Presence and Patterns of Clinically Silent Myocardial Scar-A Population-based CMR Study

Eurosurveillance

Background Women are overrepresented among individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). Biological (sex) as well as sociocultural (gender) differences between women and men might account for this imbalance, yet their impact on PASC is unknown. Aim We assessed the impact of sex and gender on PASC in a Swiss population. Method Our multicentre prospective cohort study included 2,856 (46% women, mean age 44.2 ± 16.8 years) outpatients and hospitalised patients with PCR-confirmed SARS-CoV-2 infection. Results Among those who remained outpatients during their first infection, women reported persisting symptoms more often than men (40.5% vs 25.5% of men; p < 0.001). This sex difference was absent in hospitalised patients. In a crude analysis, both female biological sex (RR = 1.59; 95% CI: 1.41–1.79; p < 0.001) and a score summarising gendered sociocultural …

Journal of Cardiovascular Magnetic Resonance

Background: The presence of myocardial scar is associated with poor prognosis in several settings. Clinically silent “unrecognized myocardial scar”(UMS) can be revealed by Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging. This population-based CMR study evaluated risk factors and patterns of UMS.Methods: Participants of the Hamburg City Health study without a history of coronary heart disease or myocarditis were consecutively included between February 8 th, 2016, and November 7 th, 2018. Presences and patterns of UMS were assessed by standard-phase-sensitive-inversion-recovery (PSIR) LGE CMR. Risk factors for the presence of UMS were assessed by multivariable, logistic regression analyses.Results: The final study population consisted of 1064 individuals (median age 66 [quartiles 59; 71] years, 37% females). UMS was detected in 244 (23%) subjects …

Scientific Reports

" Open Access funding enabled and organized by Projekt DEAL. We acknowledge financial support from the Open Access Publication Fund of UKE—Universitätsklinikum Hamburg-Eppendorf and DFG—German Research Foundation. The HCHS is supported by the Innovative medicine initiative (Grant number 116074), by the Joachim Herz Foundation, by the Foundation Leducq (Grant number 16 CVD 03), by the euCanSHare grant agreement (Grant number 825903-euCanSHare H2020), and the Deutsche Forschungsgemeinschaft (Grant number TH1106/5-1; AA93/2-1). Furthermore, it is supported by the participating institutes and departments from the University Medical Centre Hamburg-Eppendorf, which contribute with individual and scaled budgets to the overall funding. Technical equipment is provided by SIEMENS according to a contract for 12 years, the Schiller AG on a loan basis for six years, and Topcon …

Journal of Cardiovascular Magnetic Resonance

Background: The presence of myocardial scar is associated with poor prognosis in several settings. Clinically silent “unrecognized myocardial scar”(UMS) can be revealed by Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging. This population-based CMR study evaluated risk factors and patterns of UMS.Methods: Participants of the Hamburg City Health study without a history of coronary heart disease or myocarditis were consecutively included between February 8 th, 2016, and November 7 th, 2018. Presences and patterns of UMS were assessed by standard-phase-sensitive-inversion-recovery (PSIR) LGE CMR. Risk factors for the presence of UMS were assessed by multivariable, logistic regression analyses.Results: The final study population consisted of 1064 individuals (median age 66 [quartiles 59; 71] years, 37% females). UMS was detected in 244 (23%) subjects …

Die Diagnostik eines Myokardinfarktes ist mittels laborchemischer Analysen kardialer Marker, vor allem des hochsensitiven kardialen Troponins, mit hoher Spezifität und Sensitivität möglich und in Zusammenschau mit der entsprechenden Symptomatik und EKG-Veränderungen etabliert. Nach herzchirurgischen Eingriffen kann eine Troponinfreisetzung als Ausdruck einer prozeduralen Myokardschädigung auftreten. Ursachen hierfür sind beispielsweise Manipulation am Myokard oder die Verwendung von Kardioplegie bei Herzoperationen. Hierdurch ist die Diagnose eines perioperativen Myokardinfarktes jedoch herausfordernd, aber von höchster klinischer Relevanz. Studien zeigten, dass erhöhte Troponinwerte innerhalb der ersten 48 h postoperativ mit einer erhöhten Mortalität nach herzchirurgischem Eingriff korrelieren. Die B‑ACS-Pilotstudie untersuchte die Troponindynamik von 412 kardiochirurgischen …

medRxiv

Lipoprotein (a) [LP(a)] is a risk factor for cardiovascular diseases and mainly regulated by the complex LPA gene. We investigated the types of variation in the LPA gene and their predictive performance on LP(a) concentration. We determined the Kringle IV-type 2 (KIV-2) copy number (CN) using the DRAGEN LPA Caller (DLC) and a read-depth based CN estimator in 8351 whole genome sequencing samples from the GENESIS-HD study. The pentanucleotide repeat in the promoter region was genotyped with GangSTR and ExpansionHunter. LP(a) concentration was available in 4861 population-based subjects. Predictive performance on LP(a) concentration was investigated using random forests. The agreement of the KIV-2 CN between the two specialized callers was high (r=0.9966; 95% confidence interval [CI] 0.9965-0.9968). Allele-specific KIV-2 CN could be determined in 47.0% of the subjects using the DLC. Lp(a) concentration can be better predicted from allele-specific KIV-2 CN than total KIV-2 CN. Two single nucleotide variants 4925G>A and rs41272114 further improved prediction. The genetically complex LPA gene can be analyzed with excellent agreement between different callers. The allele-specific KIV-2 CN is more important for predicting LP(a) concentration than the total KIV-2 CN. It would be important that the allele-specific KIV-2 CN is determinable in all subjects.

Journal of Cardiovascular Magnetic Resonance

Background: The left atrial volume (LAV) is a crucial cardiac parameter in several clinical settings such as in atrial fibrillation or heart failure for the assessment of diastolic dysfunction and cardiac risk. Currently available LAV reference values were defined by 2d transthoracic echocardiography (2d-TTE). However, LAV measurements are routine part of CMR protocols, though data on the interchangeability of LAV values between CMR and 2d-TTE remain scarce.Methods: We performed CMR (3 T scanner MAGNETOM™ Skyra, Siemens Healthineers, Erlangen, Germany) and 2d-TTE in 2126 participants of the Hamburg City Health Study (HCHS), a population-based cohort study of the middle-aged population in Hamburg. LAV was assessed in TTE from the 4-and 2-chamber view by the method of disk summation. In CMR, LAV was also measured in cine images from the 2-and 4-chamber orientation, employing the …

Elife

The link between metabolic syndrome (MetS) and neurodegenerative as well as cerebrovascular conditions holds substantial implications for brain health in at-risk populations. This study elucidates the complex relationship between MetS and brain health by conducting a comprehensive examination of cardiometabolic risk factors, brain morphology, and cognitive function in 40,087 individuals. Multivariate, data-driven statistics identified a latent dimension linking more severe MetS to widespread brain morphological abnormalities, accounting for up to 71% of shared variance in the data. This dimension was replicable across sub-samples. In a mediation analysis, we could demonstrate that MetS-related brain morphological abnormalities mediated the link between MetS severity and cognitive performance in multiple domains. Employing imaging transcriptomics and connectomics, our results also suggest that MetS-related morphological abnormalities are linked to the regional cellular composition and macroscopic brain network organization. By leveraging extensive, multi-domain data combined with a dimensional stratification approach, our analysis provides profound insights into the association of MetS and brain health. These findings can inform effective therapeutic and risk mitigation strategies aimed at maintaining brain integrity.

European Heart Journal: Acute Cardiovascular Care

Aims High-sensitivity cardiac troponin (hs-cTn) assays are used for detection of myocardial infarction (MI). Ninety-ninth percentiles show wide inter-assay variation. The use of sex-specific cut-offs is recommended as definitory cut-off for MI. We compared diagnostic performance and prognostic value of sex-specific 99th percentiles of four hs-cTn assays in patients with suspected MI. Methods and results Concentrations of four hs-cTn assays were measured at presentation and after 3 h in patients with suspected MI. Final diagnoses were adjudicated according to the 4th Universal Definition of MI. Unisex and sex-specific 99th percentiles were evaluated as diagnostic cut-offs following the ESC 0/3 h algorithm. These cut-offs were used in Cox-regression analyses to investigate the association with a composite endpoint of MI, revascularization, cardiac rehospitalization, and death …

Journal of Cardiovascular Magnetic Resonance

BackgroundThe presence of myocardial scar is associated with poor prognosis in several underlying diseases. Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging reveals clinically silent “unrecognized myocardial scar” (UMS), but the etiology of UMS often remains unclear. This population-based CMR study evaluated prevalence, localization, patterns and risk factors of UMS.MethodsThe study population consisted of 1064 consecutive Hamburg City Health study participants without a history of coronary heart disease or myocarditis. UMS was assessed by standard-phase-sensitive-inversion-recovery LGE CMR.ResultsMedian age was 66 [quartiles 59,71] years and 37% were females. UMS was detected in 244 (23%) participants. Twenty-five participants (10%) had ischemic, and 217 participants (89%) had non-ischemic scar patterns, predominantly involving the basal …

Imaging Neuroscience

We aimed to replicate recent findings on the association between the extent of cerebral small vessel disease (cSVD), functional brain network dedifferentiation, and cognitive impairment. We analyzed demographic, imaging, and behavioral data from the prospective population-based Hamburg City Health Study. Using a fully prespecified analysis pipeline, we estimated discrete brain states from structural and resting-state functional magnetic resonance imaging (MRI). In a multiverse analysis, we varied brain parcellations and functional MRI confound regression strategies. The severity of cSVD was operationalized as the volume of white matter hyperintensities of presumed vascular origin. Processing speed and executive dysfunction were quantified using the Trail Making Test (TMT). We hypothesized a) that a greater volume of supratentorial white matter hyperintensities would be associated with less …

ESC Heart Failure

Aims Cardiomyopathies (CMPs) are a heterogeneous group of diseases that are defined by structural and functional abnormalities of the cardiac muscle. Dilated cardiomyopathy (DCM), the most common CMP, is defined by left ventricular dilation and impaired contractility and represents a common cause of heart failure. Different phenotypes result from various underlying genetic and acquired causes with variable effects on disease development and progression, prognosis, and response to medical treatment. Current treatment algorithms do not consider these different aetiologies, due to lack of insights into treatable drivers of cardiac failure in patients with DCM. Our study aims to precisely phenotype and genotype the various subtypes of DCM and hereby lay the foundation for individualized therapy. Methods and results The Geno‐ And Phenotyping of PrImary Cardiomyopathy (GrAPHIC) is a currently ongoing …

Plos one

Considering sex as a biological variable in modern digital health solutions, we investigated sex-specific differences in the trajectory of four physiological parameters across a COVID-19 infection. A wearable medical device measured breathing rate, heart rate, heart rate variability, and wrist skin temperature in 1163 participants (mean age = 44.1 years, standard deviation [SD] = 5.6; 667 [57%] females). Participants reported daily symptoms and confounders in a complementary app. A machine learning algorithm retrospectively ingested daily biophysical parameters to detect COVID-19 infections. COVID-19 serology samples were collected from all participants at baseline and follow-up. We analysed potential sex-specific differences in physiology and antibody titres using multilevel modelling and t-tests. Over 1.5 million hours of physiological data were recorded. During the symptomatic period of infection, men demonstrated larger increases in skin temperature, breathing rate, and heart rate as well as larger decreases in heart rate variability than women. The COVID-19 infection detection algorithm performed similarly well for men and women. Our study belongs to the first research to provide evidence for differential physiological responses to COVID-19 between females and males, highlighting the potential of wearable technology to inform future precision medicine approaches.

Plos one

Background Non-communicable diseases (NCDs) are responsible for many deaths. They are associated with several modifiable and metabolic risk factors and are therefore prone to significant regional variations on different scales. However, only few intra-urban studies examined spatial variation in NCDs and its association with social circumstances, especially in Germany. Thus, the present study aimed to identify associations of personal risk factors and local social conditions with NCDs in a large German city. Methods This study is based on a population-based cohort of the Hamburg City Health Study including 10,000 probands. Six NCDs were analyzed (chronic obstructive pulmonary disease [COPD], coronary heart disease [CHD], diabetes mellitus, heart failure, depression, and hypertension) in 68 city district clusters. As risk factors, we considered socio-demographic variables (age, sex, education) and risk behaviour variables (smoking, alcohol consumption). Logistic regression analyses identified associations between the district clusters and the prevalence rates for each NCD. Regional variation was detected by Gini coefficients and spatial cluster analyses. Local social condition indexes were correlated with prevalence rates of NCDs on city district level and hot-spot analyses were performed for significant high or low values. Results The analyses included 7,308 participants with a mean age of 63.1 years (51.5% female). The prevalence of hypertension (67.6%) was the highest. Risk factor associations were identified between smoking, alcohol consumption and education and the prevalence of NCDs (hypertension, diabetes, and COPD …

Frontiers in Immunology

In search for immunological correlates of protection against acute coronavirus disease 2019 (COVID-19) there is a need for high through-put assays for cell-mediated immunity (CMI) to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We established an interferon-γ release assay -based test for detection of CMI against SARS-CoV-2 spike (S) or nucleocapsid (NC) peptides. Blood samples obtained from 549 healthy or convalescent individuals were measured for interferon-γ (IFN-γ) production after peptide stimulation using a certified chemiluminescence immunoassay. Test performance was calculated applying cutoff values with the highest Youden indices in receiver-operating-characteristics curve analysis and compared to a commercially available serologic test. Potential confounders and clinical correlates were assessed for all test systems. 522 samples obtained from 378 convalescent in median 298 days after PCR-confirmed SARS-CoV-2 infection and 144 healthy control individuals were included in the final analysis. CMI testing had a sensitivity and specificity of up to 89% and 74% for S peptides and 89% and 91% for NC peptides, respectively. High white blood cell counts correlated negatively with IFN-γ responses but there was no CMI decay in samples obtained up to one year after recovery. Severe clinical symptoms at time of acute infection were associated with higher measures of adaptive immunity and reported hair loss at time of examination. This laboratory-developed test for CMI to SARS-CoV-2 NC peptides exhibits excellent test performance, is suitable for high through-put routine diagnostics, and should …

American journal of respiratory and critical care medicine

Rationale: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome with fatal outcomes. Evidence suggests that dysregulated immune responses, including autoimmunity, are key pathogenic factors. Objectives: To assess whether IgA autoantibodies target lung-specific proteins and contribute to disease severity. Methods: We collected 147 blood, 9 lung tissue, and 36 BAL fluid samples from three tertiary hospitals in Switzerland and one in Germany. Severe COVID-19 was defined by the need to administer oxygen. We investigated the presence of IgA autoantibodies and their effects on pulmonary surfactant in COVID-19 using the following methods: immunofluorescence on tissue samples, immunoprecipitations followed by mass spectrometry on BAL fluid samples, enzyme-linked immunosorbent assays on blood samples, and surface tension measurements with medical surfactant …

Diseases of the heart and brain are strongly linked to each other, and cardiac dysfunction is associated with cognitive decline and dementia. This link between cardiovascular disease and dementia offers opportunities for dementia prevention through prevention and treatment of cardiovascular risk factors and heart disease. Increasing evidence suggests the clinical utility of cardiac biomarkers as risk markers for structural brain changes and cognitive impairment. We propose the hypothesis that structural brain changes are the link between impaired cardiac function, as captured by blood‐based cardiac biomarkers, and cognitive impairment. This review provides an overview of the literature and illustrates emerging insights into the association of markers of hemodynamic stress (natriuretic peptides) and markers of myocardial injury (cardiac troponins) with imaging findings of brain damage and cognitive impairment …

Journal of the American Heart Association

Background High‐sensitivity cardiac troponin (hs‐cTn)‐based diagnostic algorithms are recommended for the management of patients with suspected myocardial infarction (MI) without ST elevation. Although mirroring different phases of myocardial injury, falling and rising troponin patterns (FPs and RPs, respectively) are equally considered by most algorithms. We aimed to compare the performance of diagnostic protocols for RPs and FPs, separately. Methods and Results We pooled 2 prospective cohorts of patients with suspected MI and stratified patients to stable, FP, and RP during serial sampling separately for hs‐cTnI and hs‐cTnT and applied the European Society of Cardiology 0/1‐ and 0/3‐hour algorithms comparing the positive predictive values to rule in MI. Overall, 3523 patients were included in the hs‐cTnI study population. The positive predictive value for patients with an FP was significantly reduced …

Annals of emergency medicine

Study objectiveThe diagnostic performance of T-wave amplitudes for the detection of myocardial infarction is largely unknown. We aimed to address this knowledge gap.MethodsT-wave amplitudes were automatically measured in 12-lead ECGs of patients presenting with acute chest discomfort to the emergency department within a prospective diagnostic multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists. Patients with left ventricular hypertrophy, complete left bundle branch block, or paced ventricular depolarization were excluded. The performance for lead-specific 95th-percentile thresholds were reported as likelihood ratios (lr), specificity, and sensitivity.ResultsMyocardial infarction was the final diagnosis in 445 (18%) of 2457 patients. In most leads, T-wave amplitudes tended to be greater in patients without myocardial infarction than those with myocardial infarction …

Journal of Cardiovascular Magnetic Resonance

Background: The relationship between myocardial blood flow (MBF) and left ventricular ejection fraction (LVEF) is poorly understood due to the number of physiological variables at play. Coronary artery disease (CAD), microvascular disease (MVD) and myocardial infarction are clearly linked to both reduced MBF and LVEF. The possibility of a correlation between LVEF and perfusion measurements has previously been suggested in non-ischemic patients using cardiac MRI (CMR) and positron-emission tomography (PET)[1, 2]. This study investigates further using high-resolution stress perfusion CMR with inline quantified mapping.Methods: 732 consecutive patients underwent vasodilatory stress perfusion CMR [adenosine 663 (90.6%)] using a 3T scanner (MAGNETOM Vida Siemens Healthineers, Erlangen, Germany) between January 2022 and April 2023. All patients were scanned using a high-resolution (1.3-1 …

Journal of Cardiovascular Magnetic Resonance

Background: Stress perfusion cardiac magnetic resonance (CMR) is guidelines-backed non-invasive test for the assessment of coronary artery disease (CAD), and its prognostic value has been well validated. However, the direct relationship between stress perfusion maps pixels and outcome is still not well understood. The aim of this study is to generate multi-vender multi-strength stress perfusion maps from legacy data and link them with mortality using artificial intelligence.Methods: This is a retrospective study involving stress perfusion CMR patients scanned between April 2011 and March 2021 in one center. Follow-up period was calculated as mean time to mortality event, patients with no events and a shorter period from CMR date to collection date were excluded. All stress perfusion images included multiple frames for 3 slices: basal, mid and apical. Peak left ventricular (LV) frame was selected based on peak …

Journal of Cardiovascular Magnetic Resonance

BackgroundMyocardial T1 and T2 mapping are reliable diagnostic markers for the detection and follow up of acute myocarditis. The aim of this study was to compare the diagnostic performance of current mapping measurement approaches to differentiate between myocarditis patients and healthy individuals.MethodsFifty patients with clinically defined acute myocarditis and 30 healthy controls underwent cardiovascular magnetic resonance (CMR). Myocardial T1 relaxation times, T2 relaxation times, left ventricular (LV) function, T2 ratio, early gadolinium enhancement ratio, and presence of late gadolinium enhancement (LGE) were analysed. Native T1 and T2 relaxation times, as well as extracellular volume fraction (ECV) were measured for the entire LV myocardium (global), within the midventricular short axis slice (mSAX), within the midventricular septal wall (ConSept), and within the remote myocardium (remote …

Journal of Cardiovascular Magnetic Resonance

Background: Comprehensive characterization of left ventricular (LV) regional function and concomitant LV modeling in acute myocardial infarction (MI) is lacking in preclinical data. 1 Often employed conventional cardiac magnetic resonance (CMR) measures of LV volumes and ejection fraction (EF) may lack resolution to delineate regional LV function and absent changes in LVEF. We hypothesized that acute MI in sheep will lead to LV segmental dysfunction and LV remodeling measured by CMR.Methods: Coronary ligation of the distal left anterior descending branch was performed on six-month old adolescent sheep (n= 11) under general anaesthesia. CMR was performed before MI surgery and at 15 days (follow-up). Cine imaging was performed to acquire short-axis stacks and three apical long-axis slices (1.44 mm x 1.44 mm x 6.6 mm) for volumetry analysis and strain analysis by feature tracking (FT). Late …

Journal of Cardiovascular Magnetic Resonance

Cardiovascular magnetic resonance (CMR) protocols can be lengthy and complex, which has driven the research community to develop new technologies to make these protocols more efficient and patient-friendly. Two different approaches to improving CMR have been proposed, specifically "all-in-one" CMR, where several contrasts and/or motion states are acquired simultaneously, and "real-time" CMR, in which the examination is accelerated to avoid the need for breathholding and/or cardiac gating. The goal of this two-part manuscript is to describe these two different types of emerging rapid CMR. To this end, the vision of each is described, along with techniques which have been devised and tested along the pathway of clinical implementation. The pros and cons of the different methods are presented, and the remaining open needs of each are detailed. Part 1 will tackle the "all-in-one" approaches, and Part 2 …

Journal of Cardiovascular Magnetic Resonance

Background: Within the congenital heart disease population, single ventricle patients have the shortest life expectancy, with sudden cardiac death (SCD) as the second leading cause 1. Little is known about risk factors for sudden cardiac arrest (SCA) in Fontan patients. Implantable cardioverter-defibrillator (ICD) implantation may prevent SCD, but appropriate patient identification for primary prevention is difficult 2. CMR plays a pivotal role in surveillance in this population 3. Understanding risk factors for SCA in Fontan patients has the potential to improve our ability to predict SCA in patients and thus prevent SCD with use of a primary prevention ICD 4.Methods: The Fontan Outcomes Registry Using CMR Examinations (FORCE) is a multi-center, international registry that collects clinical and CMR data on single ventricle patients. Patients were included in the registry if they have a CMR that allows measurement of …

Journal of Cardiovascular Magnetic Resonance

Background: Studies have failed to demonstrate a markedly increased cardiovascular mortality in Crohn’s disease (CD) patients. There is also a lack of evidence elucidating inflammation-induced mechanisms of CD in the myocardial tissue, particularly in active disease. The aim of this study was to evaluate cardiac magnetic resonance T1 mapping and strain features in CD patients with endoscopic evidence of disease activity.Methods: Fifty-one consecutive CD patients without known cardiovascular disease and 20 age-and sex-matched control subjects (44±10years; 51% female) underwent cardiac magnetic resonance at 1.5 T, including cine, myocardial strain evaluation, triple inversion recovery for edema evaluation, native T1 mapping (modified Look-Locker inversion recovery), late gadolinium enhancement and extracellular volume imaging. CD patients were staged for bowel inflammation and disease severity …

Journal of Cardiovascular Magnetic Resonance

Background: Native T1 and T1ρ mapping has shown promising results for the detection of focal and diffuse myocardial fibrosis [1], whereas T2 mapping enables characterisation of inflammation and edema [2]. In [3] we proposed a novel free-breathing, 3D whole-heart joint T1/T1ρ/T2 mapping sequence with Dixon encoding to provide native 3D T1, T1ρ and T2 maps with isotropic resolution and co-registered water and fat volumes for myocardial tissue characterisation at 1.5 T. Lower T1 relaxation times, reduced SAR, and fewer B0/B1 inhomogeneities make low-field MRI an attractive alternative for joint T1/T1ρ/T2 mapping. Here, we present preliminary results from this sequence modified to operate on a clinical 0.55 T scanner.Methods: The ECG-triggered 3D joint T1/T1ρ/T2 research sequence (Fig. 1) consists of a repeating set of preparation modules over 5 heartbeats (HBs): IR-prep, no-prep, T1ρ-prep, T2-prep …

Journal of Cardiovascular Magnetic Resonance

Background: Recent advances in fetal CMR encompass new insights into antenatal anatomy and grant novel approaches to assess fetal cardiac function. Animal studies and pilot studies in humans in late gestations have reported feasibility of ventricular volumetry in vivo [1],[2]; however, to date these have been as proof-of-concept only.Methods: In this single centre prospective study, we assessed the reliability and accuracy of motion-corrected whole heart 3D+ time reconstructions using image-based gating in a cohort of fetuses with and without congenital heart disease. Multiple non-coplanar 2D stacks of kt SENSE accelerated balanced steady-state free precession sequences (1.5 T Philips Ingenia [Best, The Netherlands]) with continuous stable state 2D acquisition using linear frequency SWEEP were acquired without fetal ECG gating at scan, no maternal breath-holds, no sedation and no contrast agent …

Journal of Cardiovascular Magnetic Resonance

Background: Despite extensive technical advancement in the field of cardiovascular MRI, long acquisition times and motion artifacts remain major challenges in this imaging modality. Computer-aided image acquisition and image reconstruction are the key factors here. While a conventional cine acquisition is typically acquired over 10-12 heart beats, we hypothesized that the improved image reconstruction techniques based on DL enable cine imaging over fewer heart beats, possibly even in real time, with diagnostic image quality.Methods: 55 healthy volunteers underwent a non-contrast CMR examination at 1.5 T (Signa Artist, GE HealthCare, Milwaukee, WI, USA). Left ventricle short axis stacks were acquired over 1, 3 and 6 cardiac cycles (RR) with the Sonic DL prototype and with the conventional bSSFP Asset-accelerated cine sequence. The field of view was 340x340mm 2 and the slice thickness 10mm. Matrix …

Journal of Cardiovascular Magnetic Resonance

Background: The left atrial volume (LAV) is a crucial cardiac parameter in several clinical settings such as in atrial fibrillation or heart failure for the assessment of diastolic dysfunction and cardiac risk. Currently available LAV reference values were defined by 2d transthoracic echocardiography (2d-TTE). However, LAV measurements are routine part of CMR protocols, though data on the interchangeability of LAV values between CMR and 2d-TTE remain scarce.Methods: We performed CMR (3 T scanner MAGNETOM™ Skyra, Siemens Healthineers, Erlangen, Germany) and 2d-TTE in 2126 participants of the Hamburg City Health Study (HCHS), a population-based cohort study of the middle-aged population in Hamburg. LAV was assessed in TTE from the 4-and 2-chamber view by the method of disk summation. In CMR, LAV was also measured in cine images from the 2-and 4-chamber orientation, employing the …

Journal of Cardiovascular Magnetic Resonance

Background: Cardiac MRF has shown promising results for quantitative multiparametric mapping [1][2] at conventional field strengths. The recent introduction of high-end low-field 0.55 T scanners could greatly increase the accessibility and affordability of this type of technique [3][4][5]. Brain [6] and liver [7] MRF have been demonstrated at 0.55 T. However, the feasibility of cardiac MRF at 0.55 T still needs to be proven. Here we demonstrate 2D T 1 and T 2 cardiac MRF at 0.55 T and evaluate its performance in phantom and healthy subjects.Methods: The proposed cardiac MRF at 0.55 T (Fig. 1) acquires data over 16 heartbeats, divided into 4 blocks of 4 heartbeats each. This follows the original formulation of cardiac MRF [1], but unlike this implementation, it uses bSSFP radial readouts to boost the SNR at low field.

Journal of Cardiovascular Magnetic Resonance

Background: Traditional CMR monitors cardiac rhythm via the vectorcardiogram (VCG) signal. Patient cooperation is necessary for adequate skin preparation and electrode placement, with a high R/T wave ratio crucial for diagnostic cardiac synchronisation. Variations in cardiac electrophysiology or a patient’s inability to comply before the CMR commences can challenge VCG gating and lead to suboptimal image quality.Cardiac Gating using Beat sensor technology is achieved via a pilot tone transmitter located within a body coil array. Negating the requirement for electrode positioning on a subject’s chest. Methods: Following application of a coronal beat sensor training acquisition, beat sensor cardiac gating was applied on a 1.5 T Siemens Sola scanner in the following 3 cases scanned at our institution, where VCG failed to be the appropriate gating method. Patient 1: 43 yr old male with high T wave amplitude …

Journal of Cardiovascular Magnetic Resonance

Background Quantitative cardiovascular magnetic resonance (CMR) first pass perfusion maps are conventionally acquired with 3 short-axis (SAX) views (basal, mid, and apical) in every heartbeat (3SAX/1RR). Thus, a significant part of the left ventricle (LV) myocardium, including the apex, is not covered. The aims of this study were 1) to investigate if perfusion maps acquired with 3 short-axis views sampled every other RR-interval (2RR) yield comparable quantitative measures of myocardial perfusion (MP) as 1RR and 2) to assess if acquiring 3 additional perfusion views (ie, total of 6) every other RR-interval (2RR) increases diagnostic confidence. Methods In 287 patients with suspected ischemic heart disease stress and rest MP were performed on clinical indication on a 1.5 T MR scanner. Eighty-three patients were examined by acquiring 3 short-axis perfusion maps with 1RR sampling (3SAX/1RR); for which also 2RR maps were reconstructed. Additionally, in 103 patients 3 short-axis and 3 long-axis (LAX; 2-, 3, and 4-chamber view) perfusion maps were acquired using 2RR sampling (3SAX+ 3LAX/2RR) and in 101 patients 6 short-axis perfusion maps using 2RR sampling (6SAX/2RR) were acquired. The diagnostic confidence for ruling in or out stress-induced ischemia was scored according to a Likert scale (certain ischemia [2 points], probably ischemia [1 point], uncertain [0 points], probably no ischemia [1 point], certain no ischemia [2 points]). Results There was a strong correlation (R= 0.99) between 3SAX/1RR and 3SAX/2RR for global MP (mL/min/g). The diagnostic confidence score increased significantly when the number of perfusion …

Journal of Cardiovascular Magnetic Resonance

Background: Quantification of aortic flow is increasingly utilized for patient management. While 4D Flow MRI provides a comprehensive assessment of aortic hemodynamics, it requires long acquisition times and is not widely available. Alternatively, contrast enhanced MR angiography (CEMRA) is easily acquired, becoming clinical routine, but provides only anatomical information. Deriving hemodynamics directly from CEMRA could significantly impact patient management. Seeking to address this using artificial intelligence (AI), we developed a CycleGAN for the prediction of systolic 3D blood flow velocity vector fields directly from CEMRA images.Methods: This study used a total of paired 771 CEMRA and aortic 4D flow datasets (median age: 42 years, 556M/215F), acquired during the same exam on either 1.5 T or 3T MRI systems (Siemens). All scans were acquired with 3D coverage of the thoracic aorta with …

Journal of Cardiovascular Magnetic Resonance

Background: Biventricular dysfunction is frequent in patients with repaired tetralogy of Fallot, necessitating routine imaging to monitor for worsening conditions and determine whether procedures like pulmonary valve replacement (PVR) are needed. This study aimed to highlight the parameters of cardiac magnetic resonance imaging (CMR) and their association with adverse outcomes in the midterm follow-up of these patients.Methods: This longitudinal study recruited all patients with a history of tetralogy of Fallot total correction (TFTC) who had two CMR images at a minimum three-month interval at Rajaie Center from 2006 through 2017.Results: Fifty-six patients at a mean age of 15.23±11.66 years at TFTC and a 1: 1 gender distribution were assessed. Regarding adverse events, right and left ventricular dysfunction occurred in 43 (76.8%) and 18 (32.1%) patients, respectively. Death did not occur in the present …

Journal of Cardiovascular Magnetic Resonance

Background: Regular and vigorous exercise leads to a constellation of structural and functional cardiovascular adaptations. Cardiopulmonary exercise testing (CPET) is the most accurate method to assess these changes and measure cardiorespiratory fitness (CRF). Cardiac Magnetic Resonance (CMR) represents the gold standard for morpho-functional evaluation and for myocardial tissue characterization.

Journal of Cardiovascular Magnetic Resonance

Background: Right ventricular (RV) function strongly influences prognosis in a range of cardiac diseases, including pulmonary hypertension (PH), but the degree of impact remains unclear in the lung transplant population. We assessed cardiac magnetic resonance (CMR) imaging, including RV global strain, trabecular complexity, and adequacy of RV functional adaptation to increased afterload in patients prior to lung transplantation.Methods: Between 2010 and 2022, 550 patients underwent lung transplantation at our institution. Pre-transplant echocardiography, and CMR (1.5 T-Siemens Avanto or Aera) to assess biventricular volumes and function as well as late gadolinium enhancement (LGE) was performed on a subgroup of 43 consecutive patients with predominantly RV abnormalities. RV trabecular complexity was assessed by its fractal dimension (FD) on CMR, using freely available code (FracAnalyse). RV …

Journal of Cardiovascular Magnetic Resonance

Background: Aromatherapy (AROM) has been shown to be an effective anxiolytic technique and can be an alternative for patients undergoing Cardiac Magnetic Resonance (CMR) exams. The sedative effect of benzodiazepines can significantly decrease the ability for patients to perform adequate breath holding, thus repeat image acquisitions may often ensue. Additional monitoring is also required. Therefore, we sought to determine the impact of AROM on scan time, repeat image acquisitions, early scan termination, and nursing monitoring time.Methods: We conducted a prospective study in patients undergoing anxiolytic therapy (AROM, alprazolam (ALP), or a combination of AROM plus alprazolam {COMBO]) between 6/2023-8/2023, who underwent CMR scans on Philips 1.5 and 3T scanners. Age, sex, and BMI were compared between the groups using ANOVA (for age and BMI) and chi square test for sex. A …

Journal of Cardiovascular Magnetic Resonance

Background: Recent advances in fetal CMR encompass new insights into antenatal anatomy and grant novel approaches to assess fetal cardiac function. Animal studies and pilot studies in humans in late gestations have reported feasibility of ventricular volumetry in vivo [1],[2]; however, to date these have been as proof-of-concept only.Methods: In this single centre prospective study, we assessed the reliability and accuracy of motion-corrected whole heart 3D+ time reconstructions using image-based gating in a cohort of fetuses with and without congenital heart disease. Multiple non-coplanar 2D stacks of kt SENSE accelerated balanced steady-state free precession sequences (1.5 T Philips Ingenia [Best, The Netherlands]) with continuous stable state 2D acquisition using linear frequency SWEEP were acquired without fetal ECG gating at scan, no maternal breath-holds, no sedation and no contrast agent …