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Programming effects of maternal undernutrition on fetal metabolic and cardiovascular systems are well elucidated, yet a detailed characterization of maternal haemodynamics is not available. This study used comprehensive cardiovascular magnetic resonance (CMR) imaging to quantify maternal haemodynamics after 29 days (111–140 days) of late‐gestation undernutrition (LGUN) in pregnant sheep. Control ewes received 100% of metabolizable energy requirements (MERs, n = 15), whereas LGUN ewes were globally nutrient restricted to 50% MER (n = 18), with a subset of fetuses undergoing continuous glucose infusion (LGUN + G, n = 6/18). Ewes underwent CMR (138–140 days' gestation), and placental tissue was collected the next day. Ewes in both LGUN groups had reduced body weight and mean blood glucose concentration across gestation. Ventricular dimensions were lower in both LGUN groups. Uterine artery blood flow (QUtA) was elevated in the LGUN group compared with controls, whereas peripheral blood flow was reduced and further diminished in LGUN + G. Maternal weight change correlated with all haemodynamic parameters across all groups. Uteroplacental oxygen and glucose delivery were increased in LGUN compared to control ewes, whereas uteroplacental oxygen consumption was preserved. LGUN did not impact placental or fetal weight, and markers of brain‐sparing physiology were absent. Placental expression of insulin‐like growth factors (IGF‐1 and IGF‐2) and their receptors, glucose, fatty acid (FA) or amino acid transporters and markers of angiogenesis was not impacted. FA transporter expression was positively correlated with QUtA, and FA binding protein correlated negatively with maternal weight change. Maternal cardiovascular adaptations in response to LGUN manifest as preservation of placental growth and function, thereby preserving fetal growth. Key points: Maternal undernutrition during pregnancy alters fetal metabolic and cardiovascular physiology, but little is known about alterations in maternal haemodynamics.Late‐gestation undernutrition (LGUN) and LGUN + G redirected maternal blood flow from the periphery to the uteroplacental unit, concomitantly increasing the delivery of glucose and oxygen to the uteroplacental unit.Substrate transporter expression and uteroplacental oxygen consumption were preserved in LGUN and LGUN + G, suggesting prioritization of the placenta.This study is the first to report detailed maternal haemodynamics in the setting of maternal undernutrition, where placental growth and function were maintained, ultimately preserving fetal oxygen metabolism and growth. [ABSTRACT FROM AUTHOR]

Among patients with congenital heart disease, those with single ventricles have the highest risk of early mortality. Sudden cardiac death is an important cause of death in this population. Understanding the risk factors for sudden cardiac events (SCE) in Fontan patients could improve prediction and prevention. The goal of this study was to determine the prevalence of SCE and risk factors for SCE in the Fontan population. The Fontan Outcomes Registry Using CMR Examinations (FORCE) is an international registry collecting clinical and imaging data on Fontan patients. SCE was defined as: 1) cardiac arrest from a shockable rhythm; 2) need for emergent cardioversion/defibrillation; or 3) documented sustained ventricular tachycardia. Univariate and multivariate Cox proportional hazards regression models estimated hazard ratios for predictors of SCE. Our sample included 3,132 patients (41% female). The median age at first cardiac magnetic resonance was 14.6 years. SCE was experienced by 3.5% (n = 109) over a median follow-up time of 4.00 years. Of the 109 patients with SCE, 39 (36%) died. On multivariable analysis, NYHA functional class >II (HR: 4.91; P < 0.0001), history of protein-losing enteropathy/plastic bronchitis (HR: 2.37; P = 0.0082), single-ventricle end-diastolic volume index >104 mL/m2 (HR: 3.15; P < 0.0001), and ejection fraction <50% (HR: 1.73; P = 0.0437) were associated with SCE. Kaplan-Meier analysis demonstrated that in patients with none of the above risk factors, the 4-year freedom from SCE was 99.5%. SCE occurred in 3.5% of the study population, and one-third of patients who experienced SCE died. Mild ventricular dysfunction and dilatation by cardiac magnetic resonance, NYHA functional class, and history of protein-losing enteropathy/plastic bronchitis were associated with SCE. [Display omitted] [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusions Cather ablation of parahisian premature ventricular complexes (PVCs) often requires ablation in multiple cardiac chambers, including the sinuses of Valsalva (SoV). The safety and efficacy of ablation within the right SoV to target parahisian arrhythmias has not been widely reported.To report on the demographic and procedural characteristics of patients undergoing catheter ablation of PVCs who underwent ablation in the right SoV, and to examine the impact of late‐gadolinium enhanced cardiac magnetic resonance (LGE‐CMR) on procedural findings.Consecutive patients undergoing ablation of parahisian PVCs and ablation in the right SoV with preprocedural LGE‐CMR were included.Eleven patients were included in the study population (11 males (100%), median age: 68 ± 7 years, median ejection fraction: 53% ± 7%, PVC burden 23% ± 13%). Intramural LGE‐CMR scar was present in all patients and involved the basal anteroseptum/outflow tract in nine patients. Ablation within the right SoV eliminated (n = 9) or suppressed (n = 2) PVCs in all patients. The successful SoV site displayed the absolute earliest presystolic activation time or matching pacemaps in only 44% and 55% of patients, respectfully. Transient heart block during right SoV ablation occurred in 1/11(9%) patients. The post procedure PVC burden decreased from 23% ± 13% to 7% ± 6%, procedural success was attained in 10/11(91%) of patients.Parahisian PVCs ablated from the right SoV are often intramural, may require ablation in multiple chambers, and colocalize with intramural LGE‐CMR scar. Traditional EGM markers of successful ablation sites were less frequently seen at successful site of SoV ablation, long term success was achieved in 91% of patients. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Accurate and automatic segmentation of pericardial adipose tissue (PEAT) in cardiac magnetic resonance (MR) images is essential for the diagnosis and treatment of cardiovascular diseases. Precise segmentation is challenging due to high costs and the need for specialized knowledge, as a large amount of accurately annotated data is required, demanding significant time and medical resources.In order to reduce the burden of data annotation while maintaining the high accuracy of segmentation tasks, this paper introduces a semi‐supervised learning method to solve the limitations of current PEAT segmentation methods.In this paper, we propose a difference‐guided collaborative mean teacher (DCMT) semi‐supervised method, designed for the segmentation of PEAT from DCMT consists of two main components: a semi‐supervised framework with a difference fusion strategy and a backbone network MCM‐UNet using Mamba‐CNN mixture (MCM) blocks. The differential fusion strategy effectively utilizes the uncertain areas in unlabeled data, encouraging the model to reach a consensus in predictions across these difficult‐to‐segment yet information‐rich areas. In addition, considering the sparse and scattered distribution of PEAT in cardiac MR images, which makes it challenging to segment, we propose MCM‐UNet as the backbone network in our semi‐supervised framework. This not only enhances the processing ability of global information, but also accurately captures the detailed local features of the image, which greatly improves the accuracy of PEAT segmentation.Our experiments conducted on the MRPEAT dataset show that our DCMT method outperforms existing state‐of‐the‐art semi‐supervised methods in terms of segmentation accuracy. These findings underscore the effectiveness of our approach in handling the specific challenges associated with PEAT segmentation.The DCMT method significantly improves the accuracy of PEAT segmentation in cardiac MR images. By effectively utilizing uncertain areas in the data and enhancing feature capture with the MCM‐UNet, our approach demonstrates superior performance and offers a promising solution for semi‐supervised learning in medical image segmentation. This method can alleviate the extensive annotation requirements typically necessary for training accurate segmentation models in medical imaging. [ABSTRACT FROM AUTHOR]

Background: A cardiac condition marked by excessive growth of heart muscle cells, hypertrophic cardiomyopathy (HCM) is a complex genetic disorder characterized by left ventricular hypertrophy, microvascular ischemia, myocardial fibrosis, and diastolic dysfunction. Obstructive hypertrophic cardiomyopathy (oHCM), a subset of HCM, involves significant obstruction in the left ventricular outflow tract (LVOT), leading to symptoms like dyspnea, fatigue, and potentially life-threatening cardiac events. With advancements in genetic understanding and the introduction of novel pharmacologic agents, including cardiac myosin inhibitors like mavacamten and aficamten, there is a paradigm shift in the therapeutic approach to oHCM. Main body: The underlying mechanisms of HCM are closely tied to genetic mutations affecting sarcomere proteins, particularly those encoded by the MYH7 and MYBPC3 genes. These mutations lead to disrupted sarcomere function, resulting in hypertrophic changes and LVOT obstruction. While genetic heterogeneity is a hallmark of HCM, clinical diagnosis relies heavily on imaging techniques such as Echocardiography and cardiac magnetic resonance imaging to assess the extent of hypertrophy and obstruction. Current pharmacological management of obstructive HCM (oHCM) focuses on alleviating symptoms rather than modifying disease progression. Beta-blockers and calcium channel blockers are primary treatment options, although their effectiveness varies among patients. Recent clinical trials have highlighted the potential of novel cardiac myosin inhibitors, including mavacamten and aficamten, in enhancing exercise capacity, reducing LVOT obstruction, and improving overall cardiac function. These innovative agents represent a significant breakthrough in targeting the fundamental pathophysiological mechanisms driving oHCM. A comprehensive literature review was conducted, utilizing top-tier databases such as PubMed, Scopus, and Google Scholar, to compile an authoritative and up-to-date overview of the current advancements in the field. This review sheds light on the updated 2024 American Heart Association (AHA) guidelines for HCM management, emphasizing the treatment cascade and tailored management for each stage of oHCM. By introducing a new paradigm for personalized medicine in oHCM, this research leverages advanced genomics, biomarkers, and imaging techniques to optimize treatment strategies. Conclusions: The introduction of cardiac myosin inhibitors heralds a new era in the management of oHCM. By directly targeting the molecular mechanisms underpinning the disease, these novel therapies offer improved symptom relief and functional outcomes. Ongoing research into the genetic basis of HCM and the development of targeted treatments holds promise for further enhancing patient care. Future studies should continue to refine these therapeutic strategies and explore their long-term benefits and potential in diverse patient populations. This review makes a significant contribution to the field by synthesizing the most recent AHA guidelines, emphasizing the crucial role of tailored management strategies in optimizing outcomes for patients with oHCM, and promoting the incorporation of cutting-edge genomics and imaging modalities to enhance personalized care. [ABSTRACT FROM AUTHOR]

Objective: Pleural effusion (PE) is a common pulmonary manifestation in patients with systemic lupus erythematosus (SLE), and is associated with disease activity. However, little is known regarding the additive effects of PE on cardiac function. Therefore, this study aimed to investigate multi-parameter cardiovascular magnetic resonance imaging (CMR) findings in SLE patients with PE and to explore whether cardiac involvement is associated with PE. Methods: Patients with SLE and age-matched/sex-matched healthy controls were included in this study. Patients with SLE were diagnosed according to the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria. Moreover, the PE diagnosis was based on computed tomography, and the height of the effusion was > 5 mm. All enrolled individuals underwent CMR imaging, including cine and late gadolinium enhancement (LGE), T1, and T2 mapping imaging. The left and right ventricular function, LGE, T1, extracellular volume (ECV), and T2 values were evaluated. Results: A total of 111 patients with SLE were enrolled, of whom 26 (23.42%) had PE. White cell count, hemoglobin, CRP, ESR, and lactate dehydrogenase levels were higher in SLE patients with PE than in SLE patients without PE (P<0.05). LGE was more prevalent in SLE patients with PE compared with those without PE (P<0.001). In addition, Native T1 (1348 ± 65 ms vs. 1284 ± 67 ms vs. 1261 ± 41 ms; P<0.001), ECV (31.92 ± 4.16% vs. 28.61 ± 3.60% vs. 26.54 ± 2.94%; P<0.001), and T2 (44.76 ± 3.68 ms vs. 41.96 ± 3.62 ms vs. 39.21 ± 2.85 ms; P<0.001) values were high in SLE patients with PE, intermediate in SLE patients without PE, and the lowest in the control group. Linear regression analysis demonstrated that PE was independently associated with LGE (β=0.329; P<0.05), T1 (β=0.346; P<0.05), ECV (β=0.353; P<0.05), and T2 (β=0.201; P<0.05). Conclusions: SLE patients with PE have a higher prevalence of LGE and more diffuse myocardial fibrosis and edema than SLE patients without PE. Moreover, PE is associated with increased diffuse interstitial fibrosis and edema. [ABSTRACT FROM AUTHOR]

Introduction: Non-invasive evaluation of myocardial tissue is a major goal of cardiac imaging. This is the case of myocardial fibrosis which is crucial in many myocardial diseases. Cardiac extracellular volume (ECV) was shown to indicate myocardial fibrosis and early cardiac involvement. With this study, our objective is to evaluate ECV measured with cardiac magnetic resonance (CMR) in patients with myotonic dystrophy type 1 (DM1) and 2 (DM2) as potential imaging biomarkers of subclinical cardiac pathology, and its relationship with demographic and clinical parameters, ECG-derived measures of cardiac conduction, and neuromuscular performance status. Materials and methods: We retrospectively analyzed 18 DM1 patients and 4 DM2 patients without apparent cardiac disease who had CMR at our center. Differences between independent distributions were evaluated using Mann–Whitney U test, while correlations were evaluated using Spearman's ρ. Results: Global ECV in DM1 patients (median 28.36; IQR 24.81–29.77) was significantly higher (p = 0.0141) than in DM2 patients (median 22.93; IQR 21.25–24.35), and than that reported in literature in healthy subjects (p = 0.0374; median 25.60; IQR 19.90–31.90). Septal ECV was significantly higher (p = 0.0074) in DM1 (median 27.37; IQR 25.97–29.74) than in DM2 patients (median 22.46; 21.57–23.19). Global ECV showed a strong, positive correlation with septal ECV (ρ = 0.9282, p < 0.0001). We observed that DM1 women showed significantly higher global (p = 0.0012) and septal (p < 0.0001) ECV values compared to men. Discussion: We found a significant increase in global and septal cardiac ECV in patients with DM1. These values might thus suggest that DM1 patients present an increased cardiovascular risk, mainly due to cardiac fibrosis, even in absence of overt cardiac pathology at other common cardiovascular exams. DM1 patients may also be at increased risk of early septal fibrosis, with important implications on the risk for fatal arrhythmias. In addition, our results suggest the presence of gender-related differences, with DM1 women being more prone to myocardial fibrosis. Physicians dealing with DM1 may consider CMR as a screening tool for the early identification of patients with increased cardiovascular risk. [ABSTRACT FROM AUTHOR]

The article discusses an unusual case of isolated Rosai-Dorfman disease (RDD) in an Asian male, where a cardiac mass was the sole manifestation without typical symptoms. The patient, a 65-year-old, presented with chest discomfort and palpitations, leading to the discovery of the intracardiac mass. Despite challenges in diagnosis, successful surgical resection of the lesion resulted in a favorable prognosis. This case highlights the diagnostic complexities of isolated cardiac RDD, which is rare in Asian populations, emphasizing the importance of pathology for accurate diagnosis and treatment. [Extracted from the article]

Background: There is an urgent need to better understand the diverse presentations, risk factors, and outcomes of immune checkpoint inhibitor (ICI)-associated cardiovascular toxicity. There remains a lack of consensus surrounding cardiovascular screening, risk stratification, and clinical decision-making in patients receiving ICIs. Methods: We conducted a single center retrospective cohort study including 2165 cancer patients treated with ICIs between 2013 and 2020. The primary outcome was adverse cardiovascular events (ACE): a composite of myocardial infarction, coronary artery disease, stroke, peripheral vascular disease, arrhythmias, heart failure, valvular disease, pericardial disease, and myocarditis. Secondary outcomes included all-cause mortality and the individual components of ACE. We additionally conducted an imaging substudy examining imaging characteristics from echocardiography (echo) and cardiac magnetic resonance (CMR) imaging. Results: In our cohort, 44% (n = 962/2165) of patients experienced ACE. In a multivariable analysis, dual ICI therapy (hazard ratio [HR] 1.23, confidence interval [CI] 1.04–1.45), age (HR 1.01, CI 1.00–1.01), male sex (HR 1.18, CI 1.02–1.36), prior arrhythmia (HR 1.22, CI 1.03–1.43), lung cancer (HR 1.17, CI 1.01–1.37), and central nervous system (CNS) malignancy (HR 1.23, CI 1.02–1.47), were independently associated with increased ACE. ACE was independently associated with a 2.7-fold increased risk of mortality (P<0.001). Dual ICI therapy was also associated with a 2.0-fold increased risk of myo/pericarditis (P = 0.045), with myo/pericarditis being associated with a 2.9-fold increased risk of mortality (P<0.001). However, the cardiovascular risks of dual ICI therapy were offset by its mortality benefit, with dual ICI therapy being associated with a ~25% or 1.3-fold decrease in mortality. Of those with echo prior to ICI initiation, 26% (n = 115/442) had abnormal left ventricular ejection fraction or global longitudinal strain, and of those with echo after ICI initiation, 28% (n = 207/740) had abnormalities. Of those who had CMR imaging prior to ICI initiation, 43% (n = 9/21) already had left ventricular dysfunction, 50% (n = 10/20) had right ventricular dysfunction, 32% (n = 6/19) had left ventricular late gadolinium enhancement, and 9% (n = 1/11) had abnormal T2 imaging. Conclusion: Dual ICI therapy, prior arrhythmia, older age, lung and CNS malignancies were independently associated with an increased risk of ACE, and dual ICI therapy was also independently associated with an increased risk of myo/pericarditis, highlighting the utmost importance of cardiovascular risk factor optimization in this particularly high-risk population. Fortunately, the occurrence of myo/pericarditis was relatively uncommon, and the overall cardiovascular risks of dual ICI therapy appeared to be offset by a significant mortality benefit. The use of multimodal cardiac imaging can be helpful in stratifying risk and guiding preventative cardiovascular management in patients receiving ICIs. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial dissection is a rare complication of ischaemic heart disease. It occurs when a haematoma forms within the cardiac muscle, either due to an endocardial rupture or rupture of an intra-myocardial vessel. Higher ventricular wall tension and reduced myocardial tensile strength increase the risk of dissection. We describe a young male who developed a myocardial dissection following an ST elevation infarction. We explore the possible pathophysiological connection between myocardial dissection and his amphetamine use. Case presentation: A 37-year-old Sri Lankan patient presented with progressively worsening heart failure for two weeks. One month before the presentation, he had developed an ischaemic chest pain, for which he had not sought medical advice. He was abusing inhalational heroin, crystal methamphetamines and cigarette smoke daily for five years. On examination, the patient had a blood pressure of 90/60 mmHg and a pulse rate of 110 beats per minute. The cardiac apex was deviated. The jugular venous pressure was elevated, bilateral pitting ankle and pulmonary oedema were present. The ECG had Q-ST elevations in the lateral leads. Serum troponin was elevated. A transthoracic echocardiogram revealed a poorly functioning dilated left ventricle with a mass within the myocardial apex. Cardiac MRI established that the mass was an intra-myocardial haematoma. A coronary angiogram demonstrated a critical plaque stenosis at the mid left-anterior-descending artery with poor distal flow. The patient did not have HIV or infective endocarditis. We treated the patient with diuretics and guideline-directed medical therapy for heart failure with reduced ejection fraction. We did not attempt surgical repair as the dissection was non-expanding, and the patient was at a high risk of operative complications. Conclusions: Myocardial dissection with aneurysm formation is a rare complication of ischaemic heart disease. Methamphetamines enhance the risk of myocardial dissection by inducing myocardial inflammation, causing a dilated cardiomyopathy and increasing the left ventricular pressures. [ABSTRACT FROM AUTHOR]

Background: Evaluating myocardial function using cardiac magnetic resonance (CMR) feature tracking provides a comprehensive cardiac assessment, particularly a detailed evaluation for patients with repaired tetralogy of Fallot (rTOF). This study aimed to identify factors associated with arrhythmias in rTOF patients utilizing conventional CMR techniques, including myocardial strain measurements. Methods: This single-center, retrospective study included 245 rTOF patients who underwent CMR between 2017 and 2023. Patients were stratified based on the presence or absence of arrhythmias during follow-up. The biventricular strain was assessed using CMR-derived feature tracking. Demographic, clinical, and imaging data were collected, and statistical analyses were performed to identify factors associated with arrhythmic events. Results: The median age at surgery was 5.6 years (range 1–44 years), with the median age at CMR was 27.5 years (range 15–69 years). Over the follow-up period, 25 patients (10.2%) experienced atrial or ventricular arrhythmias. Univariate analysis revealed significant associations between arrhythmic events and older age at surgery and CMR, lower functional class, larger heart size on chest radiograph, and prolonged QRS duration (QRSd). Additionally, arrhythmias were associated with increased right ventricular (RV) volume, reduced RV and left ventricular (LV) ejection fraction (EF), and impaired strain values. Multivariate binary logistic regression, adjusting for age at surgery, NYHA class, QRSd, and cardiothoracic ratio, identified that a lower RV EF (adjusted odds ratio [aOR] 6.97), RV global radial strain (GRS) (aOR 6.68), RV global circumferential strain (GCS) (aOR 6.36), RV global longitudinal strain (GLS) (aOR 3.14), and LV GRS (aOR 3.02) were all significantly associated with arrhythmias. Conclusion: This study highlights the significant contribution of CMR-derived myocardial strain measurements in predicting arrhythmic events in patients with rTOF. In addition to conventional RV EF, strain metrics—particularly those of the right ventricle- emerged as strong, independent predictors of arrhythmias, offering valuable prognostic information for clinical management in this patient population. These findings underscore the importance of myocardial strain analysis as a complementary tool to conventional imaging in evaluating arrhythmic risk in rTOF patients. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Deferasirox (DFX) is a once-daily oral iron chelator with proven dose-dependent efficacy in patients with thalassemia major (TM). The reason for switching from DFX dispersible tablets (Exjade®) to DFX film-coated tablets (Jadenu®) was intolerance. Many patients also reported that deferasirox® did not taste good. In this study, we compared the effect of Jadenu® and Exjade® on satisfaction, convenience, cardiac/liver MRI T2*, serum ferritin levels, and biochemical profiles in patients with thalassemia major. Method: Sixty-two patients with thalassemia over 2 years of age, who had iron overload indicated by chelation therapy, were randomly divided into two groups. The first group (n = 32) is treated with Exjade®, and the second group (n = 30) is treated with Jadenu®. Laboratory investigations included alkaline phosphatase (ALK), alanine transferase (ALT), aspartate transferase (AST), and serum ferritin levels. Cardiac/liver MRI T2* levels and patient satisfaction and convenience, were assessed before and 1 year after starting therapy. Results: The study found that 53.3% of Jadenu® patients were satisfied with the taste of the medication compared to only 12.5% of Exjade® patients, which was statistically significant (p = 0.001). Additionally, 40% of Jadenu® patients were satisfied with the ease of taking the medication compared to 28.1% of Exjade® patients, and again, the difference was statistically significant (p = 0.047). A comparison of the cardiac MRI T2* levels between the two studied groups showed no significant difference (p = 0.851). Conclusion: Jadenu® offers patients an improved formulation that can be taken on an empty stomach, has a better taste, and presents fewer gastrointestinal tolerability concerns. Overall, patient satisfaction is higher with Jadenu®, which may improve adherence and reduce the frequency and severity of complications associated with iron overload. This, in turn, may help mitigate cardiovascular and hepatic complications from iron overload in the long term. Clinical Trial Registration: https://irct.behdasht.gov.ir/search/result?query=IRCT20210830052346N1 [ABSTRACT FROM AUTHOR]

Background/Objectives: Pulmonary vein isolation (PVI) using radiofrequency catheter ablation with contact force (CF)-sensing technology has improved long-term outcomes in patients with atrial fibrillation. This prospective randomized study aimed to assess the efficacy and safety of CF-sensing technology for additional left atrial (LA) linear ablation of persistent AF (PerAF). Methods: After PVI, anteromitral (AM) line and roof line ablation were performed using a CF-sensing catheter. Patients were randomly assigned to either the CF-sensing (CFS) group or the CF-blind control (Blind) group. The primary endpoint was atrial arrhythmia recurrence. LA late gadolinium enhancement (LA-LGE) MRI was conducted at baseline and 1-year follow-up for long-term lesion evaluation. Results: A total of 62 patients with drug-refractory PerAF were enrolled (mean age: 58 ± 10 years; 77% male). The success rates of AM and roof line block were 97% and 100% in the CFS group (n = 33) and 93% and 90% in the Blind group (n = 29). The time to achieve block was reduced in the CFS group (AM: 36 ± 22 vs. 48 ± 28 min, p = 0.068; roof: 19 ± 14 vs. 27 ± 15 min, p = 0.031). The maximum CF for safety endpoints was significantly lower in the CFS group (AM: 42 vs. 69 g, p < 0.001; roof: 33 vs. 49 g, p = 0.003). Full linear LA-LGE formation on 1-year MRI did not differ significantly between the groups (AM: 17 vs. 36%; roof; 29 vs. 24%, both p = NS). Kaplan–Meier estimates of AF/AT-free survival after ablation procedures were 63.6% in the CFS group and 58.6% in the Blind group (log-rank p = 0.837). Conclusions: In patients with PerAF, additional LA linear ablation following PVI using CF-sensing technology improved procedural safety and reduced the time needed to achieve conduction block. However, it did not significantly influence clinical outcomes or the formation of permanent full linear lesions. [ABSTRACT FROM AUTHOR]

Background: Myocardial fibrosis is often detected in patients with hypertrophic cardiomyopathy (HCM), which causes left ventricular (LV) dysfunction and tachyarrhythmias. Purpose: To evaluate the potential value of a machine learning (ML) approach that uses radiomic features from late gadolinium enhancement (LGE) and cine images for the prediction of ventricular tachyarrhythmia (VT) in patients with HCM. Material and Methods: Hyperenhancing areas of LV myocardium on LGE images were manually segmented, and the segmentation was propagated to corresponding areas on cine images. Radiomic features were extracted using the PyRadiomics library. The least absolute shrinkage and selection operator (LASSO) method was employed for radiomic feature selection. Our model development employed the TabPFN algorithm, an adapted Prior-Data Fitted Network design. Model performance was evaluated graphically and numerically over five-repeat fivefold cross-validation. SHapley Additive exPlanations (SHAP) were employed to determine the relative importance of selected radiomic features. Results: Our cohort consisted of 60 patients with HCM (73.3% male; median age = 51.5 years), among whom 17 had documented VT during the follow-up. A total of 1612 radiomic features were extracted for each patient. The LASSO algorithm led to a final selection of 18 radiomic features. The model achieved a mean area under the receiver operating characteristic curve of 0.877, demonstrating good discrimination, and a mean Brier score of 0.119, demonstrating good calibration. Conclusion: Radiomics-based ML models are promising for predicting VT in patients with HCM during the follow-up period. Developing predictive models as clinically useful decision-making tools may significantly improve risk assessment and prognosis. [ABSTRACT FROM AUTHOR]

Background: Children with repaired tetralogy of Fallot (rToF) often have pulmonary regurgitation with right ventricular (RV) dilatation and dysfunction, whereas less is known about the effect on the left ventricle (LV). The aim was to investigate LV haemodynamic variables derived from non-invasive pressure-volume loops in children with rToF and how they compare to controls and previous research on adults. Materials and methods: Ten children with rToF and pulmonary regurgitation (12 years [10–13], 6 males) and 10 age- and sex-matched healthy controls (12 years [10–14], 6 males) underwent brachial blood pressure in conjunction with cardiac magnetic resonance imaging. Pressure-volume loops were derived by brachial blood pressure together with LV volumes throughout the cardiac cycle in short-axis cine images yielding several haemodynamic variables, including arterial elastance. The RV endocardial border was delineated in end-diastole and end-systole. Results: Children with rToF and pulmonary regurgitation had larger RV end-diastolic volume (136 [114-156]) than controls (100 [94-112] ml/m2; p = 0.0015) and smaller LV end-diastolic volume (83 [58–91] ml/m2) than controls (101 [92–110] ml/m2; p = 0.002). Arterial elastance was higher in children with rToF (1.5 [1.3-2.7] mmHg/ml) than in controls (1.1 [1.0-1.5] mmHg/ml; p = 0.02). Heart rate was higher in children with rToF (77 [74-81] bpm) than in controls (69 [65–75] bpm; p = 0.027). Conclusion: Children with rToF had higher arterial elastance and heart rate than controls, likely due to increased sympathetic tone to compensate for impaired LV filling following pulmonary regurgitation. If this contributes to increased risk of adverse cardiovascular and cerebrovascular events remains to be studied. [ABSTRACT FROM AUTHOR]

The impact of hypertension (HT) on phenotypic expression in individuals with hypertrophic cardiomyopathy (HCM) is unclear. Thirty-six HCM individuals without HT, 27 HCM with HT, and 20 age- and sex-matched healthy controls who underwent cardiovascular magnetic resonance imaging (CMR) to evaluate left ventricular (LV) function and strain were enrolled. Three groups' LV function and strain were compared. We also investigated whether HT was associated with reduced LV strain in HCM patients using univariate and multivariate linear regression analyses. HCM (with/without HT) patients had higher LV mass and LV mass index than the normal controls group. Furthermore, global radial strain, global circumferential strain (GCS), global longitudinal strain, global peak systolic strain rate of radial, and global peak diastolic strain rate of radial were significantly lower in HCM patients with HT, intermediate in HCM patients without HT, and greater in the normal controls (all, P<0.05). Worse GCS was observed in HCM patients with HT than those without HT (P<0.05). Multivariable linear regression analysis showed that HT was independently associated with impaired LV ejection fraction and reduced strain (all P<0.05). The presence of HT was associated with an adverse phenotype, including worse ejection fraction and reduced strains in HCM patients. In addition, management of HT and its effect on the clinical outcomes in HCM patients needs to be studied. • HT had an additive deleterious effect on LV strain in patients with HCM. • HT was associated with reduced strains in patients HCM. • CMR may be a valuable tool for detecting LV injury in HCM patients with HT. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the prognostic value of cardiac magnetic resonance (CMR) variables and compare them with biological and echocardiographic markers in patients with AL cardiac amyloidosis (CA). Methods: We conducted a prospective study across three tertiary centres, where patients underwent clinical examination, blood tests, echocardiography, and CMR. The primary endpoint was all-cause mortality. Results: A total of 176 patients with AL CA were included, with a median age of 68 years (IQR 58-75). According to the 2004 Mayo Clinic staging, 121 patients (69%) were in stage 3. During a median follow-up of 22 months (IQR 8–48), 45 patients died, and 55 were hospitalized for heart failure. Patients who died had higher NT-proBNP and troponin levels, and lower LVEF, cardiac output, and longitudinal strain. Among CMR variables, extracellular volume (ECV) was most strongly associated with all-cause mortality. In multivariate Cox models, including Mayo Clinic staging, ECV ≥ 0.45 was independently associated with mortality (HR 2.36, CI 95% 1.47–5.60) and also with heart failure hospitalizations (HR 4.10, 95%CI 2.15–8.8). Conclusion: ECV is a powerful predictor of outcomes in AL CA, providing additional prognostic value on top of Mayo Clinic staging. [ABSTRACT FROM AUTHOR]

• Myocardial fibrosis is found across heart diseases and is a predictor of mortality. • Current diagnostic tools have limited availability, specificity and sensitivity. • Extracellular matrix-derived circulating biomarkers of fibrosis are warranted. • Lack of mechanistic insight impedes development of anti-fibrotic therapy. • Extracellular matrix components may constitute novel therapeutic drug targets. Fibrosis is defined by the excessive accumulation of extracellular matrix (ECM) and constitutes a central pathophysiological process that underlies tissue dysfunction, across organs, in multiple chronic diseases and during aging. Myocardial fibrosis is a key contributor to dysfunction and failure in numerous diseases of the heart and is a strong predictor of poor clinical outcome and mortality. The excess structural and matricellular ECM proteins deposited by cardiac fibroblasts, is found between cardiomyocytes (interstitial fibrosis), in focal areas where cardiomyocytes have died (replacement fibrosis), and around vessels (perivascular fibrosis). Although myocardial fibrosis has important clinical prognostic value, access to cardiac tissue biopsies for histological evaluation is limited. Despite challenges with sensitivity and specificity, cardiac magnetic resonance imaging (CMR) is the most applicable diagnostic tool in the clinic, and the scientific community is currently actively searching for blood biomarkers reflecting myocardial fibrosis, to complement the imaging techniques. The lack of mechanistic insights into specific pro- and anti-fibrotic molecular pathways has hampered the development of effective treatments to prevent or reverse myocardial fibrosis. Development and implementation of anti-fibrotic therapies is expected to improve patient outcomes and is an urgent medical need. Here, we discuss the importance of the ECM in the heart, the central role of fibrosis in heart disease, and mechanistic pathways likely to impact clinical practice with regards to diagnostics of myocardial fibrosis, risk stratification of patients, and anti-fibrotic therapy. [ABSTRACT FROM AUTHOR]

Diastolic vortex ring (VR) plays a key role in the blood-pumping function exerted by the left ventricle (LV), with altered VR structures being associated with LV dysfunction. Herein, we sought to characterize the VR diastolic alterations in ischemic cardiomyopathy (ICM) patients with systo-diastolic LV dysfunction, as compared to healthy controls, in order to provide a more comprehensive understanding of LV diastolic function. 4D Flow MRI data were acquired in ICM patients (n = 15) and healthy controls (n = 15). The λ2 method was used to extract VRs during early and late diastolic filling. Geometrical VR features, e.g., circularity index (CI), orientation (α), and inclination with respect to the LV outflow tract (ß), were extracted. Kinetic energy (KE), rate of viscous energy loss ( EL ˙ ), vorticity (W), and volume (V) were computed for each VR; the ratios with the respective quantities computed for the entire LV were derived. At peak E-wave, the VR was less circular (p = 0.032), formed a smaller α with the LV long-axis (p = 0.003) and a greater ß (p = 0.002) in ICM patients as compared to controls. At peak A-wave, CI was significantly increased (p = 0.034), while α was significantly smaller (p = 0.016) and β was significantly increased (p = 0.036) in ICM as compared to controls. At both peak E-wave and peak A-wave, EL ˙ VR / EL ˙ LV , WVR/WLV, and VVR/VLV significantly decreased in ICM patients vs. healthy controls. KEVR/VVR showed a significant decrease in ICM patients with respect to controls at peak E-wave, while VVR remained comparable between normal and pathologic conditions. In the analyzed ICM patients, the diastolic VRs showed alterations in terms of geometry and energetics. These derangements might be attributed to both structural and functional alterations affecting the infarcted wall region and the remote myocardium. [ABSTRACT FROM AUTHOR]

Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data is not currently available for ECG-gated computed tomography angiography (CTA). We sought to establish ECG-gated CTA-derived normative values for the aortic root, aorta, and aortic arch in children. Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 and December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface areaAE (BSAAE) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements. Conclusion: Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta, and aortic arch in children. What is Known: • Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity. What is New: • Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the aortic root, aorta and aortic arch in children. [ABSTRACT FROM AUTHOR]

It is well appreciated that the Fontan circulation perturbs central venous hemodynamics, with elevated pressure being the clearest change associated with Fontan comorbidities, such as Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE). Our group has better quantity of these venous perturbations through single- and multi-location analyses of flow waveforms obtained from magnetic resonance imaging of Fontan patients. Here, we determine if such analyses, which yield principal components (PC) that describe flow features, are associated with Fontan survival. Patients with a Fontan circulation (N = 140) that underwent free-breathing and mechanically ventilated cardiac MRI were included in this study. Standard volumetric and functional hemodynamics, as well as flow analysis principal components, were subjected to univariate and bivariate Cox regression analyses to determine composite clinical outcome, including plastic bronchitis, PLE, and referral and receipt of transplant. Unsurprisingly, ventricular function measures of ejection fraction (EF; HR = 0.88, p < 0.0001), indexed end-systolic volume (ESVi; HR 1.02, p < 0.0001), and indexed end-diastolic volume (EDVi; HR = 1.02, p = 0.0007) were found as specific predictors of clinical events, with specificities uniformly > 0.75. Additionally a feature of IVC flow (PC2) indicating increased flow in systole was found as a highly sensitive predictor (HR = 0.851, p = 0.027, sensitivity 0.93). In bivariate prediction, combinations of ventricular function (EF, ESVi, EDVi) with this IVC flow feature yielded best overall prediction of composite outcome. This suggests that central venous waveform analysis relays additional information about Fontan patient survival and that coupling sensitive and specific measures in bivariate analysis is a useful approach for obtaining superior prediction of survival. [ABSTRACT FROM AUTHOR]

Left ventricular shape alterations predict cardiovascular outcomes and have been observed in children born preterm and after fetal growth restriction (FGR). The aim was to investigate whether left ventricular shape is altered in adolescents born very preterm and if FGR has an additive effect. Adolescents born very preterm due to verified early-onset FGR and two control groups with birthweight appropriate for gestational age (AGA), born at similar gestational age and at term, respectively, underwent cardiac MRI. Principal component analysis was applied to find the modes of variation best explaining shape variability for end-diastole, end-systole, and for the combination of both, the latter indicative of function. Seventy adolescents were included (13–16 years; 49% males). Sphericity was increased for preterm FGR versus term AGA for end-diastole (36[0–60] vs − 42[− 82–8]; p = 0.01) and the combined analysis (27[− 23–94] vs − 51[− 119–11]; p = 0.01), as well as for preterm AGA versus term AGA for end-diastole (30[− 56–115] vs − 42[− 82–8]; p = 0.04), for end-systole (57[− 29–89] vs − 30[− 79–34]; p = 0.03), and the combined analysis (44[− 50–145] vs − 51[− 119–11]; p = 0.02). No group differences were observed for left ventricular mass or ejection fraction (all p ≥ 0.33). Sphericity was increased after very preterm birth and exacerbated by early-onset FGR, indicating an additive effect to that of very preterm birth on left ventricular remodeling. Increased sphericity may be a prognostic biomarker of future cardiovascular disease in this cohort that as of yet shows no signs of cardiac dysfunction using standard clinical measurements. [ABSTRACT FROM AUTHOR]

The technique of PC-MRI flow measurement offers a great opportunity to diagnose and understand the pathogenesis of various diseases and clinical pictures. Although previously criticized for its lack of accuracy, the method is now expanding the possibilities in several research areas. In this study, the design of an MR-compatible pump for the validation of PC-MRI flow measurements is presented. Initial PC-MRI measurements have demonstrated MRcompatibility and the ability to record artifact-free flows. The flow generated by the pump was further measured with an ultrasound flow sensor and compared with a physiological flow curve. The results showed that both the course and the minima and maxima match. Thus, the resulting pump generates a bidirectional, pulsatile flow within a physiological range and a variable frequency between 60-90 rpm with a stroke volume of 0.9 ml. Further flows, frequencies and stroke volumes can be adjusted. This enables the validation of PCMRI flow measurements and addresses current difficulties such as the lack of in vivo data. [ABSTRACT FROM AUTHOR]

Previous observational studies have explored the association between serum lipids, apolipoproteins, and adverse ventricular/aortic structure and function. However, whether a causal link exists is uncertain. This study employed a two-sample Mendelian randomization (MR), colocalization, reverse, and multivariable MR (MVMR) approach to examine the causal associations among five serum lipids, two apolipoproteins, and 32 cardiac magnetic resonance (CMR) traits. Utilizing single-nucleotide polymorphisms (SNPs) linked to serum lipids and apolipoproteins as instrumental variables. CMR traits from seven independent genome-wide association studies served as preclinical endophenotypes, offering insights into aortic and cardiac structure/function. The primary analysis utilized a random-effects inverse variance method (IVW), followed by sensitivity and validation analyses. In the primary IVW MR analyses, genetically predicted low-density lipoprotein cholesterol (LDL-C) levels were positively correlated with increased descending aorta strain (DAo strain) (β = 0.098; P = 2.69E-07) and ascending aorta strain (AAo strain) (β = 0.079; P = 5.19E-05). Genetically predicted high-density lipoprotein cholesterol (HDL-C) levels were positively correlated with left ventricular radial peak diastolic strain rate (LV-PDSRll) (β = 0.176; P = 2.89E-05) and the left ventricular longitudinal peak diastolic strain rate (LV-PDSRrr) (β = 0.059; P = 2.44E-06), and negatively correlated with left ventricular regional wall thickness (LVRWT). While apolipoprotein B (ApoB) levels were positively correlated with AAo strain (β = 0.076; P = 1.16E-05), DAo strain (β = 0.065; P = 2.77E-05). A shared causal variant was identified to demonstrate the associations of ApoB with AAo strain and DAo strain using colocalization analysis. Sensitivity analyses confirmed the robustness of these associations. Targeting lipid and apolipoprotein levels through interventions may provide novel strategies for the primary prevention of CVDs. [ABSTRACT FROM AUTHOR]

Cardiac magnetic resonance (CMR) enables the assessment of tissue characteristics of the myocardium. Changes in the extracellular volume (ECV) and fibrosis volume (FV) of the myocardium are sensitive and early pathogenetic markers and have prognostic significance. The aim of the study was to assess ECV and FV of left ventricular myocardium in T1 mapping sequence in patients with a history of SARS-CoV-2 infection, considering vaccination status against COVID-19. The study group consisted of 97 patients (52.54 ± 8.31 years, 53% women and 47% men). The participants were divided into three subgroups: A) patients with a history of symptomatic SARS-CoV-2 infection, unvaccinated against COVID-19 (n = 39), B) patients with a history of symptomatic SARS-CoV-2 infection, with a full vaccination schedule against COVID-19 (n = 22), and C) persons without a history of SARS-CoV-2 infection constituting the control subgroup (C, n = 36). All patients underwent 1.5 T cardiac magnetic resonance. In subgroup A compared to subgroups B and C, both the ECV whole myocardium and ECV segments 2, 5–6, 8, and 10–11 were statistically significantly higher. In addition, the ECV segment 16 was statistically significantly higher in subgroup A than in subgroup C. Also, the FV whole myocardium was statistically significantly higher in subgroup A in comparison to subgroups B and C. There were no significant differences in ECV and FV between subgroups B and C. In summary, unvaccinated against COVID-19 patients with a history of symptomatic SARS-CoV-2 infection have higher myocardial ECV and FV values in the T1 mapping sequence, compared to those without COVID-19 and those suffering from COVID-19, previously vaccinated with the full vaccination schedule. [ABSTRACT FROM AUTHOR]

Native T1 mapping is a non‐invasive technique used for early detection of diffused myocardial abnormalities, and it provides baseline tissue characterization. Post‐contrast T1 mapping enhances tissue differentiation, enables extracellular volume (ECV) calculation, and improves myocardial viability assessment. Accurate and precise segmenting of the left ventricular (LV) myocardium on T1 maps is crucial for assessing myocardial tissue characteristics and diagnosing cardiovascular diseases (CVD). This study presents a deep learning (DL)–based pipeline for automatically segmenting LV myocardium on T1 maps and automatic computation of radial T1 and ECV values. The study employs a multicentric dataset consisting of retrospective multiparametric MRI data of 332 subjects to develop and assess the performance of the proposed method. The study compared DL architectures U‐Net and Deep Res U‐Net for LV myocardium segmentation, which achieved a dice similarity coefficient of 0.84 ± 0.43 and 0.85 ± 0.03, respectively. The dice similarity coefficients computed for radial sub‐segmentation of the LV myocardium on basal, mid‐cavity, and apical slices were 0.77 ± 0.21, 0.81 ± 0.17, and 0.61 ± 0.14, respectively. The t‐test performed between ground truth vs. predicted values of native T1, post‐contrast T1, and ECV showed no statistically significant difference (p > 0.05) for any of the radial sub‐segments. The proposed DL method leverages the use of quantitative T1 maps for automatic LV myocardium segmentation and accurately computing radial T1 and ECV values, highlighting its potential for assisting radiologists in objective cardiac assessment and, hence, in CVD diagnostics. [ABSTRACT FROM AUTHOR]

The diagnostic work-up for myocarditis largely depends on non-invasive imaging because of the low yield of endomyocardial biopsy. In addition, differentiation among possible impressions is essential because of its non-specific clinical presentations. This ambiguity has led to the predominant use of cardiac magnetic resonance imaging techniques in the management of myocarditis, particularly during the global pandemic. Despite the unique ability of F-18 fluorodeoxyglucose positron emission tomography to visualize and quantify active myocardial inflammation, which has been well established in cardiac sarcoidosis, its diagnostic contribution in non-sarcoidotic myocarditis remains uncertain. This article reviews the current evidence on the non-invasive imaging diagnosis of non-sarcoidotic myocarditis and discusses the potential role of F-18 fluorodeoxyglucose positron emission tomography as a clinically relevant imaging tool. [ABSTRACT FROM AUTHOR]

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Aging-induced aortic stiffness has been associated with altered fatty acid metabolism. We studied aortic stiffness using cardiac magnetic resonance (CMR)-assessed ventriculo-arterial coupling (VAC) and novel aortic (AO) global longitudinal strain (GLS) combined with targeted metabolomic profiling. Among community older adults without cardiovascular disease, VAC was calculated as aortic pulse wave velocity (PWV), a marker of arterial stiffness, divided by left ventricular (LV) GLS. AOGLS was the maximum absolute strain measured by tracking the phasic distance between brachiocephalic artery origin and aortic annulus. In 194 subjects (71 ± 8.6 years; 88 women), AOGLS (mean 5.6 ± 2.1%) was associated with PWV (R = −0.3644, p < 0.0001), LVGLS (R = 0.2756, p = 0.0001) and VAC (R = −0.3742, p <0.0001). Stiff aorta denoted by low AOGLS <4.26% (25th percentile) was associated with age (OR 1.13, 95% CI 1.04–1.24, p = 0.007), body mass index (OR 1.12, 95% CI 1.01–1.25, p = 0.03), heart rate (OR 1.04, 95% CI 1.01–1.06, p = 0.011) and metabolites of medium-chain fatty acid oxidation: C8 (OR 1.005, p = 0.026), C10 (OR 1.003, p = 0.036), C12 (OR 1.013, p = 0.028), C12:2-OH/C10:2-DC (OR 1.084, p = 0.032) and C16-OH (OR 0.82, p = 0.006). VAC was associated with changes in long-chain hydroxyl and dicarboxyl carnitines. Multivariable models that included acyl-carnitine metabolites, but not amino acids, significantly increased the discrimination over clinical risk factors for prediction of AOGLS (AUC [area-under-curve] 0.73 to 0.81, p = 0.037) and VAC (AUC 0.78 to 0.87, p = 0.0044). Low AO GLS and high VAC were associated with altered medium-chain and long-chain fatty acid oxidation, respectively, which may identify early metabolic perturbations in aging-associated aortic stiffening. Trial registration: ClinicalTrials.gov Identifier: NCT02791139 [ABSTRACT FROM AUTHOR]

Background: Four‐dimensional‐flow cardiac MR (4DF‐MR) offers advantages in primary mitral regurgitation. The relationship between 4DF‐MR‐derived mitral regurgitant volume (MR‐Rvol) and the post‐operative left ventricular (LV) reverse remodeling has not yet been established. Purpose: To ascertain if the 4DF‐MR‐derived MR‐Rvol correlates with the LV reverse remodeling in primary mitral regurgitation. Study Type: Prospective, single‐center, two arm, interventional vs. nonintervention observational study. Population: Forty‐four patients (male N = 30; median age 68 [59–75]) with at least moderate primary mitral regurgitation; either awaiting mitral valve surgery (repair [MVr], replacement [MVR]) or undergoing "watchful waiting" (WW). Field Strength/Sequence: 5 T/Balanced steady‐state free precession (bSSFP) sequence/Phase contrast imaging/Multishot echo‐planar imaging pulse sequence (five shots). Assessment: Patients underwent transthoracic echocardiography (TTE), phase‐contrast MR (PMRI), 4DF‐MR and 6‐minute walk test (6MWT) at baseline, and a follow‐up PMRI and 6MWT at 6 months. MR‐Rvol was quantified by PMRI, 4DF‐MR, and TTE by one observer. The pre‐operative MR‐Rvol was correlated with the post‐operative decrease in the LV end‐diastolic volume index (LVEDVi). Statistical Tests: Included Student t‐test/Mann–Whitney test/Fisher's exact test, Bland–Altman plots, linear regression analysis and receiver operating characteristic curves. Statistical significance was defined as P < 0.05. Results: While Bland–Altman plots demonstrated similar bias between all the modalities, the limits of agreement were narrower between 4DF‐MR and PMRI (bias 15; limits of agreement −36 mL to 65 mL), than between 4DF‐MR and TTE (bias −8; limits of agreement −106 mL to 90 mL) and PMRI and TTE (bias −23; limits of agreement −105 mL to 59 mL). Linear regression analysis demonstrated a significant association between the MR‐Rvol and the post‐operative decrease in the LVEDVi, when the MR‐Rvol was quantified by PMRI and 4DF‐MR, but not by TTE (P = 0.73). 4DF‐MR demonstrated the best diagnostic performance for reduction in the post‐operative LVEDVi with the largest area under the curve (4DF‐MR 0.83; vs. PMRI 0.78; and TTE 0.51; P = 0.89). Data Conclusion: This study demonstrates the potential clinical utility of 4DF‐MR in the assessment of primary mitral regurgitation. Evidence Level: 2 Technical Efficacy: Stage 5 [ABSTRACT FROM AUTHOR]

Background: Balanced steady‐state free precession (bSSFP) imaging is commonly used in cardiac cine MRI but prone to image artifacts. Ferumoxytol‐enhanced (FE) gradient echo (GRE) has been proposed as an alternative. Utilizing the abundance of bSSFP images to develop a computationally efficient network that is applicable to FE GRE cine would benefit future network development. Purpose: To develop a variable‐splitting spatiotemporal network (VSNet) for image reconstruction, trained on bSSFP cine images and applicable to FE GRE cine images. Study Type: Retrospective and prospective. Subjects: 41 patients (26 female, 53 ± 19 y/o) for network training, 31 patients (19 female, 49 ± 17 y/o) and 5 healthy subjects (5 female, 30 ± 7 y/o) for testing. Field Strength/Sequence: 1.5T and 3T, bSSFP and GRE. Assessment: VSNet was compared to VSNet with total variation loss, compressed sensing and low rank methods for 14× accelerated data. The GRAPPA×2/×3 images served as the reference. Peak signal‐to‐noise‐ratio (PSNR), structural similarity index (SSIM), left ventricular (LV) and right ventricular (RV) end‐diastolic volume (EDV), end‐systolic volume (ESV), and ejection fraction (EF) were measured. Qualitative image ranking and scoring were independently performed by three readers. Latent scores were calculated based on scores of each method relative to the reference. Statistics: Linear mixed‐effects regression, Tukey method, Fleiss' Kappa, Bland–Altman analysis, and Bayesian categorical cumulative probit model. A P‐value <0.05 was considered statistically significant. Results: VSNet achieved significantly higher PSNR (32.7 ± 0.2), SSIM (0.880 ± 0.004), rank (2.14 ± 0.06), and latent scores (−1.72 ± 0.22) compared to other methods (rank >2.90, latent score < −2.63). Fleiss' Kappa was 0.52 for scoring and 0.61 for ranking. VSNet showed no significantly different LV and RV ESV (P = 0.938) and EF (P = 0.143) measurements, but statistically significant different (2.62 mL) EDV measurements compared to the reference. Conclusion: VSNet produced the highest image quality and the most accurate functional measurements for FE GRE cine images among the tested 14× accelerated reconstruction methods. Level of Evidence: 3 Technical Efficacy: Stage 1 [ABSTRACT FROM AUTHOR]

Background: Patients with restrictive cardiomyopathy (RCM) have impaired diastolic filling and hemodynamic congestion. Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) reflect the hemodynamic status, but the relationship with left ventricle (LV) dysfunction remains unclear. Purpose: To evaluate the PTT and PBVi in RCM patients, the association with diastolic dysfunction and LV deformation, and the effects on the occurrence of major adverse cardiac events (MACE) in RCM patients. Study Type: Retrospective. Population: 137 RCM patients (88 men, age 58.80 ± 10.83 years) and 68 age‐ and sex‐matched controls (46 men, age 57.00 ± 8.59 years). Field Strength/Sequence: 3.0T/Balanced steady‐state free precession sequence, recovery prepared echo‐planar imaging sequence, and phase‐sensitive inversion recovery sequence. Assessment: The LV function and peak strain (PS) parameters were measured. The PTT was calculated and corrected by heart rate (PTTc). The PBVi was calculated as the product of PTTc and RV stroke volume index. Statistical Tests: Chi‐squared test, student's t‐test, Mann–Whitney U test, Pearson's or Spearman's correlation, multivariate linear regression, Kaplan–Meier survival analysis, and Cox regression models analysis. A P‐value <0.05 was considered statistically significant. Results: The PTTc showed a significant correlation with the E/A ratio (r = 0.282), and PBVi showed a significant correlation with the E/e′ ratio, E/A ratio, and diastolic dysfunction stage (r = 0.222, 0.320, and 0.270). PTTc showed an independent association with LVEF, LV circumferential PS, and LV longitudinal PS (β = 0.472, 0.299, and 0.328). In Kaplan–Meier analysis, higher PTTc and PBVi were significantly associated with MACE. In multivariable Cox regression analysis, PTTc was a significantly independent predictor of the MACE in combination with both cardiac MRI functional and tissue parameters (hazard ratio: 1.23/1.32, 95% confidence interval: 1.10–1.42/1.20–1.46). Data Conclusion: PTTc and PBVi are associated with diastolic dysfunction and deteriorated LV deformation, and PTTc independently predicts MACE in patients with RCM. Level of Evidence: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Deep phenotyping the right ventricle (RV) is essential for understanding the mechanisms of adaptive and maladaptive RV responses to pulmonary hypertension (PH). In this study, feature selection coupled with machine learning classification/ranking of specific cardiac magnetic resonance imaging (MRI) features from cine-MRI, flow-sensitized, and extracellular-volume techniques were used to assess RV remodelling in monocrotaline (MCT) and Sugen hypoxia (SuHx) PH rats. Early physiological changes associated with RV adaptation were detected along with prediction of RV maladaptive outcomes. Key adaptation features included haemodynamic alterations of pulmonary blood flow ejection and wave reflection, mild RV dilatation, progressive RV hypertrophy with subtle extracellular volume growth of RV wall. A dominant component of maladaptation was the extracellular matrix increase at RV insertion points and septum, observations compatible with histopathologic and RNA-sequencing results. The upregulation of mammalian target of rapamycin (mTOR) paralleled by AMP-activated protein kinase (AMPK) deactivation was seen at 4-week MCT and 8-week SuHx, along with reduced sarcoplasmic/endoplasmic reticulum Ca2+ATPase (SERCA2) expression, strongly associated with the RV systolic malfunction seen at this stage in vivo. The here established MRI features can serve as potential imaging biomarkers to evaluate PH treatment efficacy in preclinical studies and build up translational markers for the PH clinic. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Left atrial (LA) remodeling plays a significant role in the progression of atrial fibrillation (AF). Although LA wall thickness (LAWT) has emerged as an indicator of structural remodeling, its impact on AF outcomes remains unclear. We aimed to determine the association between LAWT and AF recurrence after pulmonary vein isolation (PVI), as well as to evaluate the relationship between LAWT and LA fibrosis.Single‐center registry of patients enrolled for radiofrequency PVI from 2016 to 2018. In all cases, a pre‐ablation CT was performed within less than 48 h. Mean LAWT was retrospectively measured by a semi‐automated machine learning method (ADAS 3D). A subgroup of patients also underwent pre‐ablation cardiac MRI. The primary endpoint was time to AF recurrence after a 3‐month blanking period.A total of 439 patients (mean age 61 ± 12 years, 62% male, 78% with paroxysmal AF) were included. The mean LAWT was 1.4 ± 0.2 mm (0.9–1.9 mm). During a median follow‐up of 5.8 (IQR: 4.9–6.6) years, 238 patients (54%) had an AF relapse. After adjusting for 8 clinical and imaging potential confounders, LAWT remained an independent predictor of time‐to‐recurrence (aHR: 4.25 [95% CI: 1.65–10.95], p = 0.003). AF recurrence rates were 11%, 15%, and 21%/year across terciles of increasing LAWT (log‐rank p < 0.001). Additionally, the AF recurrence rate increased across the spectrum of LA structural remodeling, ranging from 8% (normal LAWT and LAVI) to 30%/year (LAWT and LAVI both increased). In the 62 patients who also underwent pre‐ablation MRI, a moderate relationship between LAWT and fibrosis (assessed by late‐gadolinium enhancement) was found (Spearman R 0.468; p < 0.001).Mean LAWT, easily assessed by commercially available machine learning software, is an independent predictor of time to AF recurrence after PVI in the long term. Whether patients with increased LAWT should receive tailored therapy deserves further investigation. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Recent advances in deep learning have sparked new research interests in dynamic magnetic resonance imaging (MRI) reconstruction. However, existing deep learning‐based approaches suffer from insufficient reconstruction efficiency and accuracy due to the lack of time correlation modeling during the reconstruction procedure.Inappropriate tensor processing steps and deep learning models may lead to not only a lack of modeling in the time dimension but also an increase in the overall size of the network. Therefore, this study aims to find suitable tensor processing methods and deep learning models to achieve better reconstruction results and a smaller network size.We propose a novel unrolling network method that enhances the reconstruction quality and reduces the parameter redundancy by introducing time correlation modeling into MRI reconstruction with low‐rank core matrix and convolutional long short‐term memory (ConvLSTM) unit.We conduct extensive experiments on AMRG Cardiac MRI dataset to evaluate our proposed approach. The results demonstrate that compared to other state‐of‐the‐art approaches, our approach achieves higher peak signal‐to‐noise ratios and structural similarity indices at different accelerator factors with significantly fewer parameters.The improved reconstruction performance demonstrates that our proposed time correlation modeling is simple and effective for accelerating MRI reconstruction. We hope our approach can serve as a reference for future research in dynamic MRI reconstruction. [ABSTRACT FROM AUTHOR]

Summary Visual perceptual artefacts are distortions or illusions in medical image interpretation arising from the human visual system rather than hardware or imaging acquisition processes. These artefacts, emerging at various visual processing stages, such as the retina, visual pathways, visual cortex, and cognitive interpretation stages, impact the interpretation of cardiothoracic images. This review discusses artefacts including Mach bands, Dark Rim, Background Effects, Ambiguous Figures, Subjective Contours, and the Parallax Effect. A thorough literature search was conducted using PubMed and Google Scholar. Search terms included ‘visual perceptual artifacts’, ‘cardiothoracic imaging’, ‘Mach bands’, ‘dark rim artifact’, ‘stress cardiac MRI’, and ‘radiology visual illusions’. Inclusion criteria encompassed studies focusing on visual perceptual artefacts in cardiothoracic imaging published in peer‐reviewed journals. Studies not addressing visual perceptual artefacts or those focusing on imaging technology, hardware, or software‐related artefacts were excluded. Duplicate studies were removed, and a final selection of 32 studies was analysed. Several key visual perceptual artefacts relevant to cardiothoracic imaging were identified. Mach bands, caused by lateral inhibition in the retina, create false contrasts at object boundaries, potentially mimicking pathologies such as fractures or pneumothoraces. The dark rim artefact observed on stress cardiac MRI, resulting from Gibbs ringing or truncation artefacts, can simulate perfusion defects and complicate diagnosis. Lateral inhibition can possibly accentuate the appearance of the dark rim artefact. Artefacts also fall under illusions of sensation, perception, and image formation. These illusions present both risks and benefits to diagnostic radiology. Recognizing visual perceptual artefacts is crucial for improving diagnostic accuracy and developing strategies to mitigate their impact. A comprehensive understanding and training on these artefacts are essential for radiologists to enhance interpretive skills, reduce diagnostic errors, and ultimately improve patient care in radiology. [ABSTRACT FROM AUTHOR]

Background: Microvascular obstruction (MVO) develops in approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) after undergoing percutaneous coronary intervention (PCI). MVO is strongly linked to inflammation, myocardial fibrosis, and adverse clinical outcomes. Soluble suppression of tumorigenicity 2 (sST2) serves as a biomarker for inflammation and myocardial fibrosis. Yet, the correlation between sST2 and MVO in STEMI patients has not been fully elucidated. This study attempts to evaluate the association between sST2 levels and MVO in STEMI patients following pPCI. Methods: In this retrospective study, 315 STEMI patients who underwent pPCI at the Affiliated Hospital of Xuzhou Medical University between June 2018 and August 2023 were included. Cardiac magnetic resonance imaging (CMR) was used to assess the characteristics of myocardial infarction and microvascular obstruction (MVO), while sST2 levels were measured upon admission. Results: The median time for completion of CMR after hospitalization was 5 (4, 6) days. Multivariate regression analysis showed that sST2 (OR 1.01, 95% CI 1.01–1.02, p < 0.001), peak high-sensitivity troponin T (OR 2.40, 95% CI 1.66–3.47, p < 0.001), peak high-C-reactive protein (OR 1.01, 95% CI 1.01–1.02, p < 0.001), left ventricular ejection fraction (OR 0.93, 95% CI 0.89– 0.98, p = 0.009) and age (OR 1.03, 95% CI 1.01– 1.05, p = 0.042)were independently associated with MVO. Conclusion: sST2 is associated with MVO after pPCI in STEMI patients. Incorporating soluble ST2 (sST2) into the risk model for MVO leads to significant improvement. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Echogenic masses in the mitral annulus are often incidental findings during routine echocardiography examinations. Most represent the wide spectrum of underlying mitral annular calcifications and usually do not require further diagnostic workup. However, a rare variant called “caseous calcification of the mitral annulus” (CCMA) can be challenging to diagnose and often requires an extensive workup with the use of multiple imaging studies in order to accurately confirm the pathology. Case Reports: The aim of this case series was to illustrate the range of challenges associated with CCMA in various clinical scenarios to highlight the importance of multi-modality imaging in the differential diagnosis. Patient 1 was a 78-year-old asymptomatic woman with a round echo-dense structure incidentally found during a routine echocardiographic examination. Patient 2 was a 79-year-old woman with a suspected mitral abscess. Patient 3 was a 73-year-old woman with an incidentaloma (lung mass), with a concomitant lesion of the mitral annulus. All 3 patients required a unique combination of confirmatory imaging studies to ultimately confirm their diagnosis. Conclusions: The incidental detection of CCMA-like changes requires multi-modality imaging to differentiate from abscesses and proliferative changes in the mitral annulus. Transthoracic echocardiography, transesophageal echocardiography, computed tomography, and cardiac magnetic resonance imaging play a key role in this diagnostic workup. Using a combination of these imaging modalities can enhance diagnostic accuracy and strongly influence the subsequent treatment and management strategies. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion Right ventricular reverse remodelling (RVRR) is linked to improved survival in patients with severe tricuspid regurgitation (TR) and right‐sided heart failure who underwent interventional treatment. However, the role of residual TR on RVRR remains unclear. In this analysis the impact of residual TR on RVRR after interventional TR treatment, which was validated by two independent cohorts at four sites using echocardiography or cardiac magnetic resonance (CMR) imaging, was investigated.Overall, 253 patients who were treated for severe TR and right‐sided heart failure using different treatment modalities (tricuspid transcatheter edge‐to‐edge repair [T‐TEER], transcatheter tricuspid valve annuloplasty, orthotopic transcatheter TV replacement [TTVR], heterotopic TTVR) were included. Three‐dimensional echocardiographic and CMR‐based assessment of RVRR and clinical evaluation of decongestion or exercise capacity were performed at baseline and 30 days after the procedure. Mortality was analysed at 1 year after transcatheter tricuspid valve intervention (TTVI). In patients with residual TR ≤1+ pronounced reduction of right ventricular end‐diastolic and end‐systolic volumes was observed. In patients with residual TR ≥2+ the effect of RVRR gradually decreased with higher residual TR reinforcing the relevance of optimal procedural results for RVRR. These findings were validated in two independent cohorts. In contrast to RVRR, residual TR ≤1+ and 2+ were associated with similar 1‐year survival. RVRR was only observed after T‐TEER or orthotopic TTVR, but not after heterotopic TTVR as expected. However, all three treatment modalities were accompanied by significant decongestion and functional improvement at 30‐day follow‐up.In patients with severe TR and right‐sided heart failure undergoing TTVI, superior procedural results were associated with more pronounced RVRR. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial Infarct Size (IS) determined soon after ST-segment elevation myocardial infarction (STEMI) has prognostic significance, and can be assessed by cardiac biomarker levels, electrocardiographic (ECG) parameters, and imaging modalities (including echocardiography and cardiac magnetic resonance imaging [CMRI]). Objectives and methods: We evaluated methods of IS assessment, 12-lead ECG Selvester QRS scores and high-sensitivity Troponin T (hsTnT) levels measured ≥48hr (plateau phase of hsTnT elevation), compared to paired CMRIs and echocardiograms, in a prospective cohort of patients with STEMI undergoing percutaneous coronary intervention (PCI) during the index hospitalisation. Associations were determined between IS, as assessed by these methods, and 24-month major adverse cardiac events (MACE), a hierarchical composite of: death, stroke and hospitalization for heart failure. Results: Of 233 patients undergoing early CMRI after STEMI, 211 patients (86% male; 54% anterior MI) had first STEMIs, median age 56 years [interquartile range 50–64], of whom 165 (78%) underwent primary PCI and 46 (22%) pharmaco-invasive PCI. Ejection fraction improved from 48% [42–54] acutely to 52% [44–60] at 2 months (p< 0.05). Plateau phase hsTnT levels, QRS scoring and CMRI-determined IS post-STEMI correlated for anterior MIs (all comparisons r>0.4, p<0.01); highest tertiles of these 3 parameters predicted 24 month MACE (log-rank <0.01). Multi-variable binary logistic regression analysis showed 72h hsTnT levels predicted 24-month MACE (p<0.01). Conclusion: Post-PCI treatment of STEMI, hsTnT levels measured ≥48h and Selvester QRS scoring correlated with CMRI-determined IS. These parameters predicted MACE at 24 months and should be routinely assessed for post-STEMI risk stratification. [ABSTRACT FROM AUTHOR]

Background: Integration of artificial intelligence enhances precision, yielding dependable evaluations of left ventricular volumes and ejection fraction despite image quality variations. Commercial software like HeartModelAI provides fully automated 3DE quantification, simplifying the measurement of left chamber volumes and ejection fraction. In this manuscript, we present a cross-sectional study to assess and compare the diagnostic accuracy of automated 3D echocardiography (HeartModelAI) to the standard Cardiac Magnetic Resonance Imaging in patients with dilated cardiomyopathy. Methods: In this cross-sectional study, 30 patients with dilated cardiomyopathy referring to the Tehran Heart Center with cardiac magnetic resonance imaging and comprehensive 3D transthoracic echocardiography within 24 h were included. All 3D volume analysis was performed with fully automated quantification software (HeartModelAI) using 3D images of 2,3, and 4-chamber views at the end of systole and diastole. Results: Excellent Inter- and Intra-observer correlation coefficient was reported for HeartModelAI software for all indexes. HeartModelAI displayed a remarkable correlation with cardiac magnetic resonance for left ventricular end-systolic volume index (r = 0.918 and r = 0.911); nevertheless, it underestimated left ventricular end-systolic volume index and left ventricular end-diastolic volume index. Conversely, ejection fraction, stroke volume, and left ventricular mass were overestimated. It was found that manual contour correction can enhance the accuracy of automated model estimations, particularly concerning EF in participants needing correction. Conclusion: HeartModelAI software emerges as a rapid and viable imaging approach for evaluating the left ventricle's structure and function. In our study, LV volumes assessed by HeartModelAI demonstrated strong correlations with cardiac magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients. Methods: One hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS−) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain. Results: Compared to MetS(CAS−), MetS(NOCAS+) showed a significantly increased LV mass index (p < 0.05). Global longitudinal peak strain was decreased gradually from MetS(CAS−) through MetS(NOCAS+) to MetS(OCAS+) (− 13.02 ± 2.32% vs. − 10.34 ± 4.05% vs. − 7.55 ± 4.48%, p < 0.05). MetS(OCAS+) groups showed significantly decreased LV global peak strain (GPS), PSSR and PDSR in radial and circumferential directions compared with MetS(NOCAS+) (all p < 0.05). The degree of CAS was independently associated with impaired global radial peak strain (GRPS) (β = − 0.289, p < 0.001) and global longitudinal peak strain (GLPS) (β = 0.254, p = 0.004) in MetS patients. The ROC analysis showed that the degree of CAS can predict impaired GRPS (AUC = 0.730) and impaired GLPS (AUC = 0.685). Conclusion: Besides traditional biochemical indicators, incorporating CAS assessment and CMR assessment of the LV into routine evaluations ensures a more holistic approach to managing MetS patients. Timely intervention of CAS is crucial for improving cardiovascular outcomes in this high-risk population. [ABSTRACT FROM AUTHOR]

Computer-aided Medical Image Segmentation (MIS) plays a leading role in diagnosing diseases automatically. MIS is used extensively in diagnosing medical ailments to obtain clinically relevant information of the shapes and volumes of the target organs and tissues. In order to facilitate accurate segmentation, a Block Attention Based Deep Residual Neural Network, i.e., CBAR-UNet model, is proposed to perform cardiac image segmentation on short axis Magnetic Resonance Images (MRI) stacks from top to bottom slice. The Automated Cardiac Diagnosis Challenge (ACDC) dataset is used in the proposed work, which comprise of a 3D MRI of 100 patients (i.e., 200 MRI stacks). Further, 3D MRIs are converted into 2D by slicing each image to train the model, and Contrast Limited Adaptive Histogram Equalization (CLAHE) is performed on the 2D dataset. Residual connections are introduced that aid in training deeper models. Convolutional Block Attention Module (CBAM) is also added in the proposed network, which consists of Spatial and Channel attention that enhances the spatial and channel-wise features in the image by providing information like 'what' and 'where' to pay attention respectively. To test and validate the proposed methodology, extensive experimentations were conducted and it was observed that proposed image segmentation model delivers better results by 2.47% when compared to both 2D and 3D State-Of-The-Art (SOTA) methods with a Dice Score of 0.9428. [ABSTRACT FROM AUTHOR]

Background: Accurate measurements of flow and ventricular volume and function are critical for clinical decision-making in cardiovascular medicine. Cardiac magnetic resonance (CMR) is the current gold standard for ventricular functional evaluation but is relatively expensive and time-consuming, thus limiting the scale of clinical applications. New volumetric acquisition techniques, such as four-dimensional flow (4D-flow) and three-dimensional volumetric cine (3D-cine) MRI, could potentially reduce acquisition time without loss in accuracy; however, this has not been formally tested on a large scale. Methods: 4DCarE (4D-flow MRI for cardiovascular evaluation) is a prospective, multi-centre study designed to test the non-inferiority of a compressed 20 min exam based on volumetric CMR compared with a conventional CMR exam (45–60 min). The compressed exam utilises 4D-flow together with a single breath-hold 3D-cine to provide a rapid, accurate quantitative assessment of the whole heart function. Outcome measures are (i) flow and chamber volume measurements and (ii) overall functional evaluation. Secondary analyses will explore clinical applications of 4D-flow-derived parameters, including wall shear stress, flow kinetic energy quantification, and vortex analysis in large-scale cohorts. A target of 1200 participants will enter the study across three sites. The analysis will be performed at a single core laboratory site. Pilot Results: We present a pilot analysis of 196 participants comparing flow measurements obtained by 4D-flow and conventional 2D phase contrast, which demonstrated moderate–good consistency in ascending aorta and main pulmonary artery flow measurements between the two techniques. Four-dimensional flow underestimated the flow compared with 2D-PC, by approximately 3 mL/beat in both vessels. Conclusions: We present the study protocol of a prospective non-inferiority study of a rapid cardiac MRI exam compared with conventional CMR. The pilot analysis supports the continuation of the study. Study Registration: This study is registered with the Australia and New Zealand Clinical Trials Registry (Registry number ACTRN12622000047796, Universal Trial Number: U1111-1270-6509, registered 17 January 2022—Retrospectively registered). [ABSTRACT FROM AUTHOR]

Cardiac magnetic resonance (cMRI) imaging has recently become essential in cardiology. cMRI is widely recognized as the most reliable imaging technique for assessing the size and performance of the right ventricle. It allows for objective and functional cardiac tissue evaluations. Early in disease progression, cardiac structure and activity decrease subclinically. Late-phase clinically visible signs have been associated with less favourable outcomes. Subclinical alterations ought to be recognized for rapid evaluations and accurate treatment. An increasing amount of evidence supports cMRI deformation parameter quantification. Strain imaging enables cardiologists to assess heart function beyond traditional measurements. Prognostic information for cardiovascular disease patients is obtained through the right ventricle (RV) strain, including information primarily about the left ventricle (LV). Right atrial (RA) function evaluations using RA strain have been promising in recent studies. Therefore, this narrative review aims to present an overview of the data that are currently available for assessing right myocardial strain and biomechanics using cMRI. [ABSTRACT FROM AUTHOR]

Cardiac tumors present substantial diagnostic challenges due to their diverse manifestations and similarity to other cardiac pathologies. Cardiac lipomas are rare tumors that originate from adipose cells and can develop in any location within the heart. Cardiac lipomas account for 2.4% of all primary cardiac tumors. Most lipomas are located within the cardiac chambers. Among the lipomas occurring within the cardiac chambers, the most common localization is the right atrium. Currently, the gold standard for imaging cardiac tumors is cardiac magnetic resonance (CMR). Despite the significant advantages of CMR, cardiac computed tomography angiography (CCTA) continues to be a valuable technique when CMR is either unavailable or contraindicated. In some cardiac tumors, CCTA can identify the type of tumor. A classic example of this type is a lipoma. We present images of a large interatrial septal lipoma filling the right atrium diagnosed by CCTA in a 57-year-old female Caucasian patient. In summary, CCTA effectively identifies lipomas' characteristic features and provides crucial information for appropriate management. [ABSTRACT FROM AUTHOR]

Introduction. Post-coronavirus disease-2019 (COVID-19) patients may develop cardiac symptoms. We hypothesized that cardiovascular magnetic resonance (CMR) can assess the background of post-COVID-19 cardiac symptoms using multi-parametric evaluation. We aimed to conduct an investigation of symptomatic patients with post-COVID-19 syndrome using CMR (INSPIRE-CMR). Methods. INSIPRE-CMR is a retrospective multicenter study including 174 patients from five centers referred for CMR due to cardiac symptoms. CMR was performed using 3.0 T/1.5 T system (24%/76%, respectively). Myocardial inflammation was determined by the updated Lake Louise criteria. Results. Further, 174 patients with median age of 40 years (IQR: 26–54), 72 (41%) were women, and 17 (9.7%) had a history of autoimmune disease, muscular dystrophy, or cancer. In total, 149 (86%) patients were late gadolinium enhanced (LGE)-positive with a non-ischemic pattern, and of those evaluated with the updated Lake Louise criteria, 141/145 (97%) had ≥1 pathologic T1 index. Based on the T2-criterion, 62/173 (36%) patients had ≥1 pathologic T2 index. Collectively, 48/145 (33%) patients had both positive T1- and T2-criterion. A positive T2-criterion or a combination of a positive T1- and T2-criterion were significantly more common amongst patients with severe COVID-19 [45 (31%) vs. 17 (65%), p = 0.001 and 32 (27%) vs. 16 (64%), p < 0.001, respectively]. During the one-year evaluation, available for 65/174 patients, shortness of breath, chest pain, and arrhythmia were identified in 7 (4%), 15 (8.6%), and 43 (24.7%), respectively. CMR evaluation, available in a minority of them, showed mildly reduced LVEF, while nat T1 mapping and EVC remained at levels higher than the normal values of the local MRI units. Conclusions. The majority of post-COVID-19 patients with cardiac symptoms presented non-ischemic LGE and abnormalities in T1 and T2-based indices. Multi-parametric CMR reveals important information on post-COVID-19 patients, supporting its role in short/long-term evaluation. [ABSTRACT FROM AUTHOR]