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Purpose To assess the influence of deep learning (DL)-based image reconstruction on acquisition time, volumetric results, and image quality of cine sequences in cardiac MRI. Materials and Methods This prospective study (performed from January 2023 to March 2023) included 55 healthy volunteers who underwent a noncontrast cardiac MRI examination at 1.5 T. Short-axis stack DL cine sequences of the left ventricle (LV) were performed over one (1RR), three (3RR), and six cardiac (6RR) cycles and compared with a standard cine sequence (without DL, performed over 10-12 cardiac cycles) in regard to acquisition time, subjective image quality, edge sharpness, and volumetric results. Results Total acquisition time (median) for a short-axis stack was 47 seconds for the 1RR cine, 108 seconds for 3RR cine, 184 seconds for 6RR cine, and 227 seconds for the standard sequence. Volumetric results showed no difference for the conventional cine (median LV ejection fraction [EF] 63%), 6RR cine (median LVEF, 62%), and 3RR cine (median LVEF, 61%). The 1RR cine sequence significantly underestimated EF (57%) because of a different segmentation of the papillary muscles. Subjective image quality ( P = .37) and edge sharpness ( P = .06) of the three-heartbeat DL cine did not differ from the reference standard, while both metrics were lower for single-heartbeat DL cine and higher for six-heartbeat DL cine. Conclusion For DL-based cine sequences, acquisition over three cardiac cycles appears to be the optimal compromise, with no evidence of differences in image quality, edge sharpness, and volumetric results, but with a greater than 50% reduced acquisition time compared with the reference sequence. Keywords: MR Imaging, Cardiac, Heart, Technical Aspects, Cardiac MRI, Deep Learning, Clinical Imaging, Accelerated Imaging Supplemental material is available for this article. © RSNA, 2024.

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.

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., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Infective endocarditis (IE) is a severe cardiac condition associated with substantial morbidity and mortality. Traditionally, the modified Duke's criteria have been used to establish the diagnosis of IE, which includes using transthoracic and transesophageal echocardiography. While echocardiography performs well in diagnosing native valve endocarditis, its diagnostic accuracy decreases in patients with prosthetic valves or implanted cardiac devices such as pacemakers and defibrillators. Given these limitations and advancements in cardiac imaging, including multimodal computed tomography, magnetic resonance imaging, and positron emission tomography, there has been growing interest in the utility of these techniques for diagnosing prosthetic valve endocarditis (PVE) and Cardiovascular implantable electronic device infection (CIEDI). Although numerous studies have investigated the value of these imaging modalities, their findings have been inconsistent. This article aims to reevaluate the role of advanced imaging in diagnosing PVE and CIEDI and its impact on managing prosthetic valves and device-related infective endocarditis. Methods A comprehensive literature search was conducted in PubMed, Cochrane library, Google Scholar, Embase, and other relevant databases. Key terms such as 'infective endocarditis,' 'multimodal imaging,' 'prosthetic valve endocarditis,' '18F-FDG PET,' 'cardiac MRI,' and 'cardiac CT' were used to identify studies that investigated the role of these imaging modalities in diagnosing PVE and CIEDI. Publications with full text including randomized controlled trials, retrospective studies, case reports, case series, reviews of literature, and society guidelines were included., Competing Interests: Declarations. Competing interests: The authors have no conflicts of interest or financial disclosures relevant to the manuscript., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Primary intimal sarcoma of the pulmonary artery is a rare and aggressive malignancy that presents significant diagnostic and therapeutic challenges due to its nonspecific symptoms and propensity for late detection. This case report aimed to elucidate the diagnostic journey, surgical intervention, and multidisciplinary management of this rare entity. In September 2023, a 42-year-old male presented with dyspnea on exertion and retrosternal chest pain, classified as NYHA FC II. Initial investigations, including ECG and lab tests, indicated tachycardia and elevated troponin and NT-pro-BNP levels. Transthoracic and transesophageal echocardiography identified a multilobulated mass in the right ventricular outflow tract and main pulmonary artery. Cardiac MRI and CT angiography confirmed a high-grade pleomorphic spindle cell tumor, leading to surgical resection in October 2023. Histopathology confirmed intimal sarcoma. Postsurgery, the patient underwent chemotherapy and radiotherapy, showing significant clinical improvement and no recurrence on follow-up PET-CT. This case highlights the importance of a multidisciplinary approach in diagnosing and managing primary intimal sarcoma of the pulmonary artery, emphasizing the role of advanced imaging, timely surgical intervention, and combined chemotherapy with radiotherapy in improving patient outcomes., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background and Objectives : Coronary sinus oxygen saturation is a useful indicator of health and disease states. However, it is not routinely used in clinical practice. Cardiovascular magnetic resonance imaging (CMR) oximetry can accurately estimate oxygen saturation in the pulmonary artery. This research aimed to provide a method for calculating coronary sinus oxygen saturation (ScsO 2 ) from pulmonary artery oxygen saturation (SpaO 2 ) that could be applied to CMR. Materials and Methods : A systematic literature review was conducted to identify prior work that included invasive measures of ScsO 2 and either SpaO 2 or right ventricular oxygen saturation. This revealed one study with appropriate data (ScsO 2 and SpaO 2 measurements, n = 18). We then carried out agreement and correlation analyses. Results : Regression analysis demonstrated a statistically significant, positive relationship between ScsO 2 and SpaO 2 , giving a regression equation of ScsO 2 = -31.198 + 1.062 × SpaO 2 ( r = 0.76, p < 0.001). A multivariable regression analysis of all reported variables, excluding SpaO 2 , independently identified superior vena cava oxygen saturation (SsvcO 2 ) and arterial oxygen saturation (SaO 2 ) as predictors of ScsO 2 ( r = 0.78, p < 0.001), deriving the equation ScsO 2 = -452.8345 + 4.3579 × SaO 2 + 0.8537 × SsvcO 2 . Conclusions : In this study, we demonstrated a correlation between coronary sinus oxygen saturation and pulmonary artery oxygen saturation, allowing the estimation of ScsO 2 from SpaO 2 . This association enables the estimation of ScsO 2 from purely CMR-derived data. We have also described a second model using arterial and superior vena cava saturation measurements, providing an alternative method. Future validation in larger, independent cohorts is needed.

The transition in medical image segmentation from fine-grained to coarse-grained annotation methods, notably scribble annotation, offers a practical and efficient preparation for deep learning applications. However, these methods often compromise segmentation precision and result in irregular contours. This study targets the enhancement of scribble-supervised segmentation to match the accuracy of fine-grained annotation. Capitalizing on the consistency of target shapes across unpaired datasets, this study introduces a shape-aware scribble-supervised learning framework (MaskMixAdv) addressing two critical tasks: (1) Pseudo label generation, where a mixup-based masking strategy enables image-level and feature-level data augmentation to enrich coarse-grained scribbles annotations. A dual-branch siamese network is proposed to generate fine-grained pseudo labels. (2) Pseudo label optimization, where a CNN-based discriminator is proposed to refine pseudo label contours by distinguishing them from external unpaired masks during model fine-tuning. MaskMixAdv works under constrained annotation conditions as a label-efficient learning approach for medical image segmentation. A case study on public cardiac MRI datasets demonstrated that the proposed MaskMixAdv outperformed the state-of-the-art methods and narrowed the performance gap between scribble-supervised and mask-supervised segmentation. This innovation cuts annotation time by at least 95%, with only a minor impact on Dice performance, specifically a 2.6% reduction. The experimental outcomes indicate that employing efficient and cost-effective scribble annotation can achieve high segmentation accuracy, significantly reducing the typical requirement for fine-grained annotations.

Background: Peripartum cardiomyopathy (PPCM) is associated with significant morbidity and mortality. Recent studies show recovery of left ventricular ejection fraction (LVEF) can still be associated with longitudinal adverse clinical outcomes. Cardiac MRI (CMR) may yield additional prognostic parameters of serious adverse outcomes (SAE) beyond LVEF., Methods: Individuals with PPCM and CMR within 3 months of diagnosis were analyzed from the Investigations in Pregnancy Associated Cardiomyopathy (IPAC) trial and our institution from 2010-present. Indexed left ventricular (LV) mass, ventricular volumes, cardiac output, global longitudinal strain (GLS), extracellular cellular volume (ECV) as well as epicardial fat volume (EFV) were analyzed. SAEs included left ventricular assist device (LVAD), heart transplant and death. CMR parameters were compared between SAE and no SAEs groups by non-parametric techniques., Results: Among 51 individuals with mean age of 31 years at diagnosis, 6/51 (12 %) experienced 11 adverse outcomes. EF at time of CMR (15.0 vs 37.3 %, p  < 0.001), peak LV GLS (-4.1 % vs -10.0, p  = 0.002) ECV (43.6 vs 28.2, p  = 0.02) and stroke volume differed significantly among groups. In univariate regression analysis, worse LVEF, lower peak GLS and greater LVESVi were predictive of adverse outcomes., Conclusion: Prior studies found baseline LVEF by echo is a predictor of serious adverse outcomes. CMR identified significantly different baseline LVESVi peak LV GLS and ECV among PPCM with SAEs vs no SAEs. If confirmed in larger studies, diffuse myocardial fibrosis may represent a therapeutic target in PPCM., Competing Interests: The authors have no conflicts of interest to disclose., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Obesity is a known risk factor for heart failure with preserved ejection fraction (HFpEF) and is considered a distinct phenotype with more concentric remodeling. Epicardial adipose tissue (EAT) is also increased in obesity-related HFpEF and is associated with adverse events., Objective: The Cardiac Magnetic Resonance (CMR) Substudy of the SUMMIT trial was aimed to examine the effects of tirzepatide on cardiac structure and function with the underlying hypothesis that it would reduce left ventricular (LV) mass and EAT in obesity-related HFpEF., Methods: One hundred seventy-five patients with obesity-related HFpEF from the parent study of tirzepatide (2.5mg SQ weekly, increasing to a maximum of 15mg weekly) or matching placebo underwent CMR at baseline, which consisted of multiplanar cine imaging. One hundred six patients completed the CMR and had adequate image quality for analysis of LV and LA structure and function and paracardiac (epicardial plus pericardial) adipose tissue at both baseline and 52 weeks. The prespecified primary endpoint of this substudy was between-group changes in LV mass., Results: LV mass decreased by 11 g (95% C.I. -19 to -4) in the treated group (n = 50) when corrected for placebo (n =56) (p=0.004). Paracardiac adipose tissue decreased in the treated group by 45 ml (95% C.I. -69 to -22) when corrected for placebo (p<0.001). The change in LV mass in the treated group correlated with changes in body weight (p<0.02) and, tended to correlate with changes in waist circumference and blood pressure (p=0.06 for both). The LV mass change also correlated with changes in LV end diastolic volume and LA end diastolic and end systolic volumes (p<0.03 for all)., Conclusion: The CMR substudy of the SUMMIT trial demonstrated that tirzepatide therapy in obesity-related HFpEF led to reduced LV mass and paracardiac adipose tissue as compared to placebo and the change in LV mass paralleled weight loss. These physiologic changes may contribute to the reduction in heart failure events seen in the main SUMMIT trial., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: Structural and fibrotic remodelling is a well-known contributor to the atrial fibrillation (AF) substrate. Epicardial adipose tissue (EAT) is increasingly recognized as a contributor through electrical remodelling in the atria. We aimed to assess the association of LA fibrosis and EAT with LA strain and function using cardiac magnetic resonance (CMR) imaging in patients with AF., Methods and Results: LA fibrosis was assessed using late gadolinium enhancement CMR, LA EAT was assessed using the fat-water separation Dixon sequence, and feature tracking was applied to assess global longitudinal strain in its three components [reservoir (GLRS), conduit (GLCdS), and contractile (GLCtS)]. LA emptying fraction and LA volume were measured using the cine sequences. All CMR images were acquired in sinus rhythm. One hundred one AF patients underwent pre-ablation CMR (39% female, average age 62 years). LA fibrosis was negatively associated with the three components of global longitudinal strain (GLRS: R = -0.35, P < 0.001; GLCdS: R = -0.24, P = 0.015; GLCtS: R = -0.2, P = 0.046). Out of the different sections of the LA, fibrosis in the posterior and lateral walls was most negatively correlated with GLRS (R = -0.32, P = 0.001, and R = -0.33, P = 0.001, respectively). LA EAT was negatively correlated with GLCdS (R = -0.453, P < 0.001). LA fibrosis was negatively correlated with LA emptying fraction but LA EAT was not (R = -0.27, P = 0.007, and R = -0.22, P = 0.1, respectively). LA EAT and fibrosis were both positively correlated with LA volume (R = 0.38, P = 0.003, and R = 0.24, P = 0.016, respectively)., Conclusion: LA fibrosis, a major component of the AF substrate, and EAT, an important contributor, are associated with a worsening LA function through strain analysis by CMR., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Immune-mediated systemic inflammatory disorders present a latent threat for cardiovascular disease. Early involvement may be associated with constitutional symptoms, while clinical evidence of disease may manifest later in an insidious manner. Multimodality imaging is crucial to detect myocardial involvement, with transthoracic echocardiogram as a first-line imaging modality; however, cardiac MRI (CMRI) has the potential to significantly impact our diagnostic and therapeutic approaches through high-fidelity chamber quantification and parametric mapping techniques. Novel imaging techniques are currently under investigation, including stress CMRI, feature tracking CMR, late gadolinium enhancement (LGE) entropy, and 4 dimensional flow CMRI., Competing Interests: Disclosure B. Weber reports consulting/scientific advisory board fees from Novo Nordisk, Kiniksa Pharmaceuticals, Bristol Meyer Squib (BMS) and Horizon Therapeutics (now Amgen), unrelated to the current work. R. Kwong has no relevant disclosures. J.A. Aun: The views expressed in this article are those of Dr J.A. Aun and do not reflect the official policy of the United States Air Force, the Department of the Defense, the Defense Health Agency, or the United States Government. The identification of specific products or scientific instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of Dr J.A. Aun, the Department of Defense, or any component agency. Funding: Dr B. Weber is supported by research grants from NHLBIK23 HL159276-01, AHA 21CDA851511. Dr R. Kwong is supported by research grants from Alynlam, Myocardia, and Cytokinetics. Dr J.A. Aun: N/A., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Multi-modality imaging is the recommended approach to assess the severity of valvular heart diseases. Rheumatic mitral stenosis (MS), however, has yet to benefit from this approach. The aim of this study is to assess the added value of cardiac MRI (CMR) and computed tomography (CT) calcium score in assessing severity of MS when compared to 3D echocardiography. Patients with MS in sinus rhythm were included. Both CMR and 3D echo assessments of the mitral valve were performed. Subsequently, three radiologists and three cardiologists independently measured mitral valve area (MVA). In addition, CT of the mitral valve was conducted. Mitral calcium score was calculated according the Agatston method. A total of 41 patients were included. CMR significantly overestimated MVA when compared to 3D echo MVA regardless of the investigator [F (1, 40) = 23.3, p < 0.001, η2 = 0.36]. The more severe the MS, the greater the overestimation by CMR compared to 3D echo. Regarding CT of the mitral valve, 25 (61%) patients had an undetectable calcium. There was no significant difference in CT calcium scores between severe and non-severe MS (74 ± 282 HU vs. 65 ± 210 HU, p = 0.9). MVA measurement by CMR is overestimated when compared to 3D echo. Additionally, mitral valve calcium score is not correlated to MS severity., Competing Interests: Declarations Ethical approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Monastir University Hospital. Consent to participate Informed consent was obtained from all individual participants included in the study. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Thyroid hormones play a crucial role in cardiovascular physiology. Subclinical thyroid dysfunction has been associated with adverse cardiovascular outcomes, but evidence is mixed regarding causality., Objective: The purpose of this study was to investigate the potential causal relationships of thyroid-stimulating hormone (TSH), free thyroxine, hypothyroidism, and hyperthyroidism with cardiovascular outcomes, including atrial fibrillation (AF), coronary artery disease, myocardial infarction, heart failure, and ischemic stroke, as well as their effect on cardiac structure and function assessed by cardiac magnetic resonance imaging., Methods: A comprehensive 2-sample Mendelian randomization analysis was performed using summary data from large-scale meta-analyses of European ancestry individuals., Results: Genetically determined lower TSH levels (odds ratio 0.928; 95% confidence interval 0.884-0.974; P = .003) and genetic risk of hyperthyroidism (odds ratio 1.049; 95% confidence interval 1.016-1.083; P = .003) were associated with increased AF risk. These associations remained significant even after adjusting for cardiovascular risk factors. Colocalization and multivariable Mendelian randomization revealed height as a key mediator between TSH/hyperthyroidism and AF. These findings were further corroborated in the independent FinnGen cohort. However, no clear evidence was found for relationships between thyroid function and other cardiovascular outcomes and cardiac structure and function., Conclusion: Our study shows that reduced TSH levels and hyperthyroidism heighten AF risk, with height serving as an important mediator in these associations. The primary focus of thyroid management in cardiovascular health should be on preventing and treating arrhythmias, particularly AF. Our research highlights the importance of routine screening and timely treatment of thyroid dysfunction to optimize the prevention and management of arrhythmias., Competing Interests: Disclosures The authors declare that the study was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Right ventricular (RV) pressure-volume (PV) loops require postacquisition volume calibration by cardiac MRI (CMR) or hypertonic saline (HS). We defined the impact of these 2 volume calibration methods on rest-to-exercise ventricular contractility (end-systolic elastance: Ees), arterial afterload (Ea), and coupling (Ees/Ea)., Methods: In a prospective study, 82 RV PV-loop datapoints (rest, exercise stages every 25 W, and recovery) and CMR were acquired in 19 participants., Results: In comparison to CMR, HS-based calibration overestimated RV end-systolic volume at rest, mean (SD) by +38 ml (48) and end-diastolic volume by +46 ml (68), resulting in underestimated right ventricular ejection fraction (RVEF) by -8%. However, Ees and Ea were similar at rest (r 2 = 0.76 and 0.71, respectively, p < 0.001 for both), and Ees:Ea was identical (r 2 = 1.00, p < 0.001). Exercise metrics also remained similar: RV reserve (ΔEes) and change in coupling (ΔEes/Ea)., Conclusions: In comparison to CMR (gold-standard), HS-based calibration underestimates RVEF at rest; however, it is a robust approach for measuring coupling and RV reserve., (Published by Elsevier Inc.)

Background: To investigate the ability of a delayed respiratory-navigated, electrocardiographically-gated three-dimensional inversion recovery-prepared flash low angle shot (3D IR FLASH) sequence to evaluate the lower airways in children undergoing routine cardiovascular magnetic resonance (CMR)., Methods: This retrospective study included pediatric patients (0-18 years) who underwent clinical CMR where a delayed 3D IR FLASH sequence was performed between July 2020 and April 2021. The airway image quality and extent of lower airway visibility was graded by two blinded readers using a four-point ordinal scale (0-3). Lower airway anatomical variants and abnormalities were recorded., Results: 180 patients were included with a median age of 11.7 (4.6-15.3) years. 51/180 (28%) were under general anesthesia (GA). Overall, the median grading of airway image quality was 3 (2-3) and extent of lower airway visibility was 3 (3-3). Interrater agreement was almost perfect (κ = 0.867 and κ = 0.956, respectively). Image quality correlated with extent of lower airway visibility (r = 0.62, p < 0.01). Delayed 3D IR FLASH was able to characterize the segmental bronchi in 137/180 (76%) and lobar bronchi in 172/180 (96%) of patients. Lower airway abnormalities were identified in 37/180 (21%) of patients and in 33/129 (26%) with congenital heart disease (CHD). Identified abnormalities included tracheobronchial branching anomalies in 6/180 (3%), abnormal tracheobronchial situs in 6/180 (3%), and extrinsic vascular compression in 25/180 (14%)., Conclusions: Delayed 3D IR FLASH has excellent performance for evaluation of the lower airway anatomy and can simultaneously assess for myocardial late gadolinium enhancement. Lower airway abnormalities are not infrequently seen in children undergoing routine CMR for CHD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aortic root dilation has been reported commonly after repair of tetralogy of Fallot. However, the rate and risk factors of progression of the dilation are not fully understood. This is a single-centre, retrospective study to assess the rate and factors associated with progressive dilatation of the aortic root in repaired tetralogy of Fallot patients using cardiac MRI. The presence of the significant aortic dilation and the progression of dilation between initial and follow-up cardiac MRI were examined. The study cohort comprised 72 patients with repaired tetralogy of Fallot. The median age at the initial cardiac MRI scan was 19.6 (interquartile range: 14.6-31) years, and the median follow-up interval was 4.3 (2.9-5.7) years. Median dimension of ascending aorta at initial and follow-up cardiac MRI was 27.0 (22.3-31.0) mm and 29.2 (25.0-32.1) mm, respectively. Significant aortic dilation (the percentage predicted ascending aorta ≥150%) was observed in 11 (15.2%) patients at the initial cardiac MRI and 24 (33.3%) at the follow-up cardiac MRI. The significant aortic dilation at follow-up cardiac MRI was associated with increased indexed left ventricular stroke volume (odds ratio 1.062, p = 0.023). Thirteen patients demonstrated the significant progressive dilation of aorta between initial and follow-up cardiac MRI. The progressive dilation was associated with left ventricular ejection fraction at initial cardiac MRI (odds ratio 1.135, p = 0.048). In patients with repaired tetralogy of Fallot, aortic dilation is common and progresses over time. Cardiac MRI is a valuable tool for identifying individuals at risk for progressive aortic dilation.

Background: In patients with significant tricuspid regurgitation, cardiac magnetic resonance imaging (CMR) is the preferred method for the evaluation of right ventricular function and volumes. However validated thresholds are lacking., Aim: The aim of this study was to evaluate CMR assessment of right ventricular volumes in patients with significant (moderate or severe) tricuspid regurgitation, and to define its association with outcomes., Methods: The PRONOVAL study is a retrospective multicentre study using the clinical data warehouse of Greater Paris University Hospitals (AP-HP). Patients were screened for CMR in the PMSI (Programme de médicalisation des systèmes d'information). Hospitalization reports were analysed by natural language processing to include patients with tricuspid regurgitation. Exclusion criteria were left heart valvular disease, heart transplantation and cardiac amyloidosis. Primary outcome was a combined criterion of death or tricuspid surgery., Results: Between September 2017 and September 2021, 151 patients with isolated tricuspid regurgitation were screened. Right ventricular function and volumes were available in 86 (57.0%) CMR reports (the complete CMR group). In the complete CMR group, tricuspid regurgitation was severe in 62 patients (72.1%). Median age was 67.0 years (interquartile range 58.0-75.8). Median right ventricular indexed end-diastolic volume was 98.0 mL/m 2 (interquartile range 66.8-118.5). At 2-year follow-up, six patients (9.2%) had undergone tricuspid valve surgery, and 12 patients (18.5%) had died. Right ventricular indexed end-diastolic volume was associated with death or surgery at 2years, with an area under the receiver operating characteristic curve of 0.76 (95% confidence interval 0.75-0.77) for a threshold of 119mL/m 2 ., Conclusion: Right ventricular indexed end-diastolic volume >119mL/m 2 was found to be an independent indicator of death or surgery in patients with significant tricuspid regurgitation., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

We present a case of a 51-year-old woman diagnosed with light chain amyloidosis associated with monoclonal gammopathy of undetermined significance (MGUS). Initially, she presented with symptoms of heart failure, including palpitations, chest tightness, and shortness of breath, which were attributed to myocarditis based on cardiac magnetic resonance (CMR) imaging findings. However, her condition rapidly deteriorated, with recurrent admissions for worsening heart failure, cardiogenic shock, and stroke. A cardiac biopsy ultimately confirmed light chain amyloidosis, a rare complication of MGUS, which has a long-term risk of 0.8% in patients with light chain MGUS. Despite aggressive treatment, including chemotherapy and biventricular assist device implantation, her condition continued to decline, and she became ventilator-dependent and subsequently passed away. This case highlights the importance of considering amyloidosis in patients with MGUS and underscores the need for early diagnosis and intervention to prevent catastrophic outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Owolabi et al.)

Background: Amyloid light chain (AL) amyloidosis is a systemic disease that can cause restrictive cardiomyopathy (AL-CM). Current imaging techniques are not sensitive to detect myocardial dysfunction in AL-CM. We sought to evaluate role of a novel marker of myocardial dysfunction (myocardial function index, MFI) obtained using changes in left ventricular (LV) blood pool and myocardial volume in diastole and systole., Methods: Consecutive patients diagnosed with AL-CM who had underwent cardiac MRI between 2001-2017 were identified and compared to healthy individuals. Two independent operators used cardiac MRI to perform epicardial and endocardial tracings in systole and diastole to obtain myocardial volume in diastole (MVd) and myocardial volume in systole (MVs). Changes in myocardial volumes during the cardiac cycle were measured to calculate the MFI by M V d - M V s + S t r o k e v o l u m e MVd + L V e n d d i a s t o l i c v o l u m e . Multivariable analysis was performed to evaluate predictors of all-cause mortality and survival was evaluated using Kaplan Meier analysis., Results: Patients with AL-CM (n = 129, 61 ± 10 years, 32 % women) were older and more likely to be men compared to the normal cohort (n = 101, 39 ± 15 years, 61 % women). MFI was lower in patients with AL-CM (19 % [15; 23] vs 38 % [35; 41], p < 0.001) and MFI < 30 % discriminated between AL-CM with 92 % sensitivity and 100 % specificity (AUC 0.98, p < 0.001). Higher MFI was independently associated with survival even after adjusting for conventional prognostic biomarkers of AL-CM (HR 0.02, 95 % CI 2.23 *104 - 0.24, p < 0.05). Two independent operators demonstrated high intra and inter-rater correlation in measurements used to calculate MFI., Conclusion: MFI is a novel metric for assessing LV function. It is abnormal in patients with AL-CM and may play a role in risk stratification., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier B.V.)

Background: 2020 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines state that the ideal time for mitral valve surgery in primary mitral regurgitation (PMR) is when the LV approaches but has not yet reached echocardiographic LV ejection fraction (EF) < 60% or LV end-systolic dimension (ESD) > 40 mm. However, it is difficult to know the imminent risk of crossing this threshold when the surgical outcome is less optimal., Objective: Using machine learning and statistical models, we have shown that cardiac magnetic resonance (CMR) LV sphericity index (SI) and LV mid circumferential strain rate (SR circ ) added to LVEF and LVESD predict LVEF < 50% after mitral valve surgery. Here we test the hypothesis that these CMR features predict LVEF < 60% in asymptomatic PMR patients at 18 months., Methods: 33 asymptomatic PMR patients with moderate to severe mitral regurgitation had CMR with tissue tagging at baseline and every 6 months for 18 months. Two types of models were employed to predict LVEF < 60% at 18 months: a model using CMR features at a single time point (e.g., baseline) and a model utilizing repeated measurements over time., Results: CMR LVEF decreased below 60% in 13 patients over 18 months. LVEF varied over time with an inverse relation to mean arterial pressure and mean end-systolic wall stress. Random Forest models utilizing LV SI, LV mid SR circ , LVESD, and LVEF at a single time point (baseline) had a predictive accuracy of 64%. LV SI, LV mid SR circ , LVESD and LVEF at baseline, 6, and 12 months achieved a higher predictive accuracy of 79%, improved sensitivity from 57% to 85% than baseline alone and identified a threshold of CMR LVEF 63%-64% signaling LVEF < 60%., Conclusion: The variability of LVEF due to blood pressure dependence may require a longitudinal study that incorporates LVEF, LVESD, SR circ at multiple time points to identify the threshold at which LVEF is at risk for decline to less than 60%., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Zheng, Huang, Ahmed, Pat, Lloyd, Sharifov, Denney and Dell'Italia.)

Competing Interests: Conflict of interest: None declared.

Objectives: We aimed to study classical, publicly available convolutional neural networks (3D-CNNs) using a combination of several cine-MR orientation planes for the estimation of left ventricular ejection fraction (LVEF) without contour tracing., Methods: Cine-MR examinations carried out on 1082 patients from our institution were analysed by comparing the LVEF provided by the CVI42 software (V5.9.3) with the estimation resulting from different 3D-CNN models and various combinations of long- and short-axis orientation planes., Results: The 3D-Resnet18 architecture appeared to be the most favourable, and the results gradually and significantly improved as several long-axis and short-axis planes were combined. Simply pasting multiple orientation views into composite frames increased performance. Optimal results were obtained by pasting two long-axis views and six short-axis views. The best configuration provided an R 2 = 0.83, a mean absolute error (MAE) = 4.97, and a root mean square error (RMSE) = 6.29; the area under the ROC curve (AUC) for the classification of LVEF < 40% was 0.99, and for the classification of LVEF > 60%, the AUC was 0.97. Internal validation performed on 149 additional patients after model training provided very similar results (MAE 4.98). External validation carried out on 62 patients from another institution showed an MAE of 6.59. Our results in this area are among the most promising obtained to date using CNNs with cardiac magnetic resonance., Conclusion: (1) The use of traditional 3D-CNNs and a combination of multiple orientation planes is capable of estimating LVEF from cine-MRI data without segmenting ventricular contours, with a reliability similar to that of traditional methods. (2) Performance significantly improves as the number of orientation planes increases, providing a more complete view of the left ventricle.

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6-15 % of MI patients. Cardiac magnetic resonance (CMR) imaging identifies MINOCA etiologies, but access may be limited., Methods: We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI and < 50 % angiographic stenosis in all vessels were prospectively enrolled at 16 sites. CMR (median 6d from MI) was analyzed for late gadolinium enhancement (LGE), myocardial edema, and wall motion. We assessed ECGs for T-wave inversions (TWI), Q-waves (QW), ST-elevations (STE), ST-depressions (STD), and fragmented QRS complexes (fQRS). We calculated the DETERMINE score (# leads TWI + # fQRS +2*[# QW], excluding aVR, V1)., Results: Among 112 women with interpretable ECG, 81.3 % (91/112) had abnormal ECG; 50 % (56/112) had ≥1 TWI. CMR was abnormal in 74.1 % (83/112), with LGE in 49.1 % (55/112) and myocardial edema in 61.6 % (69/112). DETERMINE score ≥ 3 was associated with abnormal CMR (adjusted odds ratio [aOR] aOR 6.06 [1.89, 24.6], p = 0.002) and LGE (aOR 3.10 [1.26, 8.00], p = 0.013), but not edema (aOR 1.86 [0.80, 4.43], p = 0.152). TWI was also associated with abnormal CMR and LGE after adjustment (aOR 3.13 [1.08, 10.1], p = 0.036, aOR 3.23 [1.27, 8.63], p = 0.013, respectively), but not edema (aOR 1.26 [0.54, 2.96], p = 0.589). Specificity for abnormal CMR was 0.83 for DETERMINE score ≥ 3 and 0.75 for TWI. No other ECG findings were associated with CMR abnormality., Conclusion: DETERMINE score ≥ 3 and the presence of any TWI were associated with abnormal CMR and with LGE in MINOCA. Our findings demonstrate that the index ECG can provide insight on CMR findings but without sensitivity or specificity required to forgo the CMR. We reaffirm the central role of CMR in elucidating MINOCA pathophysiology., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background : The diagnosis and follow-up of cardiac involvement in Fabry disease constitutes an important challenge for clinicians caring for affected patients. Combining cardiac imaging with laboratory biomarkers appears most appropriate for longitudinal monitoring. Therefore, we examined the use of NT-proBNP and its association with imaging findings in patients with Fabry disease. Methods : We analysed cardiac MRI and echocardiography data, as well as laboratory results, from a single-centre prospective registry. Results : Repetitive follow-ups of 38 patients with Fabry disease, of whom 18 presented with left ventricular hypertrophy (LVH), revealed a correlation of NT-proBNP with left ventricular (LV) interventricular septal thickness, LV maximum wall thickness, LV and right ventricular (RV) mass index and trabecular mass in patients with LVH. Patients without LVH did not exhibit any tangible association between NT-proBNP and the mentioned parameters. Conversely, we could not detect an association of NT-proBNP with impairment of LV or RV ejection fraction or diastolic volume. Conclusions : NT-proBNP plays a pivotal role as a biomarker for cardiac involvement in patients with Fabry disease. Interestingly, in this specific population with mostly preserved ejection fraction, it seems to reflect ventricular hypertrophy rather than ventricular dysfunction or dilatation. While strong associations were found in hypertrophic patients, NT-proBNP's prognostic value appears limited in non- or pre-hypertrophic stages.

Background: Pericardial haemangiomas represent a very rare subset of benign cardiac tumour in an unusual location, posing a diagnostic and clinical challenge. Historically, the definitive diagnosis was achieved through surgical resection or at biopsy. In recent years, multi-parametric cardiac magnetic resonance imaging (MRI) has proven to offer a non-invasive, biopsy-like approach to tumour characterization., Case Summary: In our case, multimodality imaging was used to characterize a pericardial mass as a haemangioma discovered coincidentally with a brain glioma. Diagnostic certainty was substantially improved through utilization of successive post-contrast bright-blood imaging at cardiac MRI, demonstrating a characteristic enhancement pattern of haemangiomas in direct comparison to the blood pool. Conservative management and mid-term follow-up showed an uneventful clinical course and partial regression of the presumed pericardial haemangioma., Discussion: In the presence of typical features and application of individually tailored protocols, multimodality imaging can characterize cardiac tumours and guide patient management so that more invasive measures may be avoided. In our case of a suspected pericardial haemangioma, a conservative strategy was adopted with clinically uneventful course over a 2-year period. Whether this strategy can be applied to other patients with this rare tumour remains unclear, but the case report provides important information about the natural history of this entity and tissue characterization by cardiac MRI., Competing Interests: Conflict of interest: D.A.S. has received research support from Philips Healthcare. The other authors have no disclosures., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure and electrical dyssynchrony. Cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular (LV) function. However, the feasibility of using CMR with active CRT is still uncertain., Purpose: To assess the feasibility of a CRT "off-on" protocol during CMR and measure the acute effects of CRT interruption on LV function., Methods: Patients underwent CMR before (pre-CRT) and 6 months after (post-CRT) an MR-conditional CRT defibrillator implantation. The post-CRT scan included two complete sets of cine images, one with inactive (post-CRT OFF ) and one with active CRT (post-CRT ON ), maintaining a continuous connection between device and programmer., Results: Out of 29 enrolled patients, 8 (28%) had complete and analyzable post-CRT data. Unsuccessful procedures were attributed to connection problems between the CRT device and the programmer (n = 10), poor image quality (n = 7), and lack of patient cooperation (n = 4). LV ejection fraction significantly increased between pre-CRT scan (28.1%) and both post-CRT OFF (37.9%; p = 0.046) and post-CRT ON CMR (35.0%; p = 0.037), with a nonstatistically significant trend toward decreased LV volumes. No adverse events or significant changes in device electrical parameters (including battery level) were detected during the post-CMR scan period., Conclusion: A CRT "off-on" protocol during CMR studies can be safely executed in patients with an MR-conditional CRT defibrillator. However, technical improvements are needed to facilitate high-quality scans during active CRT. Favorable changes in LV function induced by CRT remodeling were not acutely reversed with the interruption of electrical therapy., (© 2024 Wiley Periodicals LLC.)

Purpose: Cardiac perfusion MRI is vital for disease diagnosis, treatment planning, and risk stratification, with anomalies serving as markers of underlying ischemic pathologies. AI-assisted methods and tools enable accurate and efficient left ventricular (LV) myocardium segmentation on all DCE-MRI timeframes, offering a solution to the challenges posed by the multidimensional nature of the data. This study aims to develop and assess an automated method for LV myocardial segmentation on DCE-MRI data of a local hospital., Methods: The study consists of retrospective DCE-MRI data from 55 subjects acquired at the local hospital using a 1.5 T MRI scanner. The dataset included subjects with and without cardiac abnormalities. The timepoint for the reference frame (post-contrast LV myocardium) was identified using standard deviation across the temporal sequences. Iterative image registration of other temporal images with respect to this reference image was performed using Maxwell's demons algorithm. The registered stack was fed to the model built using the U-Net framework for predicting the LV myocardium at all timeframes of DCE-MRI., Results: The mean and standard deviation of the dice similarity coefficient (DSC) for myocardial segmentation using pre-trained network Net&#95;cine is 0.78 ± 0.04, and for the fine-tuned network Net&#95;dyn which predicts mask on all timeframes individually, it is 0.78 ± 0.03. The DSC for Net&#95;dyn ranged from 0.71 to 0.93. The average DSC achieved for the reference frame is 0.82 ± 0.06., Conclusion: The study proposed a fast and fully automated AI-assisted method to segment LV myocardium on all timeframes of DCE-MRI data. The method is robust, and its performance is independent of the intra-temporal sequence registration and can easily accommodate timeframes with potential registration errors., (© 2024. CARS.)

Purpose: To develop and validate a highly efficient motion compensated free-breathing isotropic resolution 3D whole-heart joint T 1 /T 2 mapping sequence with anatomical water/fat imaging at 0.55 T., Methods: The proposed sequence takes advantage of shorter T 1 at 0.55 T to acquire three interleaved water/fat volumes with inversion-recovery preparation, no preparation, and T 2 preparation, respectively. Image navigators were used to facilitate nonrigid motion-compensated image reconstruction. T 1 and T 2 maps were jointly calculated by a dictionary matching method. Validations were performed with simulation, phantom, and in vivo experiments on 10 healthy volunteers and 1 patient. The performance of the proposed sequence was compared with conventional 2D mapping sequences including modified Look-Locker inversion recovery and T 2 -prepared balanced steady-SSFP sequence., Results: The proposed sequence has a good T 1 and T 2 encoding sensitivity in simulation, and excellent agreement with spin-echo reference T 1 and T 2 values was observed in a standardized T 1 /T 2 phantom (R 2  = 0.99). In vivo experiments provided good-quality co-registered 3D whole-heart T 1 and T 2 maps with 2-mm isotropic resolution in a short scan time of about 7 min. For healthy volunteers, left-ventricle T 1 mean and SD measured by the proposed sequence were both comparable with those of modified Look-Locker inversion recovery (640 ± 35 vs. 630 ± 25 ms [p = 0.44] and 49.9 ± 9.3 vs. 54.4 ± 20.5 ms [p = 0.42]), whereas left-ventricle T 2 mean and SD measured by the proposed sequence were both slightly lower than those of T 2 -prepared balanced SSFP (53.8 ± 5.5 vs. 58.6 ± 3.3 ms [p < 0.01] and 5.2 ± 0.9 vs. 6.1 ± 0.8 ms [p = 0.03]). Myocardial T 1 and T 2 in the patient measured by the proposed sequence were in good agreement with conventional 2D sequences and late gadolinium enhancement., Conclusion: The proposed sequence simultaneously acquires 3D whole-heart T 1 and T 2 mapping with anatomical water/fat imaging at 0.55 T in a fast and efficient 7-min scan. Further investigation in patients with cardiovascular disease is now warranted., (© 2024 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by the deposition of amyloid fibrils in the myocardium. It manifests in two primary subtypes: transthyretin cardiac amyloidosis (ATTR) and immunoglobulin light chain cardiac amyloidosis (AL). ATTR is further classified into wild-type and hereditary based on transthyretin gene mutation. Advances in diagnostics and therapeutics have transformed CA from a rare and untreatable condition to a more prevalent and manageable disease. Noninvasive diagnostic tools such as electrocardiography, echocardiography, and cardiac magnetic resonance can raise suspicion for CA; bone scintigraphy can non-invasively confirm ATTR, while AL necessitates histological confirmation. The severity of ATTR and AL can be assessed through serum biomarker-based staging. Treatment approaches differ, ranging from silencing or stabilizing transthyretin and degrading amyloid fibrils in ATTR to employing anti-plasma cell therapies and autologous stem cell transplantation in AL., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To develop a novel low-rank tensor reconstruction approach leveraging the complete acquired data set to improve precision and repeatability of multiparametric mapping within the cardiovascular MR Multitasking framework., Methods: A novel approach that alternated between estimation of temporal components and spatial components using the entire data set acquired (i.e., including navigator data and imaging data) was developed to improve reconstruction. The precision and repeatability of the proposed approach were evaluated on numerical simulations, 10 healthy subjects, and 10 cardiomyopathy patients at multiple scan times for 2D myocardial T 1 /T 2 mapping with MR Multitasking and were compared with those of the previous navigator-derived fixed-basis approach., Results: In numerical simulations, the proposed approach outperformed the previous fixed-basis approach with lower T 1 and T 2 error against the ground truth at all scan times studied and showed better motion fidelity. In human subjects, the proposed approach showed no significantly different sharpness or T 1 /T 2 measurement and significantly improved T 1 precision by 20%-25%, T 2 precision by 10%-15%, T 1 repeatability by about 30%, and T 2 repeatability by 25%-35% at 90-s and 50-s scan times The proposed approach at the 50-s scan time also showed comparable results with that of the previous fixed-basis approach at the 90-s scan time., Conclusion: The proposed approach improved precision and repeatability for quantitative imaging with MR Multitasking while maintaining comparable motion fidelity, T 1 /T 2 measurement, and septum sharpness and had the potential for further reducing scan time from 90 s to 50 s., (© 2024 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: To develop a method for quantifying the fatty acid composition (FAC) of human epicardial adipose tissue (EAT) using accelerated MRI and identify its potential for detecting proinflammatory biomarkers in patients with ST-segment elevation myocardial infarction (STEMI)., Methods: A multi-echo radial gradient-echo sequence was developed for accelerated imaging during a breath hold using a locally low-rank denoising technique to reconstruct undersampled images. FAC mapping was achieved by fitting the multi-echo images to a multi-resonance complex signal model based on triglyceride characterization. Validation of the method was assessed using a phantom comprised of multiple oils. In vivo imaging was performed in STEMI patients (n = 21; 14 males/seven females). FAC was quantified in EAT, subcutaneous AT, and abdominal visceral AT., Results: Phantom validation demonstrated strong correlations (r > 0.97) and statistical significance (p < 0.0001) between measured and reference proton density fat fraction and FAC values. In vivo imaging of STEMI patients revealed a distinct EAT FAC profile compared to subcutaneous AT and abdominal visceral AT. EAT FAC parameters had significant correlations with left ventricular (LV) end-diastolic volume index (p < 0.05), LV end-systolic volume index (p < 0.05), and LV mass index (p < 0.05)., Conclusions: Accelerated MRI enabled accurate quantification of human EAT FAC. The relationships between the EAT FAC profile and LV structure and function in STEMI patients suggest the potential of EAT FAC MRI as a biomarker for adipose tissue quality and inflammatory status in cardiovascular disease., (© 2024 The Author(s). Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Introduction: Chemotherapy-induced cardiotoxicity poses a significant challenge in the treatment of breast cancer, potentially compromising both the efficacy of cancer therapy and cardiac health of patients. This study aimed to enhance the early detection of cardiotoxic effects by integrating advanced imaging modalities and biomarker analysis, thereby facilitating timely interventions to mitigate cardiac risk., Methods: A prospective cohort design was employed, enrolling breast cancer patients scheduled for potentially cardiotoxic chemotherapy regimens. The study utilized a comprehensive diagnostic toolkit, including echocardiography with strain imaging, cardiac MRI, and serial measurements of cardiac biomarkers such as high-sensitivity troponins and natriuretic peptides., Results: The analysis revealed that subtle changes in myocardial strain parameters and early biomarker elevations were predictive of subsequent declines in left ventricular function, preceding conventional echocardiographic evidence of cardiotoxicity. Logistic regression analysis highlighted the additive predictive value of integrating biomarker data with advanced imaging findings to identify patients with the highest risk of significant cardiotoxicity., Discussion: The study concluded that an integrated diagnostic approach, combining detailed imaging assessments with sensitive biomarker analysis, offers a superior strategy for the early detection of chemotherapy-induced cardiotoxicity in breast cancer patients. This proactive diagnostic strategy empowers clinicians to tailor cancer therapy more precisely, balancing oncologic efficacy with cardiovascular safety and underscores the importance of a multidisciplinary approach in the management of patients undergoing potentially cardiotoxic chemotherapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Guo, Zhang, Wang, Zhang, Liu, Pei, Liu and Jia.)

Background: We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM)., Methods: In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The primary outcome was presence of myocardial injury as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging., Findings: Patients with C-VAM were predominantly white (67%) adolescent males (91%, 15.7 ± 2.8 years). Their initial clinical course was more likely to be mild (80% vs. 23%, p < 0.001) and cardiac dysfunction was less common (17% vs. 68%, p < 0.0001), compared to MIS-C. In contrast, LGE on CMR was more prevalent in C-VAM (82% vs. 16%, p < 0.001). The probability of LGE was higher in males (OR 3.28 [95% CI: 0.99, 10.6, p = 0.052]), in older patients (>15 years, OR 2.74 [95% CI: 1.28, 5.83, p = 0.009]) and when C-VAM occurred after the first or second dose as compared to the third dose of mRNA vaccine. Mid-term clinical outcomes of C-VAM at a median follow-up of 178 days (IQR 114-285 days) were reassuring. No cardiac deaths or heart transplantations were reported until the time of submission of this report. LGE persisted in 60% of the patients at follow up., Interpretation: Myocardial injury at initial presentation and its persistence at follow up, despite a mild initial course and favorable mid-term clinical outcome, warrants continued clinical surveillance and long-term studies in affected patients with C-VAM., Funding: The U.S. Food and Drug Administration., Competing Interests: SSJ, LGW, SA, JMS, HCW, JCM, JHS, RSB, VM, XJ, OHF, BF, SB, RCA, SAM, NM, JAS, SS, DV, AKVH, MJC, JK, SH, CM, MDC, MS, LN, JYA, SCU, PR, JKP, JGM, JAV, MPD, MB, PB, PE, KM, KG, MLD, KAA, AK, SBB, ALD, PKM, JS, ALC, JDR, ZP, AC, YS, LG, MA, MJ, JDR, NN, EDD report no competing interests. ASH: Site PI for the CAMP study—NHLBI funded, Site PI for MUSIC—NIH funded, Site PI for PREVAIL, supported by a sub-agreement from the Johns Hopkins University with funds provided by Grant No. R61HD105591 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development and the Office of the Director, National Institute of Health (OD). Scientific advisory board member of OP2 DRUGS (“OP2”), states that no work has been done. ABY: Institution received funds for conducting phase 3 clinical trials for Pfizer mRNA COVID-19 vaccine (C4591007 and C4591048). LEH: Patent US11457889B2, issued: Oct 4, 2022, Patent US2023/0016283A1 Published: Jan 19, 2023. JK: $530 Honorarium for speaking at Cleveland Clinic Valve Disease, Structural Interventions, and Diastology/Imaging Summit in 2/2023. FH: Payment for Expert Testimony in pending court case as an expert witness to discuss the risk of C-VAM. DT and SS: Grant or contract from New England Research Institute for participation in Pediatric Heart Network CAMP Study. MJC: Subject matter expert for CDC CISA program, Consulting fees Longerone Inc., (© 2024 The Author(s).)

Background: Infective endocarditis (IE) predominantly involves the cardiac valves. Timely diagnosis and initiation of therapy significantly reduce morbidity and mortality. Infective endocarditis presenting as a large left ventricular outflow tract (LVOT) mass is an atypical manifestation that provides significant challenges to the treating team., Case Summary: A 19-year-young male presented with exertional shortness of breath, palpitations, and presyncope for 4 months with constitutional symptoms for the last 6 months. Two-dimensional echocardiogram showed a large LVOT mass arising from the mitral aortic intervalvular fibrosa causing dynamic severe aortic valve obstruction, moderate aortic regurgitation, and severe mitral regurgitation. He was managed on lines of IE and received intravenous antibiotics. In view of worsening heart failure and cardiogenic shock, he underwent mass excision, mechanical aortic valve replacement, and mitral valve repair. Histopathology confirmed it as vegetation. He was discharged and is doing well at 2-month follow-up., Discussion: An atypical presentation of IE as a large LVOT mass was observed in this young male. Sound clinical judgement, judicious use of ancillary imaging, and a multidisciplinary approach ensured timely diagnosis and appropriate treatment. Management included appropriate intravenous antibiotics followed by surgery., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Cardiac magnetic resonance imaging (MRI) is widely used for non-invasive assessment of cardiac morphology, function, and tissue characteristics due to its exquisite soft-tissue contrast. However, it remains time-consuming and requires proficiency, making it costly and limiting its widespread use. Traditional cardiac MRI is inefficient as signal acquisition is often limited to specific cardiac phases and requires complex view planning, parameter adjustments, and management of both respiratory and cardiac motion. Recent efforts have aimed to make cardiac MRI more efficient and accessible. Among these innovations, the free-running framework enables 5D whole-heart imaging without the need for an electrocardiogram signal, respiratory breath-holding, or complex planning. It uses a fully self-gated approach to extract cardiac and respiratory signals directly from the acquired image data, allowing for more efficient coverage in time and space without the need for electrocardiogram gating, triggering, navigators, or breath-holds. This review provides a comprehensive overview of the free-running framework, detailing its history, concepts, recent improvements, and clinical applications.

Purpose: The purpose of this study was to evaluate the diagnostic performance and relationships of cardiac MRI structural parameters and strain components in patients with cardiac amyloidosis (CA) and to estimate the capabilities of these variables to discriminate between CA and non-amyloid cardiac hypertrophy (NACH)., Materials and Methods: Seventy patients with CA (56 men; mean age, 76 ± 10 [standard deviation] years) and 32 patients (19 men; mean age, 63 ± 10 [standard deviation] years) with NACH underwent cardiac MRI. Feature tracking (FT) global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS), strain AB ratio (apical strain divided by basal strain), myocardial T1, myocardial T2 and extracellular volume (ECV) were calculated. Comparisons between patients with CA and those with NACH were made using Mann-Whitney rank sum test. The ability of each variable to discriminate between CA and NACH was estimated using area under the receiver operating characteristic curve (AUC)., Results: Patients with CA had higher median GLS (-7.0% [Q1, -9.0; Q3, -5.0]), higher median GCS (-12.0% [Q1, -15.0; Q3, -9.0]), and lower median GRS (16.5% [Q1, 13.0; Q3, 23.0]) than those with NACH (-9.0% [Q1, -11.0; Q3, -8.0]; -17.0% [Q1, -20.0; Q3, -14.0]; and 25.5% [Q1, 16.0; Q3, 31.5], respectively) (P < 0.001 for all). Median myocardial T1 and ECV were significantly higher in patients with CA (1112 ms [Q1, 1074; Q3, 1146] and 47% [Q1, 41; Q3, 55], respectively) than in those with NACH (1056 ms [Q1, 1011; Q3, 1071] and 28% [Q1, 26; Q3, 30], respectively) (P < 0.001). Basal ECV showed the best performance for the diagnosis of CA (AUC = 0.975; 95% confidence interval [CI]: 0.947-1). No differences in AUC were found between AB ratio of GRS (0.843; 95% CI: 0.768-0.918) and basal myocardial T1 (0.834; 95% CI: 0.741-0.928) for the diagnosis of CA (P = 0.81). The combination of the AB ratio of FT-GRS and basal myocardial T1 had a diagnostic performance not different from that of basal ECV (P = 0.06)., Conclusion: ECV outperforms FT-strain for the diagnosis of CA with cardiac MRI. The AB ratio of FT-GRS associated with myocardial T1 provides diagnostic performance similar to that achieved by ECV., Competing Interests: Declaration of competing interest The authors have no competing interests to disclose in relation with this article., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

The aim was to investigate LA strain by feature tracking cardiac MRI in mitral stenosis (MS) patients before and after percutaneous balloon mitral valvuloplasty (PBMV). Patients underwent cardiac MRI before and after successful PBMV (n = 18). Mitral valve area, transmitral velocity and gradients, LA volumes and ejection fraction (LAEF) were measured. LA strain feature tracking analysis was used to calculate LA reservoir, conduit, and booster strain. LA strain, LA volumes, LAEF and mitral valve severity indices were compared before and after PBMV. Correlations between LA strain and other cardiac MRI parameters were assessed. After PBMV, mitral valve area increased from 1.18 ± 0.25 cm 2 to 2.26 ± 0.27 cm 2 , p < 0.001. Transmitral peak velocity decreased from 1.7 ± 0.37 m/s to 1.3 ± 0.27 m/s, p < 0.001. Transmitral peak gradient decreased from 12.4 ± 4.8 mmHg to 6.8 ± 2.9 mmHg, p < 0.001, and mean gradient decreased from 6.9 ± 3.8 mmHg to 2.9 ± 1.4 mmHg, p < 0.001. Maximal LA volume decreased from 73.1 ± 14.2 ml/m 2 to 62.7 ± 16.3 ml/m 2 , p = 0.018; corrected p value = 0.054. LAEF increased from 36.3 ± 8.7% to 44.4 ± 9.5%, p = 0.010. Reservoir strain increased from 11.7 ± 3.1% to 14.9 ± 3.6% after PBMV, p = 0.009, and conduit strain from 3.8 ± 2% to 6 ± 2.3%, p = 0.005. Booster strain insignificantly increased after PBMV. Cardiac MRI feature tracking provides information on the 3 LA functional phases. Significant improvement was observed in reservoir and conduit functions after successful PBMV., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To develop and evaluate a deep learning (DL) -based rapid image reconstruction and motion correction technique for high-resolution Cartesian first-pass myocardial perfusion imaging at 3T with whole-heart coverage for both single-slice (SS) and simultaneous multi-slice (SMS) acquisitions., Methods: 3D physics-driven unrolled network architectures were utilized for the reconstruction of high-resolution Cartesian perfusion imaging. The SS and SMS multiband (MB) = 2 networks were trained from 135 slices from 20 subjects. Structural similarity index (SSIM), peak SNR (PSNR), and normalized RMS error (NRMSE) were assessed, and prospective images were blindly graded by two experienced cardiologists (5, excellent; 1, poor). For respiratory motion correction, a 2D U-Net based motion corrected network was proposed, and the temporal fidelity and second-order derivative were calculated to assess the performance of the motion correction., Results: Excellent performance was demonstrated in the proposed technique with high SSIM and PSNR, and low NRMSE. Image quality scores were (4.3 [4.3, 4.4], 4.5 [4.4, 4.6], 4.3 [4.3, 4.4], and 4.5 [4.3, 4.5]) for SS DL and SS L1-SENSE, MB = 2 DL and MB = 2 SMS-L1-SENSE, respectively, showing no statistically significant difference (p > 0.05 for SS and SMS) between (SMS)-L1-SENSE and the proposed DL technique. The network inference time was around 4 s per dynamic perfusion series with 40 frames while the time of (SMS)-L1-SENSE with GPU acceleration was approximately 30 min., Conclusion: The proposed DL-based image reconstruction and motion correction technique enabled rapid and high-quality reconstruction for SS and SMS MB = 2 high-resolution Cartesian first-pass perfusion imaging at 3T., (© 2024 International Society for Magnetic Resonance in Medicine.)

Background: Pulmonary artery involvement (PAI) is not rare in Takayasu arteritis (TA). Persistently elevated pulmonary arterial pressure in TA-PAI patients leads to pulmonary hypertension (PH), and eventually cardiac death. Thus, the early detection of right ventricular dysfunction before the onset of PH is important., Purpose: To explore the potential of right ventricular global peak longitudinal and circumferential strain (RVGLS and RVGCS, respectively) in detecting right ventricular myocardial damage in TA-PAI patients without PH., Study Type: Retrospective., Population: One hundred and six TA patients (39.6 ± 13.9 years), of whom 52 were non-PAI and 54 were PAI patients (36 without PH and 18 with PH), along with 58 sex- and age-matched healthy volunteers (HVs) (36.7 ± 13.2 years). The involved arteries were validated by aorta magnetic resonance (MR) angiography and pulmonary artery computed tomography angiography., Field Strength/sequence: 3 T/Cine imaging sequence with a steady-state free precession readout., Assessment: Cardiac MRI-derived parameters measured by two radiologists independently were compared among HVs, and TA patients with and without PAI. In addition, these indices were further compared among HVs, and TA-PAI patients with and without PH., Statistical Tests: Student's t test, one-way ANOVA analysis, Pearson and Spearman correlation analysis, and reproducibility analysis. A P-value of <0.05 was considered statistically significant., Results: Although the TA-PAI patients without PH had a similar RV ejection fraction (RVEF) with HV (P = 0.348), RVGLS (non-PH 20.6 ± 3.7% vs. HV 24.0 ± 3.1%) was significantly lower and RVGCS (non-PH 14.8 ± 3.9% vs. HV 13.0 ± 2.7%) higher. The TA-PAI patients with PH had significantly poorer RVGLS (PH 13.5 ± 3.8% vs. non-PH 20.6 ± 3.7%) and RVGCS (PH 10.9 ± 3.2% vs. non-PH 14.8 ± 3.9%) than those without PH., Data Conclusion: Right ventricular dysfunction was detected in the TA-PAI patients without PH. MR-feature tracking may be an effective method for detecting early cardiac damage in the TA-PAI patients without PH., Level of Evidence: 3 TECHNICAL EFFICACY: Stage 3., (© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Cardiac amyloidosis, characterized by amyloid fibril deposition in the myocardium, leads to restrictive cardiomyopathy and heart failure. This review explores recent advancements in imaging techniques for diagnosing and managing cardiac amyloidosis, highlighting their clinical applications, strengths, and limitations. Echocardiography remains a primary, non-invasive imaging modality but lacks specificity. Cardiac MRI (CMR), with Late Gadolinium Enhancement (LGE) and T1 mapping, offers superior tissue characterization, though at higher costs and limited availability. Scintigraphy with Tc-99m-PYP reliably diagnoses transthyretin (TTR) amyloidosis but is less effective for light chain (AL) amyloidosis, necessitating complementary diagnostics. Amyloid-specific PET tracers, such as florbetapir and flutemetamol, provide precise imaging and quantitative assessment for both TTR and AL amyloidosis. Challenges include differentiating between TTR and AL amyloidosis, early disease detection, and standardizing imaging protocols. Future research should focus on developing novel tracers, integrating multimodality imaging, and leveraging AI to enhance diagnostic accuracy and personalized treatment. Advancements in imaging have improved cardiac amyloidosis management. A multimodal approach, incorporating echocardiography, CMR, scintigraphy, and PET tracers, offers comprehensive assessment. Continued innovation in tracers and AI applications promises further enhancements in diagnosis, early detection, and patient outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Inflammation is implicated in cardiovascular disease (CVD) pathogenesis, but causal roles of specific circulating inflammatory cytokines remain unclear. Mendelian randomization (MR) studies are well-poised to provide etiological insights beyond constraints of conventional research., Methods: We conducted a large-scale MR study to investigate potential causal relationships of 91 inflammatory proteins with CVD outcomes and cardiac remodeling using summary-level genetic data. Outcomes included coronary artery disease, myocardial infarction, stroke, atrial fibrillation, heart failure, abdominal aortic aneurysm, deep vein thrombosis of lower extremities, pulmonary embolism, cardiac structure and functional parameters. Inverse-variance weighted analysis was undertaken as the primary analysis, with several sensitivity analyses applied., Results: Hepatocyte growth factor (HGF) demonstrated a causal relationship with increased susceptibility to both any stroke (OR 1.111; 95 % CI 1.044 - 1.183; P = 9.50e-04) and ischemic stroke (OR 1.121; 95 % CI 1.047 - 1.200; P = 1.04e-03). Programmed cell death 1 ligand 1 (PD-L1) was negatively associated with atrial fibrillation risk (OR 0.936, 95 % CI 0.901 - 0.973; P = 7.69e-04). CCL20, CDCP1, Flt3L and IL-10RA were identified as causal coronary artery disease risk factors, while LIF and ST1A1 had protective effects. IL-4 and LIF-R demonstrated causal links with right heart functional changes., Conclusions: Our MR study nominates specific circulating inflammatory cytokines as potential targets for CVD treatment and prevention. Further research into mechanisms and clinical translation are warranted., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Chest pain is a common presenting complaint in adolescent patients. Myocarditis is an important and potentially serious etiology of chest pain for clinicians who care for these patients to recognize. Myocarditis is commonly virally mediated, while extra-intestinal cardiac manifestations of bacterial enteritis, such as Campylobacter infections,are rare. Awareness of this uncommon, but potentially life-threatening pathophysiology is important for clinicians to understand.  In our case, a 17-year-old male presented with chest discomfort, chest pain on inspiration, headache, myalgias, vomiting, and diarrhea. He denied recent viral illnesses or immunizations. He lived in rural Ohio, swam recently in a freshwater lake, and had eaten home-prepared deer meat. His father had diarrhea as well. Presenting vital signs were within normal limits for age. The patient was obese (BMI 48.5), with an otherwise normal physical exam, including a thorough cardiopulmonary assessment. Laboratory workup revealed leukocytosis (16.1 x 10 9 /L) and elevated high-sensitivity troponin (15,857 ng/L, >22,000 ng/L three hours later, ref range <20). Gastrointestinal polymerase chain reaction (PCR) panel detected Campylobacter spp., and stool culture was positive for Campylobacter jejuni . ECG, echocardiography, chest X-ray, and CT angiography were normal. Cardiac MRI revealed an increased T2 signal consistent with myocarditis. The patient was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and azithromycin and had complete resolution in symptoms. He was exercise-restricted for six months.  Myocarditis is a potentially fatal pathology, representing a significant cause of sudden death in young adults. Myocarditis can present with a broad spectrum of signs and symptoms as well as variable clinical severity. Bacterial causes of myocarditis are uncommon, with Campylobacter among the least common. Campylobacter gastroenteritis, however, is quite common worldwide. Extra-intestinal and cardiac manifestations are rare; thus, it is important to maintain a high index of suspicion. Due in part to its rarity, treatment for Campylobacter- associated myocarditis is not well established. Treatment for myocarditis, regardless of etiology, is largely supportive in nature.  Campylobacter -directed antibiotics, such as azithromycin, have been used successfully in adolescents with  Campylobacter -associated myocarditis. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for symptom control, though their use remains controversial. Activity restriction is recommended for six months to reduce the risk of sudden cardiac death.  Myocarditis is an important cause of sudden death in young adults and is a rare extra-intestinal manifestation of Campylobacter bacterial gastroenteritis. Pediatric and adult providers should be aware of this presentation and its pathophysiology. They should also utilize a multi-modal workup, aggressive supportive care, appropriate subspecialty consultation, and appropriate antibiotics for patients with diarrheal illness and a high clinical suspicion for extra-intestinal involvement, such as myocarditis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ream et al.)

Background: Hydroxychloroquine (HCQ) is a disease-modifying antirheumatic used in rheumatological diseases such as systemic lupus erythematosus. Long-term exposure to HCQ results in drug accumulation and predisposes to adverse effects., Case Summary: We present the case of a 45-year-old woman with long-term treatment with HCQ who presented to the Emergency Department with acute heart failure. Transthoracic echocardiogram, previously normal, showed severe biventricular hypertrophy and biventricular systolic dysfunction. Cardiac magnetic resonance (CMR) confirmed the previous findings and showed elevated native T1 and T2 values, elevated extracellular volume, and extensive mid-wall late gadolinium enhancement (LGE). Infiltrative cardiomyopathy was suspected, and endomyocardial biopsy performed. Light microscopy showed myocyte hypertrophy and vacuolar change and absence of lymphocytic inflammatory infiltrates. The diagnosis of HCQ-induced cardiomyopathy was established, and the drug was withdrawn. A CMR performed 1 year later showed normal systolic function of both ventricles and normalization of T2 values, reflecting resolution of myocardial oedema. However, severe hypertrophy, elevated native T1 values, and LGE persisted., Discussion: Our case shows that although discontinuation of the drug stops the progression of the disease, established myocardial structural damage persists. Early diagnosis of this entity is therefore essential to improve prognosis., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Myocarditis is a cardiovascular disease characterised by inflammation of the heart muscle which can lead to heart failure. There is heterogeneity in the mode of presentation, underlying aetiologies, and clinical outcome with impact on a wide range of age groups which lead to diagnostic challenges. Cardiovascular magnetic resonance (CMR) is the preferred imaging modality in the diagnostic work-up of those with acute myocarditis. There is a need for systematic analytical approaches to improve diagnosis. Artificial intelligence (AI) and machine learning (ML) are increasingly used in CMR and has been shown to match human diagnostic performance in multiple disease categories. In this review article, we will describe the role of CMR in the diagnosis of acute myocarditis followed by a literature review on the applications of AI and ML to diagnose acute myocarditis. Only a few papers were identified with limitations in cases and control size and a lack of detail regarding cohort characteristics in addition to the absence of relevant cardiovascular disease controls. Furthermore, often CMR datasets did not include contemporary tissue characterisation parameters such as T1 and T2 mapping techniques, which are central to the diagnosis of acute myocarditis. Future work may include the use of explainability tools to enhance our confidence and understanding of the machine learning models with large, better characterised cohorts and clinical context improving the diagnosis of acute myocarditis., Competing Interests: GS is a scientiific adviser to BioAiHealth. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Shyam-Sundar, Harding, Khan, Abdulkareem, Slabaugh, Mohiddin, Petersen and Aung.)

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated reduction in heart failure outcomes in patients with type 2 diabetes mellitus, although the exact mechanism of benefit remains unclear. Alteration in left atrial (LA) function due to chronic pressure or volume overload is a hallmark of heart failure., Objective: To evaluate the effect of the SGLT2 inhibitor empagliflozin on LA volume and function., Methods: 90 patients with coronary artery disease and type 2 diabetes (T2DM) were randomized to empagliflozin (n = 44) or placebo (n = 46), and underwent cardiac magnetic resonance (CMR) imaging at baseline and after 6 months. The main outcome was change in LA volume; LA function, including active and passive components, was also measured by a blinded reader., Results: At baseline, there was no significant difference in LA volumes between the empagliflozin (indexed maximum LA volume 26.4 ± 8.4mL/m 2 , minimum LA volume 11.1 ± 5.7mL/m 2 ) and placebo (indexed maximum LA volume 28.7 ± 8.2mL/m 2 , minimum LA volume 12.6 ± 5.0mL/m 2 ) groups. After 6 months, changes in LA volumes did not differ with adjusted difference (empagliflozin minus placebo): 0.99 mL/m 2 (95% CI: -1.7 to 3.7 mL/m 2 ; p = 0.47) for indexed maximum LA volume, and 0.87 mL/m 2 (95% CI: -0.9 to 2.6 mL/m 2 ; p = 0.32) for indexed minimum LA volume. Changes in total LA emptying fraction were also similar, with between-group adjusted mean difference - 0.01 (95% CI: -0.05 to 0.03, p = 0.59)., Conclusion: SGLT2 inhibition with empagliflozin for 6 months did not have a significant impact on LA volume and function in patients with T2DM and coronary artery disease. (Effects of Empagliflozin on Cardiac Structure in Patients with Type 2 Diabetes [EMPA-HEART]; NCT02998970)., (© 2024. The Author(s).)

Background: Mesalazine is an established first-line therapy for inflammatory bowel disease (IBD) and remains the mainstay of treatment for mild to moderate ulcerative colitis (UC). Both mesalazine and UC are rare but recognized causes of myopericarditis. Cardiac magnetic resonance (CMR) is a non-invasive method of assessing for myopericarditis. This case reports highlights the importance of early CMR in diagnosis, and management of myocarditis in a patient with IBD., Case Summary: A 28-year-old male was admitted with a 2-day history of chest pain. Three weeks prior to this presentation, the patient was initiated on mesalazine for UC. Serum troponin T and C-reactive protein were elevated. An echocardiogram showed borderline low left ventricular systolic function (LVEF = 50-55%). A CMR showed extensive patchy late gadolinium enhancement (LGE) in the mid to epicardial basal and mid lateral wall. The findings were consistent with acute myocarditis, and a working diagnosis of mesalazine-induced myocarditis was made. Mesalazine was stopped and guideline-directed anti-inflammatories initiated. Oral prednisolone was also introduced for IBD control. Follow-up CMR at four months showed near complete resolution of LGE., Discussion: Myocarditis in the context of IBD may be infective, immune-mediated or due to mesalazine hypersensitivity. Histological conformation was not available in this case. This case report highlights the importance of access to early CMR in order establish the diagnosis and withdrawal of the culprit medication. In the majority of cases, CMR will replace the need for endomyocardial biopsy; however, this may still be required in the most severe cases., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)