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Background Increased ventricular and arterial stiffness is associated with diastolic dysfunction (DDFx) in patients with heart failure and preserved systolic function. Limited information is available regarding the impact of aortic biomechanics and the ventricular-vascular coupling (VVC) on DDFx in those patients with advanced ischemic cardiomyopathy (ICM). In addition, it is not known if cardiac magnetic resonance (CMR) measurements of LV remodeling (sphericity and scar burden) can also contribute to prediction of DDFx in these patients. We sought to examine the relationship between aortic biomechanical properties (ascending and descending distensibility, arch pulse wave velocity), ventricular-ventricular coupling (defined as the ratio between LV end-systolic elastance and effective arterial elastance), LV remodeling assessed by CMR and diastolic function assessed by echocardiography in patients with advanced ICM. Methods Patients were selected if they had undergone TTE and CMR studies within 7 days (median=1 day). 354 patients with LVEF ≤ 40% and ≥ 70% stenosis in ≥ 1c oronary artery but without prior mitral valve surgery, fused E/A waves, atrial fibrillation or > moderate mitral regurgitation were screened. Of those, 84 patients were excluded due to poor CMR image quality from artifacts and/or suboptimal temporal resolution. A total 270 charts were reviewed for demographic and laboratorial data. Diastolic function assessment was performed as per guidelines. Aortic biomechanics were measured using previously validated software (ARTFUN, INSERM U678, Paris, France) using semi-automated tracing of aortic contours with phase-contrast images and through-plane velocity encoding of the ascending and descending aorta. CMR evaluation also included long and short axis assessment of LV sphericity and function respectively on balanced steady state free precession images along with assessment of myocardial scar (on phase-sensitive inversion recovery DHE-CMR sequence ~ 10-20 minutes). Multivariate linear regression analysis was done to identify the independent predictors of DDFx. Results Males represented 76% of the cohort with a mean age of 62 ± 10 years. Mean LVEF was 23 ± 5% and DDFx was classified as either: stage 1 (44%), stage 2 (25%) or stage 3 (31%). The independent predictors of impaired diastolic function (stage > 1) are listed on Table 1. Conclusions In patients with advanced ICM, CMR assessment of VVC, LV sphericity and scar burden are independent predictors of DDFx. Aortic biomechanical properties are not independently associated with diastolic dysfunction. Funding None.

With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post Processing of the Society for Cardiovascular MR (SCMR). The aim of the task force is to recommend requirements and standards for image interpretation and post processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate.

Introduction In HCM, with progression of disease, there is often a reduction in exercise capacity, likely due to diastolic dysfunction, mitral regurgitation (MR) and dynamic left ventricular outflow tract obstruction (LVOTO). However, there is considerable variation in exercise capacity despite similar diastolic dysfunction, LVOTO and MR. Aortic stiffness could be a possible contributor in HCM pathophysiology. Pulse wave velocity (PWV), measured by cardiac magnetic resonance (CMR), is a marker of aortic stiffness and is abnormal in HCM vs. controls.

Background T1 Mapping has emerged as a new marker to quantify myocardial extracellular volume (ECV), which is typically increased in the setting of diffuse fibrosis or infiltrative heart diseases. However the reproducibility of the technique is largely unknown. We sought to identify the interobserver, intraobserver variability of different T1 mapping techniques as well as validation of one technique against the standard technique for ECV quantification. Methods We selected 10 patients with the diagnosis of cardiomyopathy (5 with delayed contrast enhancement and 5 without). The Look-Locker (LL) and Modified Look-Locker both precontrast (MOLLI_Pre) and postcontrast (MOLLI_Post) T1 time were measured by 3 investigators blinded to clinical data at 2 different time points. Interobserver and Intraobserver reproducibility were assessed using 2-way ANOVA approach. The ECV was calculated using pre and post contrast T1 and hematocrit. Results There was a strong correlation between LL T1 and Postcontrast MOLLI(MOLLI_Post) (R2 0.82, p < 0.001) and a modest correlation between MOLLI_post and ECV (R2 = 0.42, p < 0.001). The interobserver and intraobserver variability of the measurements were expressed as standard errors of measurements (SEM) and 95% CI and were summarized in table 1. MOLLI_Post had the lowest intraobserver and intraobserver variability with minimal detectable change in T1 of 13.8 and 26.1 respectively. ECV showed minimal both interobserver and intraobserver variability. Conclusions Both LL and MOLLI are highly reproducible technique. LL was strongly correlated with post-contrast MOLLI which is moderately correlated to ECV. Funding None.

Background Scar burden has been shown to be an independent predictor of mortality in patients with severe ischemic cardiomyopathy (ICM). However, it is unclear how both scar burden and end systolic volume (ESV) impact outcomes in patients with severe ischemic (ICM). Purpose In patients with severe ICM, we sought to assess the association of ESV and scar burden with outcomes in severe ICM. Methods 450 patients with > 70% stenosis in ≥1 epicardial coronary artery (75% men, median age 63 years, median LV ejection fraction (EF) 22%, median ESVi 106ml, median scar % of 29%) underwent delayed hyperenhancementMRI (Siemens 1.5-T scanner, Erlangen, Germany) between 2003-2007. CMR evaluation included long and short axis assessment of LV function on balanced steady state free precession images along with assessment of myocardial scar (on phase-sensitive inversion recovery DHE-CMR sequence ~ 10-20 minutes after injection of 0.2 mmol/kg of Gadolinium dimenglumine). Scar was identified as regions of interest > 2 SD above normal myocardium. LV scar was was recorded as a percentage of the total myocardium and transmural extent (0 = none, 1 = 1-25%, 2 = 26-50%, 3 = 51-75%, and 4 = > 75%). Total scar score was determined from the summed scar score of 17 segments per patient divided by 17. Cox proportional hazards survival modeling, using a primary end-point of all-cause mortality, was used to risk-adjust comparisons. Results

Background The cine steady-state free-precession (SSFP) is the standard sequence for left ventricular (LV) function evaluation. However, SSFP mandates uninterrupted RF excitations to maintain steady-state (SS) during suspended respiration. In patients who cannot perform breath-holds (BH), a respiratory triggered (RT) free breathing (FB) retrospectively cardiac gated cine SSFP sequence that drives the magnetization to SS before commencing cine acquisition may be an alternative [1]. In this work, we validate the RT FB SSFP sequence by comparing it to the BH SSFP sequence for LV function evaluation.

Address: 1Baylor College of Medicine, Houston, TX, USA, 2St Luke's Episcopal Hospital – THI, Houston, TX, USA, 3Catharina Ziekenhuis Hospital, Eindhoven, The Netherlands, 4Leeds General Infirmary, Leeds, UK, 5Siriraj Hospital, Bangkok, Thailand, 6Skejby University Hospital, Aarhus, Denmark, 7Guy's Hospital, London, UK, 8Hygeia Hospital, Maroussi, Greece, 9German Heart Institute Berlin, Berlin, Germany and 10Cleveland Clinic Foundation, Cleveland, OH, USA * Corresponding author

Introduction Evaluation of chronic aortopathies requires repeated follow-up imaging studies to assess stability. MRI/MRA routinely has been used as the imaging modality of choice for its multiple advantages over competing modalities. However, recently there is heightened concern over gadolinium-enhanced MRA in patients with significant renal insufficiency as a result of nephrogenic systemic fibrosis (NSF). Development of a robust non-gadolinium enhanced MRI/MRA technique is needed for evaluation of aortopathies, particularly in patients with renal insufficiency.

Background Right ventricular ejection fraction (RVEF) has been shown to be an independent predictor of mortality after myocardial infarction. However, the predictive value of right ventricluar (RV) assessment in patients with severe ischemic cardiomyopathy (ICM) is unknown. Purpose In patients with severe ICM, we sought to assess the association of RVEF, RV end systolic and diastolic volumes (RV ESVi/RV ESDVi), right ventricular systolic pressure (RVSP) with outcomes in severe ICM. Methods