patients with clinically suspected acute myocarditis compared to controls, with native T1 1098 ± 77 vs 990 ± 34 ms, T2 52.8 ± 4.6 ms vs 46.7 ± 2.6 ms, and ECV 29.8 ± 5.1% vs 23.3 ± 2.6% (all p-values < 0.001). Ideal cutoff values were generated using corresponding ROC curves and were for global T1 1015 ms (AUC 0.936, sensitivity 91%, specificity 86%), for global T2 48.5 ms (AUC 0.908, sensitivity 91%, specificity 74%); and for ECV 25.9% (AUC 0.918, sensitivity 86%, specificity 89%). While the diagnostic yield of the LLC was 57% (13/23) in our patient cohort, 70% (7/10) of patients missed by the LLC demonstrated abnormalities across all three global mapping parameters (native T1, T2, and ECV) and another 20% (2/10) of patients demonstrated at least one abnormal mapping value.
Conclusions
Similar to findings in adults, pediatric patients with acute myocarditis demonstrate abnormal CMR tissue mapping values compared to controls. Furthermore, we found CMR parametric mapping techniques measurably increased CMR diagnostic yield when compared with conventional LLC alone, providing additional sensitivity and specificity compared to historical references. Routine integration of these techniques into imaging protocols may aid diagnosis in children.



J Cardiovasc Magn Reson: 14 Jul 2019; 21:40
Cornicelli MD, Rigsby CK, Rychlik K, Pahl E, Robinson JD
J Cardiovasc Magn Reson: 14 Jul 2019; 21:40 | PMID: 31307467
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A simple measure of the extent of Ebstein valve rotation with cardiovascular magnetic resonance gives a practical guide to feasibility of surgical cone reconstruction.

Hughes ML, Bonello B, Choudhary P, Marek J, Tsang V
Background
Once surgical management is indicated, variation of Ebstein valve morphology affects surgical strategy. This study explored practical, easily measureable, cardiovascular magnetic resonance (CMR)-derived attributes that may contribute to the complexity and risk of cone reconstruction.
Methods
A retrospective assessment was performed of Ebstein anomaly patients older than 12 years age, with pre-operative CMR, undergoing cone surgical reconstruction by one surgeon. In addition to clinical data, the CMR-derived Ebstein valve rotation angle (EVRA), area ratios of chamber size, indexed functional RV (RVEDVi) and left ventricular (LV) volumes, tricuspid valve regurgitant fraction (TR%) and other valve attributes were related to early surgical outcome; including death, significant residual TR% or breakdown of repair.
Results
Of 26 operated patients older than 12 years age, since program start, 20 had pre-op CMR and underwent surgery at median (range) age 20 (14-57) years. TR% was improved in all patients. Four of the 20 CMR patients (20%) experienced early surgical dehiscence of the paravalve tissue, with cone-shaped tricuspid valve intact; one of whom died. A larger EVRA correlated with Carpentier category and was significantly related to dehiscence. If EVRA >60, relative risk of dehiscence was 3.2 (CI 1.3-4.9, p = 0.03). Those with dehiscence had thickened, more tethered anterior leaflet edges (RR 17, CI 3-100, p < 0.01), smaller pre-operative functional RVEDVi; (132 vs 177 mL/m2, p = 0.04), and were older (median 38 vs 19 years, p = 0.01). TR %, chamber area ratios and LV parameters were not different.
Conclusions
Comprehensive CMR assessment characterizes patients prior to cone surgical reconstruction of Ebstein anomaly. Pragmatic observation of larger EVRA, smaller RVEDVi and leaflet thickening, suggests risk of repair tension and dehiscence, and may require specific modification of cone surgical technique, such as leaflet augmentation.



J Cardiovasc Magn Reson: 26 Jun 2019; 21:34
Hughes ML, Bonello B, Choudhary P, Marek J, Tsang V
J Cardiovasc Magn Reson: 26 Jun 2019; 21:34 | PMID: 31242903
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

In-vivo validation of interpolation-based phase offset correction in cardiovascular magnetic resonance flow quantification: a multi-vendor, multi-center study.

Hofman MBM, Rodenburg MJA, Markenroth Bloch K, Werner B, ... van Rossum AC, Gatehouse PD
Background
A velocity offset error in phase contrast cardiovascular magnetic resonance (CMR) imaging is a known problem in clinical assessment of flow volumes in vessels around the heart. Earlier studies have shown that this offset error is clinically relevant over different systems, and cannot be removed by protocol optimization. Correction methods using phantom measurements are time consuming, and assume reproducibility of the offsets which is not the case for all systems. An alternative previously published solution is to correct the in-vivo data in post-processing, interpolating the velocity offset from stationary tissue within the field-of-view. This study aims to validate this interpolation-based offset correction in-vivo in a multi-vendor, multi-center setup.
Methods
Data from six 1.5 T CMR systems were evaluated, with two systems from each of the three main vendors. At each system aortic and main pulmonary artery 2D flow studies were acquired during routine clinical or research examinations, with an additional phantom measurement using identical acquisition parameters. To verify the phantom acquisition, a region-of-interest (ROI) at stationary tissue in the thorax wall was placed and compared between in-vivo and phantom measurements. Interpolation-based offset correction was performed on the in-vivo data, after manually excluding regions of spatial wraparound. Correction performance of different spatial orders of interpolation planes was evaluated.
Results
A total of 126 flow measurements in 82 subjects were included. At the thorax wall the agreement between in-vivo and phantom was - 0.2 ± 0.6 cm/s. Twenty-eight studies were excluded because of a difference at the thorax wall exceeding 0.6 cm/s from the phantom scan, leaving 98. Before correction, the offset at the vessel as assessed in the phantom was - 0.4 ± 1.5 cm/s, which resulted in a - 5 ± 16% error in cardiac output. The optimal order of the interpolation correction plane was 1st order, except for one system at which a 2nd order plane was required. Application of the interpolation-based correction revealed a remaining offset velocity of 0.1 ± 0.5 cm/s and 0 ± 5% error in cardiac output.
Conclusions
This study shows that interpolation-based offset correction reduces the offset with comparable efficacy as phantom measurement phase offset correction, without the time penalty imposed by phantom scans.
Trial registration
The study was registered in The Netherlands National Trial Register (NTR) under TC 4865 . Registered 19 September 2014. Retrospectively registered.



J Cardiovasc Magn Reson: 19 May 2019; 21:30
Hofman MBM, Rodenburg MJA, Markenroth Bloch K, Werner B, ... van Rossum AC, Gatehouse PD
J Cardiovasc Magn Reson: 19 May 2019; 21:30 | PMID: 31104632
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Quantification of aortic pulse wave velocity from a population based cohort: a fully automatic method.

Shahzad R, Shankar A, Amier R, Nijveldt R, ... van der Geest RJ,
Background
Aortic pulse wave velocity (PWV) is an indicator of aortic stiffness and is used as a predictor of adverse cardiovascular events. PWV can be non-invasively assessed using magnetic resonance imaging (MRI). PWV computation requires two components, the length of the aortic arch and the time taken for the systolic pressure wave to travel through the aortic arch. The aortic length is calculated using a multi-slice 3D scan and the transit time is computed using a 2D velocity encoded MRI (VE) scan. In this study we present and evaluate an automatic method to quantify the aortic pulse wave velocity using a large population-based cohort.
Methods
For this study 212 subjects were retrospectively selected from a large multi-center heart-brain connection cohort. For each subject a multi-slice 3D scan of the aorta was acquired in an oblique-sagittal plane and a 2D VE scan acquired in a transverse plane cutting through the proximal ascending and descending aorta. PWV was calculated in three stages: (i) a multi-atlas-based segmentation method was developed to segment the aortic arch from the multi-slice 3D scan and subsequently estimate the length of the proximal aorta, (ii) an algorithm that delineates the proximal ascending and descending aorta from the time-resolved 2D VE scan and subsequently obtains the velocity-time flow curves was also developed, and (iii) automatic methods that can compute the transit time from the velocity-time flow curves were implemented and investigated. Finally the PWV was obtained by combining the aortic length and the transit time.
Results
Quantitative evaluation with respect to the length of the aortic arch as well as the computed PWV were performend by comparing the results of the novel automatic method to those obtained manually. The mean absolute difference in aortic length obtained automatically as compared to those obtained manually was 3.3 ± 2.8 mm (p < 0.05), the manual inter-observer variability on a subset of 45 scans was 3.4 ± 3.4 mm (p = 0.49). Bland-Altman analysis between the automataic method and the manual methods showed a bias of 0.0 (-5.0,5.0) m/s for the foot-to-foot approach, -0.1 (-1.2, 1.1) and -0.2 (-2.6, 2.1) m/s for the half-max and the cross-correlation methods, respectively.
Conclusion
We proposed and evaluated a fully automatic method to calculate the PWV on a large set of multi-center MRI scans. It was observed that the overall results obtained had very good agreement with manual analysis. Our proposed automatic method would be very beneficial for large population based studies, where manual analysis requires a lot of manpower.



J Cardiovasc Magn Reson: 12 May 2019; 21:27
Shahzad R, Shankar A, Amier R, Nijveldt R, ... van der Geest RJ,
J Cardiovasc Magn Reson: 12 May 2019; 21:27 | PMID: 31088480
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings.

Backhaus SJ, Staab W, Steinmetz M, Ritter CO, ... Schuster A, Kowallick JT
Background
Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a \"real-world\" clinical setting.
Methods
Three-hundred CMR examinations were randomly selected from the local data base. Fully automated quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and end-systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software (suiteHEART®, Neosoft, Pewaukee, Wisconsin, USA). Parameters were compared to manual assessments (QMass®, Medis Medical Imaging Systems, Leiden, Netherlands). Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF).
Results
Biventricular automated segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias - 2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73-0.91; RV parameters ICC 0.41-0.94) and/or reduced image quality (LV parameters ICC 0.86-0.95; RV parameters ICC 0.56-0.91), which was more common on 3.0 T than on 1.5 T.
Conclusions
Fully automated assessments of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring are still required.



J Cardiovasc Magn Reson: 24 Apr 2019; 21:24
Backhaus SJ, Staab W, Steinmetz M, Ritter CO, ... Schuster A, Kowallick JT
J Cardiovasc Magn Reson: 24 Apr 2019; 21:24 | PMID: 31023305
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Sorted Golden-step phase encoding: an improved Golden-step imaging technique for cardiac and respiratory self-gated cine cardiovascular magnetic resonance imaging.

Guo L, Herzka DA
Background
Numerous self-gated cardiac imaging techniques have been reported in the literature. Most can track either cardiac or respiratory motion, and many incur some overhead to imaging data acquisition. We previously described a Cartesian cine imaging technique, pseudo-projection motion tracking with golden-step phase encoding, capable of tracking both cardiac and respiratory motion at no cost to imaging data acquisition. In this work, we describe improvements to the technique by dramatically reducing its vulnerability to eddy current and flow artifacts and demonstrating its effectiveness in expanded cardiovascular applications.
Methods
As with our previous golden-step technique, the Cartesian phase encodes over time were arranged based on the integer golden step, and readouts near k = 0 (pseudo-projections) were used to derive motion. In this work, however, the readouts were divided into equal and consecutive temporal segments, within which the readouts were sorted according to k. The sorting reduces the phase encode jump between consecutive readouts while maintaining the pseudo-randomness of k to sample both cardiac and respiratory motion without comprising the ability to retrospectively set the temporal resolution of the original technique. On human volunteers, free-breathing, electrocardiographic (ECG)-free cine scans were acquired for all slices of the short axis stack and the 4-chamber view of the long axis. Retrospectively, cardiac motion and respiratory motion were automatically extracted from the pseudo-projections to guide cine reconstruction. The resultant image quality in terms of sharpness and cardiac functional metrics was compared against breath-hold ECG-gated reference cines.
Results
With sorting, motion tracking of both cardiac and respiratory motion was effective for all slices orientations imaged, and artifact occurrence due to eddy current and flow was efficiently eliminated. The image sharpness derived from the self-gated cines was found to be comparable to the reference cines (mean difference less than 0.05 mm for short-axis images and 0.075 mm for long-axis images), and the functional metrics (mean difference < 4 ml) were found not to be statistically different from those from the reference.
Conclusions
This technique dramatically reduced the eddy current and flow artifacts while preserving the ability of cost-free motion tracking and the flexibility of choosing arbitrary navigator zone width, number of cardiac phases, and duration of scanning. With the restriction of the artifacts removed, the Cartesian golden-step cine imaging can now be applied to cardiac imaging slices of more diverse orientation and anatomy at greater reliability.



J Cardiovasc Magn Reson: 17 Apr 2019; 21:23
Guo L, Herzka DA
J Cardiovasc Magn Reson: 17 Apr 2019; 21:23 | PMID: 30999911
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The aorta after coarctation repair - effects of calibre and curvature on arterial haemodynamics.

Quail MA, Segers P, Steeden JA, Muthurangu V
Background
Aortic shape has been proposed as an important determinant of adverse haemodynamics following coarctation repair. However, previous studies have not demonstrated a consistent relationship between shape and vascular load. In this study, 3D aortic shape was evaluated using principal component analysis (PCA), allowing investigation of the relationship between 3D shape and haemodynamics.
Methods
Sixty subjects (38 male, 25.0 ± 7.8 years) with repaired coarctation were recruited. Central aortic haemodynamics including wave intensity analysis were measured noninvasively using a combination of blood pressure and phase contrast cardiovascular magnetic resonance (CMR). 3D curvature and radius data were derived from CMR angiograms. PCA was separately performed on 3D radius and curvature data to assess the role of arch geometry on haemodynamics. Clinical findings were corroborated using 1D vascular models.
Results
There were no independent associations between 3D curvature and any hemodynamic parameters. However, the magnitude of the backwards compression wave was related to the 1st (r = - 0.36, p = 0.005), 3rd (r = 0.27, p = 0.036) and 4th (r = - 0.31, p = 0.017) principle components of radius. The 4th principle componentof radius also correlated with central aortic systolic pressure. These aortas had larger aortic roots, more transverse arch hypoplasia and narrower aortic isthmuses.
Conclusions
There are major modes of variation in 3D aortic shape after coarctation repair witha modest association between variation in aortic radius and pathological wave reflections, but not with 3D curvature. Taken together, these data suggest that shape is not the major determinant of vascular load following coarctation repair, and calibre is more important than curvature.



J Cardiovasc Magn Reson: 10 Apr 2019; 21:22
Quail MA, Segers P, Steeden JA, Muthurangu V
J Cardiovasc Magn Reson: 10 Apr 2019; 21:22 | PMID: 30975162
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Automated quality control in image segmentation: application to the UK Biobank cardiovascular magnetic resonance imaging study.

Robinson R, Valindria VV, Bai W, Oktay O, ... Rueckert D, Glocker B
Background
The trend towards large-scale studies including population imaging poses new challenges in terms of quality control (QC). This is a particular issue when automatic processing tools such as image segmentation methods are employed to derive quantitative measures or biomarkers for further analyses. Manual inspection and visual QC of each segmentation result is not feasible at large scale. However, it is important to be able to automatically detect when a segmentation method fails in order to avoid inclusion of wrong measurements into subsequent analyses which could otherwise lead to incorrect conclusions.
Methods
To overcome this challenge, we explore an approach for predicting segmentation quality based on Reverse Classification Accuracy, which enables us to discriminate between successful and failed segmentations on a per-cases basis. We validate this approach on a new, large-scale manually-annotated set of 4800 cardiovascular magnetic resonance (CMR) scans. We then apply our method to a large cohort of 7250 CMR on which we have performed manual QC.
Results
We report results used for predicting segmentation quality metrics including Dice Similarity Coefficient (DSC) and surface-distance measures. As initial validation, we present data for 400 scans demonstrating 99% accuracy for classifying low and high quality segmentations using the predicted DSC scores. As further validation we show high correlation between real and predicted scores and 95% classification accuracy on 4800 scans for which manual segmentations were available. We mimic real-world application of the method on 7250 CMR where we show good agreement between predicted quality metrics and manual visual QC scores.
Conclusions
We show that Reverse classification accuracy has the potential for accurate and fully automatic segmentation QC on a per-case basis in the context of large-scale population imaging as in the UK Biobank Imaging Study.



J Cardiovasc Magn Reson: 13 Mar 2019; 21:18
Robinson R, Valindria VV, Bai W, Oktay O, ... Rueckert D, Glocker B
J Cardiovasc Magn Reson: 13 Mar 2019; 21:18 | PMID: 30866968
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial triglycerides in cardiac amyloidosis assessed by proton cardiovascular magnetic resonance spectroscopy.

Gastl M, Peereboom SM, Gotschy A, Fuetterer M, ... Manka R, Kozerke S
Background
Cardiac involvement of amyloidosis leads to left-ventricular (LV) wall thickening with progressive heart failure requiring rehospitalization. Cardiovascular magnetic resonance (CMR) is a valuable tool to non-invasively assess myocardial thickening as well as structural changes. Proton CMR spectroscopy (H-CMRS) additionally allows assessing metabolites including triglycerides (TG) and total creatine (CR). However, opposing results exist regarding utilization of these metabolites in LV hypertrophy or thickening. Therefore, the aim of this study was to measure metabolic alterations using H-CMRS in a group of patients with thickened myocardium caused by cardiac amyloidosis.
Methods
H-CMRS was performed on a 1.5 T system (Achieva, Philips Healthcare, Best, The Netherlands) using a 5-channel receive coil in 11 patients with cardiac amyloidosis (60.5 ± 11.4 years, 8 males) and 11 age- and gender-matched controls (63.2 ± 8.9 years, 8 males). After cardiac morphology and function assessment, proton spectra from the interventricular septum (IVS) were acquired using a double-triggered PRESS sequence. Post-processing was performed using a customized reconstruction pipeline based on ReconFrame (GyroTools LLC, Zurich, Switzerland). Spectra were fitted in jMRUI/AMARES and the ratios of triglyceride-to-water (TG/W) and total creatine-to-water (CR/W) were calculated.
Results
Besides an increased LV mass and a thickened IVS concomitant to the disease characteristics, patients with cardiac amyloidosis presented with decreased global longitudinal (GLS) and circumferential (GCS) strain. LV ejection fraction was preserved relative to controls (60.0 ± 13.2 vs. 66.1 ± 4.3%, p = 0.17). Myocardial TG/W ratios were significantly decreased compared to controls (0.53 ± 0.23 vs. 0.80 ± 0.26%, p = 0.015). CR/W ratios did not show a difference between both groups, but a higher standard deviation in patients with cardiac amyloidosis was observed. Pearson correlation revealed a negative association between elevated LV mass and TG/W (R = - 0.59, p = 0.004) as well as GCS (R = - 0.48, p = 0.025).
Conclusions
A decrease in myocardial TG/W can be detected in patients with cardiac amyloidosis alongside impaired cardiac function with an association to the degree of myocardial thickening. Accordingly, H-CMRS may provide an additional diagnostic tool to gauge progression of cardiac amyloidosis along with standard imaging sequences.
Trial registration
EK 2013-0132.



J Cardiovasc Magn Reson: 30 Jan 2019; 21:10
Gastl M, Peereboom SM, Gotschy A, Fuetterer M, ... Manka R, Kozerke S
J Cardiovasc Magn Reson: 30 Jan 2019; 21:10 | PMID: 30700314
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Accelerated free-breathing 3D T1ρ cardiovascular magnetic resonance using multicoil compressed sensing.

Kamesh Iyer S, Moon B, Hwuang E, Han Y, ... Litt H, Witschey WR
Background
Endogenous contrast T1ρ cardiovascular magnetic resonance (CMR) can detect scar or infiltrative fibrosis in patients with ischemic or non-ischemic cardiomyopathy. Existing 2D T1ρ techniques have limited spatial coverage or require multiple breath-holds. The purpose of this project was to develop an accelerated, free-breathing 3D T1ρ mapping sequence with whole left ventricle coverage using a multicoil, compressed sensing (CS) reconstruction technique for rapid reconstruction of undersampled k-space data.
Methods
We developed a cardiac- and respiratory-gated, free-breathing 3D T1ρ sequence and acquired data using a variable-density k-space sampling pattern (A = 3). The effect of the transient magnetization trajectory, incomplete recovery of magnetization between T1ρ-preparations (heart rate dependence), and k-space sampling pattern on T1ρ relaxation time error and edge blurring was analyzed using Bloch simulations for normal and chronically infarcted myocardium. Sequence accuracy and repeatability was evaluated using MnCl phantoms with different T1ρ relaxation times and compared to 2D measurements. We further assessed accuracy and repeatability in healthy subjects and compared these results to 2D breath-held measurements.
Results
The error in T1ρ due to incomplete recovery of magnetization between T1ρ-preparations was T1ρ = 6.1% and T1ρ = 10.8% at 60 bpm and T1ρ = 13.2% and T1ρ = 19.6% at 90 bpm. At a heart rate of 60 bpm, error from the combined effects of readout-dependent magnetization transients, k-space undersampling and reordering was T1ρ = 12.6% and T1ρ = 5.8%. CS reconstructions had improved edge sharpness (blur metric = 0.15) compared to inverse Fourier transform reconstructions (blur metric = 0.48). There was strong agreement between the mean T1ρ estimated from the 2D and accelerated 3D data (R = 0.99; P < 0.05) acquired on the MnCl phantoms. The mean R1ρ estimated from the accelerated 3D sequence was highly correlated with MnCl concentration (R = 0.99; P < 0.05). 3D T1ρ acquisitions were successful in all human subjects. There was no significant bias between undersampled 3D T1ρ and breath-held 2D T1ρ (mean bias = 0.87) and the measurements had good repeatability (COV = 6.4% and COV = 7.1%).
Conclusions
This is the first report of an accelerated, free-breathing 3D T1ρ mapping of the left ventricle. This technique may improve non-contrast myocardial tissue characterization in patients with heart disease in a scan time appropriate for patients.



J Cardiovasc Magn Reson: 09 Jan 2019; 21:5
Kamesh Iyer S, Moon B, Hwuang E, Han Y, ... Litt H, Witschey WR
J Cardiovasc Magn Reson: 09 Jan 2019; 21:5 | PMID: 30626437
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study.

Khan MA, Yang EY, Zhan Y, Judd RM, ... Nagueh SF, Shah DJ
Background
Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan.
Method
We identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21-52 ml/m), Mild (52-62 ml/m), Moderate (63-73 ml/m) and Severe (> 73 ml/m). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality.
Results
The distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1-71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95% Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95% CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95% CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95% CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95% CI 1.29 to 2.08)] remained independent predictors of death.
Conclusion
LAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR.



J Cardiovasc Magn Reson: 06 Jan 2019; 21:4
Khan MA, Yang EY, Zhan Y, Judd RM, ... Nagueh SF, Shah DJ
J Cardiovasc Magn Reson: 06 Jan 2019; 21:4 | PMID: 30612579
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Machine learning derived segmentation of phase velocity encoded cardiovascular magnetic resonance for fully automated aortic flow quantification.

Bratt A, Kim J, Pollie M, Beecy AN, ... Devereux RB, Weinsaft JW
Background
Phase contrast (PC) cardiovascular magnetic resonance (CMR) is widely employed for flow quantification, but analysis typically requires time consuming manual segmentation which can require human correction. Advances in machine learning have markedly improved automated processing, but have yet to be applied to PC-CMR. This study tested a novel machine learning model for fully automated analysis of PC-CMR aortic flow.
Methods
A machine learning model was designed to track aortic valve borders based on neural network approaches. The model was trained in a derivation cohort encompassing 150 patients who underwent clinical PC-CMR then compared to manual and commercially-available automated segmentation in a prospective validation cohort. Further validation testing was performed in an external cohort acquired from a different site/CMR vendor.
Results
Among 190 coronary artery disease patients prospectively undergoing CMR on commercial scanners (84% 1.5T, 16% 3T), machine learning segmentation was uniformly successful, requiring no human intervention: Segmentation time was < 0.01 min/case (1.2 min for entire dataset); manual segmentation required 3.96 ± 0.36 min/case (12.5 h for entire dataset). Correlations between machine learning and manual segmentation-derived flow approached unity (r = 0.99, p < 0.001). Machine learning yielded smaller absolute differences with manual segmentation than did commercial automation (1.85 ± 1.80 vs. 3.33 ± 3.18 mL, p < 0.01): Nearly all (98%) of cases differed by ≤5 mL between machine learning and manual methods. Among patients without advanced mitral regurgitation, machine learning correlated well (r = 0.63, p < 0.001) and yielded small differences with cine-CMR stroke volume (∆ 1.3 ± 17.7 mL, p = 0.36). Among advanced mitral regurgitation patients, machine learning yielded lower stroke volume than did volumetric cine-CMR (∆ 12.6 ± 20.9 mL, p = 0.005), further supporting validity of this method. Among the external validation cohort (n = 80) acquired using a different CMR vendor, the algorithm yielded equivalently small differences (∆ 1.39 ± 1.77 mL, p = 0.4) and high correlations (r = 0.99, p < 0.001) with manual segmentation, including similar results in 20 patients with bicuspid or stenotic aortic valve pathology (∆ 1.71 ± 2.25 mL, p = 0.25).
Conclusion
Fully automated machine learning PC-CMR segmentation performs robustly for aortic flow quantification - yielding rapid segmentation, small differences with manual segmentation, and identification of differential forward/left ventricular volumetric stroke volume in context of concomitant mitral regurgitation. Findings support use of machine learning for analysis of large scale CMR datasets.



J Cardiovasc Magn Reson: 06 Jan 2019; 21:1
Bratt A, Kim J, Pollie M, Beecy AN, ... Devereux RB, Weinsaft JW
J Cardiovasc Magn Reson: 06 Jan 2019; 21:1 | PMID: 30612574
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Pelvic cardiovascular magnetic resonance venography: venous changes with patient position and hydration status.

Behzadi AH, Khilnani NM, Zhang W, Bares AJ, ... Min RJ, Prince MR
Background
To determine the effect of hydration as well as prone versus supine positioning on the pelvic veins during cardiovascular magnetic resonance (CMR) venography.
Methods
Under institutional review board approval, 8 healthy subjects were imaged with balanced steady state free precession, non-contrast CMR venography to measure common and external iliac vein volumes and common femoral vein cross-sectional area in the supine, prone and decubitus positions after dehydration and again following re-hydration. CMR venography from 23 patients imaged both supine and prone were retrospectively reviewed and measurements of common femoral and iliac veins areas were compared using Wilcoxon test.
Results
Common femoral vein area on CMR venography increased with prone positioning (83 ± 35 mm) compared to supine positioning (59 ± 21 mm) (p = 0.02) and further increased with hydration to 123 ± 44 mm (p < 0.01). With right and left side down decubitus positioning, the common femoral vein area on dehydration increased from 29 ± 17 mm in the ante-dependent position to 134 ± 36 mm in the dependent position (p < 0. 001). Similarly, common and external iliac veins increased in volume with prone, 5.4 ± 1.9 cm and 5.8 ± 1.9 cm compared to supine positioning 4.6 ± 1.8 cm and 4.5 ± 1.9 cm (p = 0.01) and further increase with hydration to 6.7 ± 2.1 cm and 6.3 ± 1.9 cm (p = 0.01). CMR venography on patients also demonstrated an increase in mean common femoral vein luminal area from 103 ± 44 mm in supine position to 151 ± 52 mm with prone positioning (p < 0.001) as well as increases in common and external iliac vein volumes from 6.5 ± 2.6 cm and 8.0 ± 3.4 cm in the supine position to 7.5 ± 2.5 cm and 9.3 ± 3.6 cm with prone positioning (p < 0.01).
Conclusions
Common femoral and common/external iliac vein size on CMR venography may be affected by position and hydration status. Routine clinical CMR venography of the pelvis could include prone positioning and avoiding dehydration to maximize pelvic vein distension.



J Cardiovasc Magn Reson: 02 Jan 2019; 21:3
Behzadi AH, Khilnani NM, Zhang W, Bares AJ, ... Min RJ, Prince MR
J Cardiovasc Magn Reson: 02 Jan 2019; 21:3 | PMID: 30602387
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Semi-automatic detection of myocardial trabeculation using cardiovascular magnetic resonance: correlation with histology and reproducibility in a mouse model of non-compaction.

Frandon J, Bricq S, Bentatou Z, Marcadet L, ... Miquerol L, Jacquier A
Background
The definition of left ventricular (LV) non-compaction is controversial, and discriminating between normal and excessive LV trabeculation remains challenging. Our goal was to quantify LV trabeculation on cardiovascular magnetic resonance (CMR) images in a genetic mouse model of non-compaction using a dedicated semi-automatic software package and to compare our results to the histology used as a gold standard.
Methods
Adult mice with ventricular non-compaction were generated by conditional trabecular deletion of Nkx2-5. Thirteen mice (5 controls, 8 Nkx2-5 mutants) were included in the study. Cine CMR series were acquired in the mid LV short axis plane (resolution 0.086 × 0.086x1mm) (11.75 T). In a sub set of 6 mice, 5 to 7 cine CMR were acquired in LV short axis to cover the whole LV with a lower resolution (0.172 × 0.172x1mm3). We used semi-automatic software to quantify the compacted mass (M), the trabeculated mass (M) and the percentage of trabeculation (M/M) on all cine acquisitions After CMR all hearts were sliced along the short axis and stained with eosin, and histological LV contouring was performed manually, blinded from the CMR results, and M, M and M/M were quantified. Intra and interobserver reproducibility was evaluated by computing the intra class correlation coefficient (ICC).
Results
Whole heart acquisition showed no statistical significant difference between trabeculation measured at the basal, midventricular and apical parts of the LV. On the mid-LV cine CMR slice, the median M was 0.92 mg (range 0.07-2.56 mg), M was 12.24 mg (9.58-17.51 mg), M/M was 6.74% (0.66-17.33%). There was a strong correlation between CMR and the histology for M, M and M/ M with respectively: r = 0.94 (p < 0.001), r = 0.91 (p < 0.001), r = 0.83 (p < 0.001). Intra- and interobserver reproducibility was 0.97 and 0.8 for M; 0.98 and 0.97 for M; 0.96 and 0.72 for M/M, respectively and significantly more trabeculation was observed in the M Mutant mice than the controls.
Conclusion
The proposed semi-automatic quantification software is accurate in comparison to the histology and reproducible in evaluating M, M and M/ M on cine CMR.



J Cardiovasc Magn Reson: 24 Jan 2018; 20:70
Frandon J, Bricq S, Bentatou Z, Marcadet L, ... Miquerol L, Jacquier A
J Cardiovasc Magn Reson: 24 Jan 2018; 20:70 | PMID: 30355287
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Multipoint 5D flow cardiovascular magnetic resonance - accelerated cardiac- and respiratory-motion resolved mapping of mean and turbulent velocities.

Walheim J, Dillinger H, Kozerke S
Background
Volumetric quantification of mean and fluctuating velocity components of transient and turbulent flows promises a comprehensive characterization of valvular and aortic flow characteristics. Data acquisition using standard navigator-gated 4D Flow cardiovascular magnetic resonance (CMR) is time-consuming and actual scan times depend on the breathing pattern of the subject, limiting the applicability of the method in a clinical setting. We sought to develop a 5D Flow CMR framework which combines undersampled data acquisition including multipoint velocity encoding with low-rank image reconstruction to provide cardiac- and respiratory-motion resolved assessment of velocity maps and turbulent kinetic energy in fixed scan times.
Methods
Data acquisition and data-driven motion state detection was performed using an undersampled Cartesian tiny Golden angle approach. Locally low-rank (LLR) reconstruction was implemented to exploit correlations among heart phases and respiratory motion states. To ensure accurate quantification of mean and turbulent velocities, a multipoint encoding scheme with two velocity encodings per direction was incorporated. Velocity-vector fields and turbulent kinetic energy (TKE) were obtained using a Bayesian approach maximizing the posterior probability given the measured data. The scan time of 5D Flow CMR was set to 4 min. 5D Flow CMR with acceleration factors of 19 .0 ± 0.21 (mean ± std) and velocity encodings (VENC) of 0.5 m/s and 1.5 m/s per axis was compared to navigator-gated 2x SENSE accelerated 4D Flow CMR with VENC = 1.5 m/s in 9 subjects. Peak velocities and peak flow were compared and magnitude images, velocity and TKE maps were assessed.
Results
While net scan time of 5D Flow CMR was 4 min independent of individual breathing patterns, the scan times of the standard 4D Flow CMR protocol varied depending on the actual navigator gating efficiency and were 17.8 ± 3.9 min on average. Velocity vector fields derived from 5D Flow CMR in the end-expiratory state agreed well with data obtained from the navigated 4D protocol (normalized root-mean-square error 8.9 ± 2.1%). On average, peak velocities assessed with 5D Flow CMR were higher than for the 4D protocol (3.1 ± 4.4%).
Conclusions
Respiratory-motion resolved multipoint 5D Flow CMR allows mapping of mean and turbulent velocities in the aorta in 4 min.



J Cardiovasc Magn Reson: 21 Jul 2019; 21:42
Walheim J, Dillinger H, Kozerke S
J Cardiovasc Magn Reson: 21 Jul 2019; 21:42 | PMID: 31331353
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic and functional implications of left atrial late gadolinium enhancement cardiovascular magnetic resonance.

Quail M, Grunseich K, Baldassarre LA, Mojibian H, ... Sinusas AJ, Peters DC
Background
Left atrial (LA) late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is indicative of fibrosis, and has been correlated with reduced LA function, increased LA volume, and poor procedural outcomes in cohorts with atrial fibrillation (AF). However, the role of LGE as a prognostic biomarker for arrhythmia in cardiac disease has not been examined.
Methods
In this study, we assessed LA LGE using a 3D LGE CMR sequence to examine its relationships with new onset atrial arrhythmia, and LA and left ventricular (LV) mechanical function.
Results
LA LGE images were acquired in 111 patients undergoing CMR imaging, including 66 patients with no prior history of an atrial arrhythmia. During the median follow-up of 2.7 years (interquartile range (IQR) 1.8-3.7 years), 15/66 (23%) of patients developed a new atrial arrhythmia. LA LGE ≥10% of LA myocardial volume was significantly associated with an increased rate of new-onset atrial arrhythmia, with a hazard ratio of 3.16 (95% CI 1.14-8.72), p = 0.026. There were significant relationships between LA LGE and both LA ejection fraction (r = - 0.39, p < 0.0005) and echocardiographic LV septal e\' (r = - 0.24, p = 0.04) and septal E/e\' (r = 0.31, p = 0.007).
Conclusions
Elevated LA LGE is associated with reduced LA function and reduced LV diastolic function. LA LGE is associated with new onset atrial arrhythmia during follow-up.



J Cardiovasc Magn Reson: 02 Jan 2019; 21:2
Quail M, Grunseich K, Baldassarre LA, Mojibian H, ... Sinusas AJ, Peters DC
J Cardiovasc Magn Reson: 02 Jan 2019; 21:2 | PMID: 30602395
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The dynamics of extracellular gadolinium-based contrast agent excretion into pleural and pericardial effusions quantified by T1 mapping cardiovascular magnetic resonance.

Thalén S, Maanja M, Sigfridsson A, Maret E, Sörensson P, Ugander M
Introduction
Excretion of cardiovascular magnetic resonance (CMR) extracellular gadolinium-based contrast agents (GBCA) into pleural and pericardial effusions, sometimes referred to as vicarious excretion, has been described as a rare occurrence using T1-weighted imaging. However, the T1 mapping characteristics as well as presence, magnitude and dynamics of contrast excretion into these effusions is not known.
Aims
To investigate and compare the differences in T1 mapping characteristics and extracellular GBCA excretion dynamics in pleural and pericardial effusions.
Methods
Clinically referred patients with a pericardial and/or pleural effusion underwent CMR T1 mapping at 1.5 T before, and at 3 (early) and at 27 (late) minutes after administration of an extracellular GBCA (0.2 mmol/kg, gadoteric acid). Analyzed effusion characteristics were native T1, ΔR1 early and late after contrast injection, and the effusion-volume-independent early-to-late contrast concentration ratio ΔR1early/ΔR1late, where ΔR1 = 1/T1post-contrast - 1/T1native.
Results
Native T1 was lower in pericardial effusions (n = 69) than in pleural effusions (n = 54) (median [interquartile range], 2912 [2567-3152] vs 3148 [2692-3494] ms, p = 0.005). Pericardial and pleural effusions did not differ with regards to ΔR1early (0.05 [0.03-0.10] vs 0.07 [0.03-0.12] s, p = 0.38). Compared to pleural effusions, pericardial effusions had a higher ΔR1late (0.8 [0.6-1.2] vs 0.4 [0.2-0.6] s, p < 0.001) and ΔR1early/ΔR1late (0.19 [0.08-0.30] vs 0.12 [0.04-0.19], p < 0.001).
Conclusions
T1 mapping shows that extracellular GBCA is excreted into pericardial and pleural effusions. Consequently, the previously used term vicarious excretion is misleading. Compared to pleural effusions, pericardial effusions had both a lower native T1, consistent with lesser relative fluid content in relation to other components such as proteins, and more prominent early excretion dynamics, which could be related to inflammation. The clinical diagnostic utility of T1 mapping to determine quantitative contrast dynamics in pericardial and pleural effusions merits further investigation.



J Cardiovasc Magn Reson: 13 Nov 2019; 21:71
Thalén S, Maanja M, Sigfridsson A, Maret E, Sörensson P, Ugander M
J Cardiovasc Magn Reson: 13 Nov 2019; 21:71 | PMID: 31730498
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The growth and evolution of cardiovascular magnetic resonance: a 20-year history of the Society for Cardiovascular Magnetic Resonance (SCMR) annual scientific sessions.

Lee DC, Markl M, Dall\'Armellina E, Han Y, ... Zimmerman S, Schulz-Menger J
Background and purpose
The purpose of this work is to summarize cardiovascular magnetic resonance (CMR) research trends and highlights presented at the annual Society for Cardiovascular Magnetic Resonance (SCMR) scientific sessions over the past 20 years.
Methods
Scientific programs from all SCMR Annual Scientific Sessions from 1998 to 2017 were obtained. SCMR Headquarters also provided data for the number and the country of origin of attendees and the number of accepted abstracts according to type. Data analysis included text analysis (key word extraction) and visualization by \'word clouds\' representing the most frequently used words in session titles for 5-year intervals. In addition, session titles were sorted into 17 major subject categories to further evaluate research and clinical CMR trends over time.
Results
Analysis of SCMR annual scientific sessions locations, attendance, and number of accepted abstracts demonstrated substantial growth of CMR research and clinical applications. As an international field of study, significant growth of CMR was documented by a strong increase in SCMR scientific session attendance (> 500%, 270 to 1406 from 1998 to 2017, number of accepted abstracts (> 700%, 98 to 701 from 1998 to 2018) and number of international participants (42-415% increase for participants from Asia, Central and South America, Middle East and Africa in 2004-2017). \'Word clouds\' based evaluation of research trends illustrated a shift from early focus on \'MRI technique feasibility\' to new established techniques (e.g. late gadolinium enhancement) and their clinical applications and translation (key words \'patient\', \'disease\') and more recently novel techniques and quantitative CMR imaging (key words \'mapping\', \'T1\', \'flow\', \'function\'). Nearly every topic category demonstrated an increase in the number of sessions over the 20-year period with \'Clinical Practice\' leading all categories. Our analysis identified three growth areas \'Congenital\', \'Clinical Practice\', and \'Structure/function/flow\'.
Conclusion
The analysis of the SCMR historical archives demonstrates a healthy and internationally active field of study which continues to undergo substantial growth and expansion into new and emerging CMR topics and clinical application areas.



J Cardiovasc Magn Reson: 30 Jan 2018; 20:8
Lee DC, Markl M, Dall'Armellina E, Han Y, ... Zimmerman S, Schulz-Menger J
J Cardiovasc Magn Reson: 30 Jan 2018; 20:8 | PMID: 29386064
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Additive value of 3T cardiovascular magnetic resonance coronary angiography for detecting coronary artery disease.

Zhang L, Song X, Dong L, Li J, ... An J, Li D
Background
The purpose of the work was to evaluate the incremental diagnostic value of free-breathing, contrast-enhanced, whole-heart, 3 T cardiovascular magnetic resonance coronary angiography (CE-MRCA) to stress/rest myocardial perfusion imaging (MPI) and late gadolinium enhancement (LGE) imaging for detecting coronary artery disease (CAD).
Methods
Fifty-one patients with suspected CAD underwent a comprehensive cardiovascular magnetic resonance (CMR) examination (CE-MRCA, MPI, and LGE). The additive diagnostic value of MRCA to MPI and LGE was evaluated using invasive x-ray coronary angiography (XA) as the standard for defining functionally significant CAD (≥ 50% stenosis in vessels > 2 mm in diameter).
Results
90.2% (46/51) patients (54.0 ± 11.5 years; 71.7% men) completed CE-MRCA successfully. On per-patient basis, compared to MPI/LGE alone or MPI alone, the addition of MRCA resulted in higher sensitivity (100% vs. 76.5%, p < 0.01), no change in specificity (58.3% vs. 66.7%, p = 0.6), and higher accuracy (89.1% vs 73.9%, p < 0.01) for CAD detection (prevalence = 73.9%). Compared to LGE alone, the addition of CE-MRCA resulted in higher sensitivity (97.1% vs. 41.2%, p < 0.01), inferior specificity (83.3% vs. 91.7%, p = 0.02), and higher diagnostic accuracy (93.5% vs. 54.3%, p < 0.01).
Conclusion
The inclusion of successful free-breathing, whole-heart, 3 T CE-MRCA significantly improved the sensitivity and diagnostic accuracy as compared to MPI and LGE alone for CAD detection.



J Cardiovasc Magn Reson: 29 Jan 2018; 20:29
Zhang L, Song X, Dong L, Li J, ... An J, Li D
J Cardiovasc Magn Reson: 29 Jan 2018; 20:29 | PMID: 29706134
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study.

Mahmod M, Pal N, Rayner J, Holloway C, ... Neubauer S, Rider O
Background
Heart failure (HF) is characterized by altered myocardial substrate metabolism which can lead to myocardial triglyceride accumulation (steatosis) and lipotoxicity. However its role in mild HF with preserved ejection fraction (HFpEF) is uncertain. We measured myocardial triglyceride content (MTG) in HFpEF and assessed its relationships with diastolic function and exercise capacity.
Methods
Twenty seven HFpEF (clinical features of HF, left ventricular EF >50%, evidence of mild diastolic dysfunction and evidence of exercise limitation as assessed by cardiopulmonary exercise test) and 14 controls underwent H-cardiovascular magnetic resonance spectroscopy (H-CMRS) to measure MTG (lipid/water, %), P-CMRS to measure myocardial energetics (phosphocreatine-to-adenosine triphosphate - PCr/ATP) and feature-tracking cardiovascular magnetic resonance (CMR) imaging for diastolic strain rate.
Results
When compared to controls, HFpEF had 2.3 fold higher in MTG (1.45 ± 0.25% vs. 0.64 ± 0.16%, p = 0.009) and reduced PCr/ATP (1.60 ± 0.09 vs. 2.00 ± 0.10, p = 0.005). HFpEF had significantly reduced diastolic strain rate and maximal oxygen consumption (VO max), which both correlated significantly with elevated MTG and reduced PCr/ATP. On multivariate analyses, MTG was independently associated with diastolic strain rate while diastolic strain rate was independently associated with VO max.
Conclusions
Myocardial steatosis is pronounced in mild HFpEF, and is independently associated with impaired diastolic strain rate which is itself related to exercise capacity. Steatosis may adversely affect exercise capacity by indirect effect occurring via impairment in diastolic function. As such, myocardial triglyceride may become a potential therapeutic target to treat the increasing number of patients with HFpEF.



J Cardiovasc Magn Reson: 23 Jan 2018; 20:88
Mahmod M, Pal N, Rayner J, Holloway C, ... Neubauer S, Rider O
J Cardiovasc Magn Reson: 23 Jan 2018; 20:88 | PMID: 30580760
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla.

Chen H, He X, Xie G, Liang J, ... Liu X, Fan Z
Background
The aim was to investigate the feasibility of a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BBTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and a variable flip angle turbo-spin-echo readout, for the diagnosis of acute deep vein thrombosis (DVT) at 1.5 T.
Methods
BBTI was conducted in 15 healthy subjects and 30 acute DVT patients. Contrast-enhanced CMR venography (CE-CMRV) was conducted for comparison and only performed in the patients. Apparent contrast-to-noise ratios between the thrombus and the muscle/lumen were calculated to determine whether BBTI could provide an adequate thrombus signal for diagnosis. Two blinded readers assessed the randomized BBTI images from all participants and made independent decisions on the presence or absence of thrombus at the segment level. Images obtained by CE-CMRV were also randomized and assessed by the two readers. Using the consensus CE-CMRV as a reference, the sensitivity, specificity, positive and negative predictive values, and accuracy of BBTI, as well as its diagnostic agreement with CE-CMRV, were calculated. Additionally, diagnostic confidence and interobserver diagnostic agreement were evaluated.
Results
The thrombi in the acute phase exhibited iso- or hyperintense signals on the BBTI images. All the healthy subjects were correctly identified from the participants based on the segment level. The diagnostic confidence of BBTI was comparable to that of CE-CMRV (3.69 ± 0.52 vs. 3.70 ± 0.47). High overall sensitivity (95.2%), SP (98.6%), positive predictive value (96.0%), negative predictive value (98.3%), and accuracy (97.7%), as well as excellent diagnostic and interobserver agreements, were achieved using BBTI.
Conclusion
BBTI is a reliable, contrast-free technique for the diagnosis of acute DVT at 1.5 T.



J Cardiovasc Magn Reson: 24 Jan 2018; 20:42
Chen H, He X, Xie G, Liang J, ... Liu X, Fan Z
J Cardiovasc Magn Reson: 24 Jan 2018; 20:42 | PMID: 29936910
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Atherosclerosis T1-weighted characterization (CATCH): evaluation of the accuracy for identifying intraplaque hemorrhage with histological validation in carotid and coronary artery specimens.

Liu W, Xie Y, Wang C, Du Y, ... Yu W, Li D
Background
Coronary high intensity plaques (CHIPs) detected using cardiovascular magnetic resonance (CMR) coronary atherosclerosis T1-weighted characterization with integrated anatomical reference (CATCH) have been shown to be positively associated with high-risk morphology observed on intracoronary optical coherence tomography (OCT). This study sought to validate whether CHIPs detected on CATCH indicate the presence of intraplaque hemorrhage (IPH) through ex vivo imaging of carotid and coronary plaque specimens, with histopathology as the standard reference.
Methods
Ten patients scheduled to undergo carotid endarterectomy underwent CMR with the conventional T1-weighted (T1w) sequence. Eleven carotid atherosclerotic plaques removed at carotid endarterectomy and six coronary artery endarterectomy specimens removed from patients undergoing coronary artery bypass grafting (CABG) were scanned ex vivo using both the conventional T1w sequence and CATCH. Both in vivo and ex vivo images were examined for the presence of IPH. The sensitivity, specificity, and Cohen Kappa (k) value of each scan were calculated using matched histological sections as the reference. k value between each scan in the discrimination of IPH was also computed.
Results
A total of 236 in vivo locations, 328 ex vivo and matching histology locations were included for the analysis. Sensitivity, specificity, and k value were 76.7%, 95.3%, and 0.75 for in vivo T1w imaging, 77.2%, 97.4%, and 0.78 for ex vivo T1w imaging, and 95.0%, 92.1%, and 0.84 for ex vivo CATCH, respectively. Moderate agreement was reached between in vivo T1w imaging, ex vivo T1w imaging, and ex vivo CATCH for the detection of IPH: between in vivo T1w imaging and ex vivo CATCH (k = 0.68), between ex vivo T1w imaging and ex vivo CATCH (k = 0.74), between in vivo T1w imaging and ex vivo T1w imaging (k = 0.83). None of the coronary artery plaque locations showed IPH.
Conclusion
This study demonstrated that carotid CHIPs detected by CATCH can be used to assess for IPH, a high-risk plaque feature.



J Cardiovasc Magn Reson: 25 Jan 2018; 20:27
Liu W, Xie Y, Wang C, Du Y, ... Yu W, Li D
J Cardiovasc Magn Reson: 25 Jan 2018; 20:27 | PMID: 29695254
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Two-center clinical validation and quantitative assessment of respiratory triggered retrospectively cardiac gated balanced-SSFP cine cardiovascular magnetic resonance imaging in adults.

Pednekar AS, Wang H, Flamm S, Cheong BY, Muthupillai R
Background
Breath-hold (BH) requirement remains the limiting factor on the spatio-temporal resolution and coverage of the cine balanced steady-state free precession (bSSFP) cardiovascular magnetic resonance (CMR) imaging. In this prospective two-center clinical trial, we validated the performance of a respiratory triggered (RT) bSSFP cine sequence for evaluation of biventricular function.
Methods
Our study included 23 asymptomatic healthy subjects and 60 consecutive patients from Institute A (n = 39) and Institute B (n = 21) referred for a clinically indicated CMR study. We implemented a RT sequence with a respiratory synchronized drive to steady state (SS) of bSSFP signal, before the commencement of image data acquisition with prospective cardiac arrhythmia rejection and retrospectively cardiac gated reconstruction in real-time. Left (LV) and right (RV) ventricular function and LV mass were evaluated by using RT-bSSFP and conventional BH-bSSFP sequences with one cardiac cycle for SS preparation keeping all the imaging parameters identical. The performance of the sequences was evaluated by using quantitative and semi-quantitative metrics.
Results
Global LV and RV functional parameters and LV mass obtained from the RT-bSSFP and BH-bSSFP sequences were in good agreement. Quantitative metrics designed to capture fluctuation in SS signal intensity showed no significant difference between sequences. In addition, blood-to-myocardial contrast was nearly identical between sequences. The combined clinical score for image quality was excellent or good for 100% of cases with the BH-bSSFP and 83% of cases with the RT-bSSFP sequence. The de facto image acquisition time for RT-bSSFP was statistically significantly longer than that for conventional BH-bSSFP (7.9 ± 3.4 min vs. 5.1 ± 2.6 min).
Conclusions
Cine RT-bSSFP is an alternative for evaluating global biventricular function with contrast and spatio-temporal resolutions that are similar to those attained by using the BH-bSSFP sequence, albeit with a modest time penalty and a small reduction in image quality.



J Cardiovasc Magn Reson: 27 Jan 2018; 20:44
Pednekar AS, Wang H, Flamm S, Cheong BY, Muthupillai R
J Cardiovasc Magn Reson: 27 Jan 2018; 20:44 | PMID: 29950177
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Systemic arteriosclerosis is associated with left ventricular remodeling but not atherosclerosis: a TASCFORCE study.

Weir-McCall JR, Lambert M, Gandy SJ, Belch JJF, ... White RD, Graeme Houston J
Background
Arteriosclerosis (arterial stiffening) is associated with future cardiovascular events, with this effect postulated to be due to its effect on cardiac afterload, atherosclerosis (plaque formation) progression or both, but with limited evidence examining these early in disease formation. The aim of the current study is to examine the association between arteriosclerosis, atherosclerosis and ventricular remodelling in a population at low-intermediate cardiovascular risk.
Methods
One thousand six hundred fifty-one subjects free of clinical cardiovascular disease and with a < 20% 10 year cardiovascular risk score underwent a cardiovascular magnetic resonance (CMR) study and whole body CMR angiogram. Arteriosclerosis was measured using total arterial compliance (TAC) - calculated as the indexed stroke volume divided by the pulse pressure. Atherosclerosis was quantified using a standardised atheroma score (SAS) which was calculated by scoring 30 arterial segments within the body based on the degree of stenosis, summating these scores and normalising it to the number of assessable segments. Left ventricular remodelling was measured using left ventricular mass to volume ratio (LVMVR).
Results
One thousand five hundred fifteen (38% male, 53.8 ± 8.2 years old) completed the study. On univariate analysis TAC was associated with SAS but this was lost after accounting for cardiovascular risk factors in both males (B = - 0.001 (- 0.004-0.002),p = 0.62) and females (B = 0.000(95%CI -0.002--0.002),p = 0.78). In contrast compliance correlated with LVMVR after accounting for cardiovascular risk factors (B = - 0.12(95%CI -0.16--0.091),p < 0.001 in males; B = - 0.12(95%CI -0.15--0.086),p < 0.001 in females).
Conclusion
Systemic arteriosclerosis is associated with left ventricular remodelling but not atherosclerosis. Future efforts in cardiovascular risk prevention should thus seek to address both arteriosclerosis and atherosclerosis individually.



J Cardiovasc Magn Reson: 29 Jan 2018; 20:7
Weir-McCall JR, Lambert M, Gandy SJ, Belch JJF, ... White RD, Graeme Houston J
J Cardiovasc Magn Reson: 29 Jan 2018; 20:7 | PMID: 29382349
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Multidimensional fetal flow imaging with cardiovascular magnetic resonance: a feasibility study.

Goolaub DS, Roy CW, Schrauben E, Sussman D, ... Seed M, Macgowan CK
Purpose
To image multidimensional flow in fetuses using golden-angle radial phase contrast cardiovascular magnetic resonance (PC-CMR) with motion correction and retrospective gating.
Methods
A novel PC-CMR method was developed using an ungated golden-angle radial acquisition with continuously incremented velocity encoding. Healthy subjects (n = 5, 27 ± 3 years, males) and pregnant females (n = 5, 34 ± 2 weeks gestation) were imaged at 3 T using the proposed sequence. Real-time reconstructions were first performed for retrospective motion correction and cardiac gating (using metric optimized gating, MOG). CINE reconstructions of multidimensional flow were then performed using the corrected and gated data.
Results
In adults, flows obtained using the proposed method agreed strongly with those obtained using a conventionally gated Cartesian acquisition. Across the five adults, bias and limits of agreement were - 1.0 cm/s and [- 5.1, 3.2] cm/s for mean velocities and - 1.1 cm/s and [- 6.5, 4.3] cm/s for peak velocities. Temporal correlation between corresponding waveforms was also high (R~ 0.98). Calculated timing errors between MOG and pulse-gating RR intervals were low (~ 20 ms). First insights into multidimensional fetal blood flows were achieved. Inter-subject consistency in fetal descending aortic flows (n = 3) was strong with an average velocity of 27.1 ± 0.4 cm/s, peak systolic velocity of 70.0 ± 1.8 cm/s and an intra-class correlation coefficient of 0.95 between the velocity waveforms. In one fetal case, high flow waveform reproducibility was demonstrated in the ascending aorta (R = 0.97) and main pulmonary artery (R = 0.99).
Conclusion
Multidimensional PC-CMR of fetal flow was developed and validated, incorporating retrospective motion compensation and cardiac gating. Using this method, the first quantification and visualization of multidimensional fetal blood flow was achieved using CMR.



J Cardiovasc Magn Reson: 28 Jan 2018; 20:77
Goolaub DS, Roy CW, Schrauben E, Sussman D, ... Seed M, Macgowan CK
J Cardiovasc Magn Reson: 28 Jan 2018; 20:77 | PMID: 30486832
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Diabetes mellitus and insulin resistance associate with left ventricular shape and torsion by cardiovascular magnetic resonance imaging in asymptomatic individuals from the multi-ethnic study of atherosclerosis.

Yoneyama K, Venkatesh BA, Wu CO, Mewton N, ... Bluemke DA, Lima JAC
Background
Although diabetes mellitus (DM) and insulin resistance associate with adverse cardiac events, the associations of left ventricular (LV) remodeling and function with compromised glucose metabolism have not been fully evaluated in a general population. We used cardiovascular magnetic resonance (CMR) to evaluate how CMR indices are associated with DM or insulin resistance among participants before developing cardiac events.
Methods
We studied 1476 participants who were free of clinical cardiovascular disease and who underwent tagged CMR in the Multi-Ethnic Study of Atherosclerosis (MESA). LV shape and longitudinal myocardial shortening and torsion were assessed by CMR. A higher sphericity index represents a more spherical LV shape. Multivariable linear regression was used to evaluate the associations of DM or homeostasis model assessment-estimated insulin resistance (HOMA-IR) with CMR indices.
Results
In multiple linear regression, longitudinal shortening was lower in impaired fasting glucose than normal fasting glucose (NFG) (0.36% lower vs. NFG, p < 0.05); torsion was greater in treated DM (0.24 °/cm greater vs. NFG, p < 0.05) after full adjustments. Among participants without DM, greater log-HOMA-IR was correlated with greater LV mass (3.92 g/index, p < 0.05) and LV mass-to-volume ratio (0.05 /index, p < 0.01), and lower sphericity index (- 1.26/index, p < 0.01). Greater log-HOMA IR was associated with lower longitudinal shortening (- 0.26%/index, p < 0.05) and circumferential shortening (- 0.30%/index, p < 0.05). Torsion was positively correlated with log-HOMA-IR until 1.5 of log-HOMA-IR (0.16 °/cm/index, p = 0.030).), and tended to fall once above 1.5 of log-HOMA-IR (- 0.50 °/cm/index, p = 0.203). The sphericity index was associated negatively with LV mass-to-volume ratio (- 0.02/%, p < 0.001) and torsion (- 0.03°/cm/%, p < 0.001).
Conclusions
Glucose metabolism disorders are associated with LV concentric remodeling, less spherical shape, and reduced systolic myocardial shortening in the general population. Although torsion is higher in participants who are treated for DM and impaired insulin resistance, myocardial shortening was progressively decreased with higher HOMA-IR and torsion was increased only with less severe insulin resistance.
Clinical trial registration
Multi-Ethnic Study of Atherosclerosis (MESA): A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org/ . Study Start Date: January 1999 ( NCT00005487 ).



J Cardiovasc Magn Reson: 29 Jan 2018; 20:53
Yoneyama K, Venkatesh BA, Wu CO, Mewton N, ... Bluemke DA, Lima JAC
J Cardiovasc Magn Reson: 29 Jan 2018; 20:53 | PMID: 30064457
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Importance of standardizing timing of hematocrit measurement when using cardiovascular magnetic resonance to calculate myocardial extracellular volume (ECV) based on pre- and post-contrast T1 mapping.

Engblom H, Kanski M, Kopic S, Nordlund D, ... Carlsson M, Arheden H
Background
Cardiovascular magnetic resonance (CMR) can be used to calculate myocardial extracellular volume fraction (ECV) by relating the longitudinal relaxation rate in blood and myocardium before and after contrast-injection to hematocrit (Hct) in blood. Hematocrit is known to vary with body posture, which could affect the calculations of ECV. The aim of this study was to test the hypothesis that there is a significant increase in calculated ECV values if the Hct is sampled after the CMR examination in supine position compared to when the patient arrives at the MR department.
Methods
Forty-three consecutive patients including various pathologies as well as normal findings were included in the study. Venous blood samples were drawn upon arrival to the MR department and directly after the examination with the patient remaining in supine position. A Modified Look-Locker Inversion recovery (MOLLI) protocol was used to acquire mid-ventricular short-axis images before and after contrast injection from which motion-corrected T1 maps were derived and ECV was calculated.
Results
Hematocrit decreased from 44.0 ± 3.7% before to 40.6 ± 4.0% after the CMR examination (p < 0.001). This resulted in a change in calculated ECV from 24.7 ± 3.8% before to 26.2 ± 4.2% after the CMR examination (p < 0.001). All patients decreased in Hct after the CMR examination compared to before except for two patients whose Hct remained the same.
Conclusion
Variability in CMR-derived myocardial ECV can be reduced by standardizing the timing of Hct measurement relative to the CMR examination. Thus, a standardized acquisition of blood sample for Hct after the CMR examination, when the patient is still in supine position, would increase the precision of ECV measurements.



J Cardiovasc Magn Reson: 27 Jan 2018; 20:46
Engblom H, Kanski M, Kopic S, Nordlund D, ... Carlsson M, Arheden H
J Cardiovasc Magn Reson: 27 Jan 2018; 20:46 | PMID: 29950178
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Feasibility of 3D black-blood variable refocusing angle fast spin echo cardiovascular magnetic resonance for visualization of the whole heart and great vessels in congenital heart disease.

Henningsson M, Zahr RA, Dyer A, Greil GF, ... Tandon A, Hussain T
Background
Volumetric black-blood cardiovascular magnetic resonance (CMR) has been hampered by long scan times and flow sensitivity. The purpose of this study was to assess the feasibility of black-blood, electrocardiogram (ECG)-triggered and respiratory-navigated 3D fast spin echo (3D FSE) for the visualization of the whole heart and great vessels.
Methods
The implemented 3D FSE technique used slice-selective excitation and non-selective refocusing pulses with variable flip angles to achieve constant echo signal for tissue with T1 (880 ms) and T2 (40 ms) similar to the vessel wall. Ten healthy subjects and 21 patients with congenital heart disease (CHD) underwent 3D FSE and conventional 3D balanced steady-state free precession (bSSFP). The sequences were compared in terms of ability to perform segmental assessment, local signal-to-noise ratio (SNR) and local contrast-to-noise ratio (CNR).
Results
In both healthy subjects and patients with CHD, 3D FSE showed superior pulmonary vein but inferior coronary artery origin visualisation compared to 3D bSFFP. However, in patients with CHD the combination of 3D bSSFP and 3D FSE whole-heart imaging improves the success rate of cardiac morphological diagnosis to 100% compared to either technique in isolation (3D FSE, 23.8% success rate, 3D bSSFP, 5% success rate). In the healthy subjects SNR for 3D bSSFP was greater than for 3D FSE (30.1 ± 7.3 vs 20.9 ± 5.3; P = 0.002) whereas the CNR was comparable (17.3 ± 5.6 vs 17.4 ± 4.9; P = 0.91) between the two scans.
Conclusions
The feasibility of 3D FSE for whole-heart black-blood CMR imaging has been demonstrated. Due to their high success rate for segmental assessment, the combination of 3D bSSFP and 3D FSE may be an attractive alternative to gadolinium contrast enhanced morphological CMR in patients with CHD.



J Cardiovasc Magn Reson: 25 Jan 2018; 20:76
Henningsson M, Zahr RA, Dyer A, Greil GF, ... Tandon A, Hussain T
J Cardiovasc Magn Reson: 25 Jan 2018; 20:76 | PMID: 30474554
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance in heart transplant patients: diagnostic value of quantitative tissue markers: T2 mapping and extracellular volume fraction, for acute rejection diagnosis.

Vermes E, Pantaléon C, Auvet A, Cazeneuve N, ... Aupart M, Brunereau L
Background
The diagnosis of acute rejection in cardiac transplant recipients requires invasive technique with endomyocardial biopsy (EMB) which has risks and limitations. Cardiovascular magnetic resonance imaging (CMR) with T2 and T1 mapping is a promising technique for characterizing myocardial tissue. The purpose of the study was to evaluate T2, T1 and extracellular volume fraction (ECV) quantification as novel tissue markers to diagnose acute rejection.
Methods
CMR was prospectively performed in 20 heart transplant patients providing 31 comparisons EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5 Tesla scanner including T2 mapping (T2 prepared balanced steady state free precession) and T1 mapping (modified Look-Locker inversion recovery sequences: MOLLI) at basal, mid and apical level in short axis view. Global and segmental T2 and T1 values were measured before and 15 min (for T1 mapping) after contrast administration.
Results
Acute rejection was diagnosed in seven patients: six cellular rejections (4 grade IR, 2 grade 2R) and one antibody mediated rejection. Patients with acute rejection had significantly higher global T2 values at 3 levels: 58.5 ms [55.0-60.3] vs 51.3 ms [49.5-55.2] (p = 0.007) at basal; 55.7 ms [54.0-59.7] vs 51.8 ms [50.1-53.6] (p = 0.002) at median and 58.2 ms [54.0-63.7] vs 53.6 ms [50.8-57.4] (p = 0.026) at apical level. The area under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively. Patients with acute rejection had significantly higher ECV at basal level: 34.2% [32.8-37.4] vs 27.4% [24.6-30.6] (p = 0.006). The AUC for basal level was 0.84. The sensitivity, specificity and diagnosis accuracy for basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63% of EMB.
Conclusions
In heart transplant patients, a combined CMR approach using T2 mapping and ECV quantification provides a high diagnostic accuracy for acute rejection diagnosis and could potentially decrease the number of routine EMB.



J Cardiovasc Magn Reson: 26 Jan 2018; 20:59
Vermes E, Pantaléon C, Auvet A, Cazeneuve N, ... Aupart M, Brunereau L
J Cardiovasc Magn Reson: 26 Jan 2018; 20:59 | PMID: 30153847
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

TSTIR preparation for single-shot cardiovascular magnetic resonance myocardial edema imaging.

Zhu Y, Yang D, Zou L, Chen Y, Liu X, Chung YC
Background
Myocardial edema in acute myocardial infarction (AMI) is commonly imaged using dark-blood short tau inversion recovery turbo spin echo (STIR-TSE) cardiovascular magnetic resonance (CMR). The technique is sensitive to cardiac motion and coil sensitivity variation, leading to myocardial signal nonuniformity and impeding reliable depiction of edematous tissues. T-prepared balanced steady state free precession (Tp-bSSFP) imaging has been proposed, but its contrast is low, and averaging is commonly needed. T mapping is useful but requires a long scan time and breathholding. We propose here a single-shot magnetization prepared sequence that increases the contrast between edema and normal myocardium and apply it to myocardial edema imaging.
Methods
A magnetization preparation module (TSTIR) is designed to exploit the simultaneous elevation of T and T in edema to improve the depiction of edematous myocardium. The module tips magnetization down to the -z axis after T preparation. Transverse magnetization is sampled at the fat null point using bSSFP readout and allows for single-shot myocardial edema imaging. The sequence (TSTIR-bSSFP) was studied for its contrast behavior using simulation and phantoms. It was then evaluated on 7 healthy subjects and 7 AMI patients by comparing it to Tp-bSSFP and T mapping using the contrast-to-noise ratio (CNR) and the contrast ratio as performance indices.
Results
In simulation and phantom studies, TSTIR-bSSFP had improved contrast between edema and normal myocardium compared with the other two edema imaging techniques. In patients, the CNR of TSTIR-bSSFP was higher than Tp-bSSFP (5.9 ± 2.6 vs. 2.8 ± 2.0, P < 0.05) but had no significant difference compared with that of the T map (T map: 6.6 ± 3.3 vs. 5.9 ± 2.6, P = 0.62). The contrast ratio of TSTIR-bSSFP (2.4 ± 0.8) was higher than that of the T map (1.3 ± 0.1, P < 0.01) and Tp-bSSFP (1.4 ± 0.5, P < 0.05).
Conclusion
TSTIR-bSSFP has improved contrast between edematous and normal myocardium compared with commonly used bSSFP-based edema imaging techniques. TSTIR-bSSFP also differentiates between fat that was robustly suppressed and fluids around the heart. The technique is useful for single-shot edema imaging in AMI patients.



J Cardiovasc Magn Reson: 20 Nov 2019; 21:72
Zhu Y, Yang D, Zou L, Chen Y, Liu X, Chung YC
J Cardiovasc Magn Reson: 20 Nov 2019; 21:72 | PMID: 31752919
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance imaging in the prospective, population-based, Hamburg City Health cohort study: objectives and design.

Bohnen S, Avanesov M, Jagodzinski A, Schnabel RB, ... Lund GK, Muellerleile K
Background
The purpose of this work is to describe the objectives and design of cardiovascular magnetic resonance (CMR) imaging in the single center, prospective, population-based Hamburg City Health study (HCHS). The HCHS aims at improving risk stratification for coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF).
Methods
The HCHS will finally include 45,000 inhabitants of the city of Hamburg (Germany) between 45 and 74 years who undergo an extensive cardiovascular evaluation and collection of biomaterials. Risk-scores for CAD, AF and HF are used to create enriched subpopulations who are invited for CMR. A total number of approximately 12,362 subjects will undergo CMR and incident CAD, AF and HF will be assessed after 6 years follow-up. The standard CMR protocol includes cine-CMR, T1 and T2 mapping, aortic/mitral valve flow measurements, Late gadolinium enhancement, angiographies and measurements of aortic distensibility. A stress-perfusion scan is added in individuals at risk for CAD. The workflow of CMR data acquisition and analyses was evaluated in a pilot cohort of 200 unselected subjects.
Results
The obtained CMR findings in the pilot cohort agree with current reference values and demonstrate the ability of the established workflow to accomplish the objectives of HCHS.
Conclusions
CMR in HCHS promises novel insights into major cardiovascular diseases, their subclinical precursors and the prognostic value of novel imaging biomarkers. The HCHS database will facilitate combined analyses of imaging, clinical and molecular data (\"Radiomics\").



J Cardiovasc Magn Reson: 23 Jan 2018; 20:68
Bohnen S, Avanesov M, Jagodzinski A, Schnabel RB, ... Lund GK, Muellerleile K
J Cardiovasc Magn Reson: 23 Jan 2018; 20:68 | PMID: 30244673
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance.

Garg P, Crandon S, Swoboda PP, Fent GJ, ... Plein S, Dall\'Armellina E
Background
Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics that are linked to clinical outcomes. We hypothesize that LV blood flow kinetic energy (KE) is altered in MI and is associated with LV function and infarct characteristics. This study aimed to investigate the intra-cavity LV blood flow KE in controls and MI patients, using cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow assessment.
Methods
Forty-eight patients with MI (acute-22; chronic-26) and 20 age/gender-matched healthy controls underwent CMR which included cines and whole-heart 4D flow. Patients also received late gadolinium enhancement imaging for infarct assessment. LV blood flow KE parameters were indexed to LV end-diastolic volume and include: averaged LV, minimal, systolic, diastolic, peak E-wave and peak A-wave KEi. In addition, we investigated the in-plane proportion of LV KE (%) and the time difference (TD) to peak E-wave KE propagation from base to mid-ventricle was computed. Association of LV blood flow KE parameters to LV function and infarct size were investigated in all groups.
Results
LV KEi was higher in controls than in MI patients (8.5 ± 3 μJ/ml versus 6.5 ± 3 μJ/ml, P = 0.02). Additionally, systolic, minimal and diastolic peak E-wave KEi were lower in MI (P < 0.05). In logistic-regression analysis, systolic KEi (Beta = - 0.24, P < 0.01) demonstrated the strongest association with the presence of MI. In multiple-regression analysis, infarct size was most strongly associated with in-plane KE (r = 0.5, Beta = 1.1, P < 0.01). In patients with preserved LV ejection fraction (EF), minimal and in-plane KEi were reduced (P < 0.05) and time difference to peak E-wave KE propagation during diastole increased (P < 0.05) when compared to controls with normal EF.
Conclusions
Reduction in LV systolic function results in reduction in systolic flow KEi. Infarct size is independently associated with the proportion of in-plane LV KE. Degree of LV impairment is associated with TD of peak E-wave KE. In patient with preserved EF post MI, LV blood flow KE mapping demonstrated significant changes in the in-plane KE, the minimal KEi and the TD. These three blood flow KE parameters may offer novel methods to identify and describe this patient population.



J Cardiovasc Magn Reson: 29 Jan 2018; 20:61
Garg P, Crandon S, Swoboda PP, Fent GJ, ... Plein S, Dall'Armellina E
J Cardiovasc Magn Reson: 29 Jan 2018; 20:61 | PMID: 30165869
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging.

Cheang MH, Barber NJ, Khushnood A, Hauser JA, ... Hothi D, Muthurangu V
Background
Children with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect sub-clinical abnormalities, it has well-known problems with reproducibility that limit its ability to accurately detect these changes. Cardiovascular magnetic resonance (CMR) is the reference standard method for assessing blood flow, cardiac structure and function. Furthermore, recent innovations enable the assessment of radial and longitudinal myocardial velocity, such that detection of sub-clinical changes is now possible. Thus, CMR may be ideal for cardiovascular assessment in pediatric CKD. This study aims to comprehensively assess cardiovascular function in pediatric CKD using CMR and determine its relationship with CKD severity.
Methods
A total of 120 children (40 mild, 40 moderate, 20 severe pre-dialysis CKD subjects and 20 healthy controls) underwent CMR with non-invasive blood pressure (BP) measurements. Cardiovascular parameters measured included systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular (LV) structure, ejection fraction (EF), cardiac timings, radial and longitudinal systolic and diastolic myocardial velocities. Between group comparisons and regression modelling were used to identify abnormalities in CKD and determine the effects of renal severity on myocardial function.
Results
The elevation in mean BP in CKD was accompanied by significantly increased afterload (SVR), without evidence of arterial stiffness (TAC) or increased fluid overload. Left ventricular volumes and global function were not abnormal in CKD. However, there was evidence of LV remodelling, prolongation of isovolumic relaxation time and reduced systolic and diastolic myocardial velocities.
Conclusion
Abnormal cardiovascular function is evident in pre-dialysis pediatric CKD. Novel CMR biomarkers may be useful for the detection of subtle abnormalities in this population. Further studies are needed to determine to prognostic value of these biomarkers.



J Cardiovasc Magn Reson: 28 Jan 2018; 20:24
Cheang MH, Barber NJ, Khushnood A, Hauser JA, ... Hothi D, Muthurangu V
J Cardiovasc Magn Reson: 28 Jan 2018; 20:24 | PMID: 29609642
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Journal of Cardiovascular Magnetic Resonance 2017.

Manning WJ

There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3 year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!



J Cardiovasc Magn Reson: 27 Jan 2018; 20:89
Manning WJ
J Cardiovasc Magn Reson: 27 Jan 2018; 20:89 | PMID: 30593280
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein\'s anomaly.

Yang D, Li X, Sun JY, Cheng W, ... Han Y, Chen YC
Background
Myocardial fibrosis is a common pathophysiological process that is related to ventricular remodeling in congenital heart disease. However, the presence, characteristics, and clinical significance of myocardial fibrosis in Ebstein\'s anomaly have not been fully investigated. This study aimed to evaluate myocardial fibrosis using cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) and T1 mapping techniques, and to explore the significance of myocardial fibrosis in adolescent and adult patients with Ebstein\'s anomaly.
Methods
Forty-four consecutive patients with unrepaired Ebstein\'s anomaly (34.0 ± 16.2 years; 18 males), and an equal number of age- and gender-matched controls, were included. A comprehensive CMR protocol consisted of cine, LGE, and T1 mapping by modified Look-Locker inversion recovery (MOLLI) sequences were performed. Ventricular functional parameters, native T1, extracellular volume (ECV), and LGE were analyzed. Associations between myocardial fibrosis and disease severity, ventricular function, and NYHA classification were analyzed.
Results
LGE was found in 10 (22.7%) patients. Typical LGE in Ebstein\'s anomaly was located in the endocardium of the septum within the right ventricle (RV). The LV ECV of Ebstein\'s anomaly were significantly higher than those of the controls (30.0 ± 3.8% vs. 25.3 ± 2.3%, P < 0.001). An increased ECV was found to be independent of the existence of LGE. Positive LGE or higher ECV (≥30%) was associated with larger fRV volume, aRV volume, increased disease severity, and worse NYHA functional class. In addition, ECV was significantly correlated with the LV ejection fraction (P <  0.001).
Conclusions
Both focal and diffuse myocardial fibrosis were observed in adolescent and adult patients with Ebstein\'s anomaly. Increased diffuse fibrosis is associated with worse LV function, increased Ebstein\'s severity, and worse clinical status.



J Cardiovasc Magn Reson: 26 Jan 2018; 20:69
Yang D, Li X, Sun JY, Cheng W, ... Han Y, Chen YC
J Cardiovasc Magn Reson: 26 Jan 2018; 20:69 | PMID: 30257686
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association between myocardial extracellular volume and strain analysis through cardiovascular magnetic resonance with histological myocardial fibrosis in patients awaiting heart transplantation.

Cui Y, Cao Y, Song J, Dong N, ... Shi H, Han P
Background
Cardiovascular magnetic resonance (CMR)-derived extracellular volume (ECV) and tissue tracking strain analyses are proposed as non-invasive methods for quantifying myocardial fibrosis and deformation. This study sought (1) to histologically validate myocardial ECV against the collagen volume fraction (CVF) measured from tissue samples of patients undergoing heart transplantation and (2) to detect the correlations between myocardial systolic strain and the myocardial ECV and histological CVF in patients undergoing heart transplantation.
Methods
A total of 12 dilated cardiomyopathy (DCM) and 10 ischaemic cardiomyopathy (ICM) patients underwent T1 mapping with the Modified Look Locker Inversion recovery (MOLLI) sequence, T2 mapping and ECV. Myocardial systolic strain, including left ventricular global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), were quantified using CMR cine images with tissue tracking analysis software. Tissue samples were collected from each of 16 segments of the explanted hearts and were stained with picrosirius red for histological CVF quantification.
Results
A strong relationship was observed between the global myocardial ECV and histological CVF in the DCM and ICM patients based on a per-patient analysis (r = 0.904 and r = 0.901, respectively, p <  0.001). In the linear mixed-effects regression analysis, ECV correlated well with the histological CVF in the DCM and ICM patients on a per-segment basis (β = 0.838 and β = 0.915, respectively, p <  0.001). In the multivariate linear regression analysis, histological CVF was the strongest independent determinant of ECV in the patients awaiting heart transplantation (standardised β = 0.860, p <  0.001). However, the T2 time, GLS, GCS and GRS showed no significant associations with ECV and CVF in the patients awaiting heart transplantation.
Conclusions
ECV derived from CMR correlated well with histological CVF, indicating its potential as a non-invasive tool for the quantification of myocardial fibrosis. Additionally, impaired myocardial systolic strains were not associated with the ECV and CVF in the patients awaiting heart transplantation.



J Cardiovasc Magn Reson: 22 Jan 2018; 20:25
Cui Y, Cao Y, Song J, Dong N, ... Shi H, Han P
J Cardiovasc Magn Reson: 22 Jan 2018; 20:25 | PMID: 29681243
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Quantitative cardiovascular magnetic resonance: extracellular volume, native T1 and 18F-FDG PET/CMR imaging in patients after revascularized myocardial infarction and association with markers of myocardial damage and systemic inflammation.

Kunze KP, Dirschinger RJ, Kossmann H, Hanus F, ... Rischpler C, Nekolla SG
Background
Characterization of tissue integrity and inflammatory processes after acute myocardial infarction (AMI) using non-invasive imaging is predictive of patient outcome. Quantitative cardiovascular magnetic resonance (CMR) techniques such as native T and extracellular volume (ECV) mapping as well as F-FDG positron emission tomography (PET) imaging targeting inflammatory cell populations are gaining acceptance, but are often applied without assessing their quantitative potential. Using simultaneously acquired PET/CMR data from patients early after AMI, this study quantitatively compares these three imaging markers and investigates links to blood markers of myocardial injury and systemic inflammatory activity.
Methods
A total of 25 patients without microvascular obstruction were retrospectively recruited. All imaging was simultaneously performed 5 ± 1 days after revascularization following AMI on an integrated 3T PET/MRI scanner. Native and post-contrast T data were acquired using a modified Look-Locker inversion recovery (MOLLI) sequence, ECV maps were calculated using individually sampled hematocrit. F-FDG PET was executed after 1 day of dietary preparation, 12 h of fasting, and administration of heparin. ECV, F-FDG and native T data were compared mutually as well as to peak counts of peripheral blood markers (creatine kinase, creatine kinase-MB, troponin, leukocytes, monocytes) and infarct size.
Results
High intra-patient correlations of relative ECV, F-FDG PET and native T signal increases were observed in combination with no inter-patient correlation of maximum absolute values at the infarct center, suggesting well-colocalized but physiologically diverse processes begetting the respective image signals. Comparison of maximum image signals to markers of myocardial damage and systemic inflammation yielded highly significant correlations of ECV to peak creatine kinase-MB and overall infarct size as well as between native T and peak monocyte counts.
Conclusions
Absolute native T values at the infarct core early after AMI can be linked to the systemic inflammatory response independent of infarct size. Absolute ECV at the infarct core is related to both infarct size and blood markers of myocardial damage.



J Cardiovasc Magn Reson: 23 Jan 2018; 20:33
Kunze KP, Dirschinger RJ, Kossmann H, Hanus F, ... Rischpler C, Nekolla SG
J Cardiovasc Magn Reson: 23 Jan 2018; 20:33 | PMID: 29792210
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:

This program is still in alpha version.