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Echocardiographic studies indicate South Asian people have smaller ventricular volumes, lower mass and more concentric remodelling than White European people, but there are no data using cardiac MRI (CMR). We aimed to compare CMR quantified cardiac structure and function in White European and South Asian people.

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Growth hormone (GH) can profoundly influence cardiac function. While GH excess causes well-defined cardiac pathology, fewer data are available regarding the more subtle cardiac changes seen in GH deficiency (GHD). This preliminary study uses cardiac magnetic resonance imaging (CMR) to assess myocardial structure and function in GHD. Ten adult-onset GHD patients underwent CMR, before and after 6 and 12 months of GH replacement. They were compared to 10 age-matched healthy controls and sex-matched healthy controls. Left ventricular (LV) mass index (LVMi) increased with 1 year of GH replacement (53.8 vs. 57.0 vs. 57.3 g/m2, analysis of variance p= 0.0229). Compared to controls, patients showed a trend towards reduced LVMi at baseline (51.4 vs.60.0 g/m2, p= 0.0615); this difference was lost by 1 year of GH treatment (57.3 vs. 59.9 g/m2, p= 0.666). Significantly reduced aortic area was observed in GHD (13.2 vs. 19.0 cm2/m2, p= 0.001). This did not change with GH treatment. There were no differences in other LV parameters including end-diastolic volume index (EDVi), end-systolic volume index, stroke volume index (SVi), cardiac index and ejection fraction. There was a trend towards reduced baseline right ventricular (RV)SVi (44.1 vs. 49.1 ml/m2, p= 0.0793) and increased RVEDVi over 1 year (70.3 vs. 74.3 vs. 73.8 ml/m2, p= 0.062). Two patients demonstrated interstitial expansion, for example with fibrosis, and three myocardial ischaemia as assessed by late gadolinium enhancement and stress perfusion. The increased sensitivity of CMR to subtle cardiac changes demonstrates that adult-onset GHD patients have reduced aortic area and LVMi increases after 1 year of GH treatment. These early data should be studied in larger studies in the future.

Introduction:Dysregulated myocardial calcium handling may be a precursor for heart failure in type 1 (T1D) and type 2 diabetes (T2D). Manganese-enhanced magnetic resonance imaging (MEMRI) is a novel non-invasive method of assessing in vivomyocardial calcium handling.HypothesisMyocardial calcium handling is impaired in patients with either T1D or T2D, despite normal left ventricular (LV) systolic function.MethodsProspective, multicentre, study in patients with T1D (n=19), T2D (n=30), and healthy volunteers (n=28), all of whom were free of known cardiovascular disease. Cardiac MRI was performed including MEMRI, during which T1 mapping was performed at baseline and every 2.5 min for 30 min after manganese infusion (Figure 1a). The rate of myocardial manganese uptake, determined by Patlak modelling [1].ResultsNo difference in LV systolic function was observed between groups, but those with T2D had more concentric LV remodelling compared to T1Ds and healthy volunteers (LV mass:volume 0.90±0.16 vs. 0.75±0.09 vs. 0.74±0.10 g/mL, respectively; p=0.001, Table 1). Mean myocardial manganese uptake was significantly lower in both T1Ds (6.47±0.99 mL/100g/min) and T2Ds (6.43±0.77 mL/100g/min) compared with healthy volunteers (8.33±0.77 mL/100g/min; p<0.001 for both, Figure 1b).ConclusionFor the first time, we have demonstrated that myocardial calcium handling is impaired in patients with either T1D or T2D despite apparently normal LV systolic function. This may be a precursor to the development of diabetic cardiomyopathy and has implications for developing novel therapeutic targets for its prevention and treatment. [1] Skjold, A et al. J Magn Reson Imag 2006;24:1047-1055graphic_{ECFA3EC4-96D0-4ADC-8599-3D854C84F04F}graphic_{F1770AC6-718C-4C39-B107-4A5DD60957A8}

Introduction:Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently occur in parallel. Whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics is not known.Methods:Adults with heart failure with an LV EF greater than 50% on echocardiography were prospectively recruited as part of the DIAMOND HFpEF study (NCT03050593). Participants underwent phenotyping including a panel of 49 fibroinflammatory plasma biomarkers, echocardiography and comprehensive stress cardiac MRI (CMR). Between group comparisons were adjusted for age, sex, ethnicity, body mass index (BMI), diabetes, systolic blood pressure and estimated glomerular filtration rate (eGFR).Results:136 participants were included: sinus rhythm (n=75) and AF (n=61). Patients with AF were older (76 vs.70 years), less ethnically diverse (minority ethnicity 7 vs.24%) and had a lower prevalence of diabetes (36 vs.61%). There were no significant differences in heart rate, blood pressure, BMI, eGFR, HbA1c, E/e’ or B-type natriuretic peptide, but AF patients had higher NTproANP (7704 vs.5749pg/mL) and shorter E deceleration time (211±60 vs.259±78ms). On CMR, ventricular volumes, mass, stress myocardial blood flow and myocardial fibrosis were similar, but those in AF had increased atrial volume (61±30 vs.39±15mL/m2), reduced systolic function (LV EF 63±8 vs.68±8%; global longitudinal strain 13.6±2.9 vs.14.7±2.4%, p=0.003) but higher diastolic strain rate (0.73±0.28 vs.0.53±0.17/s, p<0.001). Patients with AF had higher levels of syndecan-1, matrix metalloproteinase-2, proBNP and angiopoietin-2, but lower level of interleukin-8 (p<0.05 for all; Figure 1).Conclusions:In HFpEF, AF is associated with lower systolic function but higher diastolic strain rate and a different fibroinflammatory profile compared to sinus rhythm. These findings may suggest that some patients with AF and HFpEF have a distinct endotype.

Interferon-beta (IFNβ) is currently the most used disease-modifying treatment for relapsing-remitting multiple sclerosis (RRMS), but it can lead to the production of neutralising antibodies (NABs) against IFNβ.