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Background Cardiovascular magnetic resonance (CMR) derived fractal analysis of the left ventricle (LV) has been shown in adults to be a useful quantitative measure of trabeculation with high reproducibility and accuracy for the diagnosis of LV non-compaction (LVNC). The aim of this study was to investigate the utility and feasibility of fractal analysis in children. Methods Eighty-four subjects underwent CMR: (1) 28 patients with LVNC (as defined by the Petersen criteria with NC/C ratio $$\ge$$ ≥ 2.3); (2) 28 patients referred by clinicians for assessment of hyper-trabeculation and found not to qualify as LVNC (NC/C $$\ge$$ ≥ 1.8 and Results Global fractal dimension (FD) was higher in the LVNC group than in the hyper-trabeculated group: 1.345 (SEM 0.053) vs 1.252 (SEM 0.034), p Conclusions It is technically feasible to perform fractal analysis in children using CMR and that it is quick, accurate and reproducible. Fractal scoring accurately distinguishes between LVNC, hyper-trabeculation and healthy controls as defined by the Petersen criteria.

Background: Left and right atrial function show a different pattern in advanced age in order to maintain adequate ventricular filling. It has been shown that left atrial (LA) function has a prognostic value in a number of heart conditions. Cardiovascular magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences. We used SSFP cines to characterize atrial function in healthy, normotensive, volunteers. Methods: We measured maximum, preatrial contraction and minimum left and right atrial volumes in 120 healthy subjects after careful exclusion of cardiovascular abnormality (60 men, 60 women; 20 subjects per age decile from 20 to 80 years). Data were generated from 3-dimensional modeling, including tracking of the atrioventricular ring motion and time-volume curves analysis. With those measurements, all the usual parameters for left and right atrial function were calculated. Results: Gender had significant influence on some parameters of left and right atrial conduit and booster pump function. Age significantly influenced the majority of parameters of both left and right atrial function, with typically lower reservoir and conduit functions and higher booster pump function, both in males and females belonging to older age groups. CMR normal ranges were modelled for clinical use with normalization, where appropriate, for body surface area and gender, displaying parameters with respect to age. Conclusions: CMR normal reference ranges for components of left and right atrial function are provided for males and females for a wide age range.

Histological validation of a new CMR T1-mappingbased protocol to improve accuracy for fibrosis assessment in patients with aortic stenosis Vassilis Vassiliou, Katharina Wassilew, George Asimakopoulos, Anthony de Souza, Cesare Quarto, Ee Ling Heng, Claire E Raphael, Bruce S Spottiswoode, Andreas Greiser, Evangelia Nyktari, Francisco Alpendurada, David Firmin, Andrew Jabbour, John Pepper, Dudley J Pennell, Peter Gatehouse, Sanjay Prasad

Background Although cardiovascular magnetic resonance (CMR) is showing increasingly diagnostic potential in left ventricular non-compaction (LVNC), relatively little research relevant to CMR is conducted in children with LVNC. This study was performed to characterize and compare CMR features and clinical outcomes in children with LVNC with and without late gadolinium enhancement (LGE). Methods A cohort of 40 consecutive children (age, 13.7 ± 3.3 years; 29 boys and 11 girls) with isolated LVNC underwent a baseline CMR scan with subsequent clinical follow-up. Short-axis cine images were used to calculate left ventricular (LV) ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), myocardial mass, ratio of non-compacted-to-compacted myocardial thickness (NC/C ratio), and number of non-compacted segments. The LGE images were analyzed to assess visually presence and patterns of LGE. The primary end point was a composite of cardiac death and heart transplantation. Results The LGE was present in 10 (25 %) children, and 46 (27 %) segments were involved, including 23 non-compacted segments and 23 normal segments. Compared with LGE- cohort, LGE+ cohort had significantly lower LVEF (23.8 ± 10.7 % vs. 42.9 ± 16.7 %, p

Background Coronary perfusion pressure is a combination of proximal perfusion pressure and distal coronary artery pressure resulting from contraction and relaxation of the myocardium and the consequences on the microcirculation. Wave intensity analysis (WIA) defines dominant waves causing coronary filling during the cardiac cycle and allows separation of proximally and distally originating waves.Reduced myocardial perfusion has been shown to predict mortality in hypertrophic cardiomyopathy (HCM), however no study has assessed the relationship between coronary filling patterns and downstream absolute myocardial perfusion.

Background The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR. Methods Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled. Results The most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year). Conclusion The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM. Condensed abstract The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting in a large number of cases (n > 27000). Based on our data CMR is frequently performed in European daily clinical routine. The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

Methods Twenty one body-builders were studied 14 anabolic steroid users and 7 controls matched for age and training history. First pass CMR perfusion imaging was performed on a 1.5T Avanto (Siemens, Erlangen, Germany) after adenosine-induced hyperemia (140 mcg/kg/min) and at rest using a hybrid echo-planar imaging sequence. Images of the base, mid-ventricle and apex were acquired and the myocardium was divided into 16 segments as well as endocardial and epicardial layers. After image registration, a modified Fermi-constrained deconvolution algorithm was applied pixel-wise to quantify absolute MBF. Late gadolinium enhancement (LGE) imaging was performed as well as standard assessment of ventricular volumes, function and LV mass. Data were analysed using a linear mixed effects model.

Background Cardiac involvement is a leading cause of morbidity and premature mortality in patients with scleroderma. Identification of this offers the opportunity for earlier and more stratified therapeutic intervention. Published data on the prognostic significance of left and right ventricular impairment and myocardial fibrosis in this cohort are limited. The study objective was to determine the prevalence and prognostic significance of abnormalities on cardiovascular magnetic resonance (CMR) in patients with scleroderma who have breathlessness and/or other cardiac symptoms. Methods This is a retrospective longitudinal study of 126 consecutive patients with confirmed scleroderma and cardiac symptoms, who had undergone CMR. Completed scans were available in 124 of these. All scans were performed at 1.5 Tesla (Siemens Sonata or Avanto). Thinned myocardium was defined as thickness 5mm. The presence of left ventricular (LV) or right ventricular (RV) dilatation was defined as an increase in indexed LV or RV volumes compared to previously published normal ranges. Late gadolinium enhancement (LGE) was defined as an area of clearly increased signal intensity confirmed on phase swapping. All scans were analysed by two independent operators. All cause mortality was determined from review of hospital records and the national summary care database. A Cox proportional hazards model was used to determine predictors of mortality (IBM SPSS 19, USA). Results Demographic data and CMR findings are shown in Table 1. Mean age was 55 (range 19 to 82) years, 45% were male and 81% had at least one cardiovascular abnormality on the scan. Significant LV dysfunction (ejection fraction

There were 83 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2011, which is an 11% increase in the number of articles since 2010. The quality of the submissions continues to increase. The editors had been delighted with the 2010 JCMR Impact Factor of 4.33, although this fell modestly to 3.72 for 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, we remain very pleased with the progress of the journal's impact over the last 5 years. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors feel it is useful to summarize the papers for the readership into broad areas of interest or theme, which we feel would be useful, so that areas of interest from the previous year can be reviewed in a single article in relation to each other and other recent JCMR articles [1]. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.

Background Hypertrophic cardiomyopathy (HCM) is associated with increased myocardial fibrosis and collagen deposition. Collagen reduces cardiovascular magnetic resonance (CMR) derived T2 times, however, the inflammatory milieu required for its deposition is often associated with localised oedema. Focal areas of high T2 signal intensity have been reported in association with areas of late gadolinium enhancement (LGE) in patients with HCM. However, this previous work has relied upon the subjective visual assessment of local changes in signal intensity. We hypothesised that quantitative CMR T2mapping would reveal marked differences in myocardial T2 characteristics in patients with HCM relative to controls. Methods Twenty-two consecutive patients with HCM (15 male, age 55.8±8.7 years) but no co-morbidity and 22 healthy controls (9 male, age 49.3±13.1 years) were studied. For each subject, a short axis mid-ventricular slice was acquired using a 1.5T Avanto (Siemens Healthcare, Erlangen, Germany). A breath-hold T2-prepared singleshot steady-state free precession (SSFP) sequence was used to produce three T2-weighted images with different T2 preparation times (0 ms, 24 ms, 55 ms). Parallel imaging was used to reduce the imaging time and motioncorrection was applied to improve the accuracy of T2 measurement. T2 maps were produced by fitting the signal intensity-time exponential decay curve using a linear 2-parameter model after logarithmic transformation (CMRtools, Cardiovascular Imaging Solutions, London, UK). An inversion recovery prepared gradient echo sequence with the inversion time optimised to null normal myocardium was used 10 minutes after intravenous gadolinium contrast (Gadovist, Bayer-Schering, Berlin, Germany, 0.1 mmol/kg) to detect late enhancement. Imaging was repeated in an orthogonal phase encoding direction to exclude artifact. Results There were no significant differences in baseline demographic characteristics between HCM and control patients. LV-wall thickness, indexed LV mass and ejection fraction were significantly higher in HCM patients (Table 1). In keeping with LV hypertrophy, the LV volumes were significantly smaller. None of the healthy controls exhibited any late enhancement whereas 18 (82%) HCM patients had areas of mid-wall enhancement, predominantly in the areas of hypertrophy. T2 times in patients with HCM were similar to controls with no evidence of any significant differences (HCM 54.1±2.5ms versus Controls 54.1±1.6ms, P=0.97). Conclusions

Background Abuse of anabolic steroids to induce skeletal muscle hypertrophy is widespread amongst recreational bodybuilders, however, the cardiac effects of such drugs have not been systematically documented. The ability of cardiovascular magnetic resonance (CMR) to image the myocardium in any plane and achieve full myocardial coverage renders it the gold standard for assessing LV volumes and mass.We sought to investigate the cardiac effects of anabolic steroid use with CMR hypothesising that significant hypertrophy and distinct LV remodelling would be seen in steroid users relative to non-users. Methods

Multimodality imaging in transcatheter aortic valve implantation: comparison between cardiovascular magnetic resonance, cardiac computed tomography, transesophageal and transthoracic echocardiography Andrew Jabbour, Tevfik F Ismail, Ali Vazir, Isabelle Roussin, Ankur Gulati, Francisco Alpendurada, Sameer Zaman, Oluwatosin Sotubo, Saman S Zaman, Ashwin Krishnamoorthy, Simon Davies, Sanjay K Prasad , Susanna Price, Michael B Rubens, Neil Moat, Raad H Mohiaddin

Background Cardiac resynchronization therapy (CRT) is an established treatment in advanced heart failure (HF). However, an important subset does not derive a significant benefit. Despite an established predictive role in HF, the significance of right ventricular (RV) dysfunction in predicting clinical benefit from CRT remains unclear. We investigated the role of RV function, assessed by cardiovascular magnetic resonance (CMR), in predicting response to and major adverse clinical events in HF patients undergoing CRT. Methods Sixty consecutive patients were evaluated with CMR prior to CRT implantation in a tertiary cardiac centre. The primary end-point was a composite of death from any cause or unplanned hospitalization for a major cardiovascular event. The secondary end-point was response to therapy, defined as improvement in left ventricular ejection fraction ≥ 5% on echocardiography at one year. Results Eighteen patients (30%) met the primary end-point over a median follow-up period of 26 months, and 27 out of 56 patients (48%) were considered responders to CRT. On time-to-event analysis, only atrial fibrillation (HR 2.6, 95% CI 1.02-6.84, p = 0.047) and RV dysfunction, either by a reduced right ventricular ejection fraction-RVEF (HR 0.96, 95% CI 0.94-0.99, p = 0.006) or tricuspid annular plane systolic excursion-TAPSE (HR 0.88, 95% CI, 0.80-0.96, p = 0.006), were significant predictors of adverse events. On logistic regression analysis, preserved RVEF (OR 1.05, 95% CI 1.01-1.09, p = 0.01) and myocardial scar burden (OR 0.90, 95% CI 0.83-0.96, p = 0.004) were the sole independent predictors of response to CRT. Patients with marked RV dysfunction (RVEF < 30%) had a particularly low response rate (18.2%) to CRT. Conclusions Right ventricular function is an important predictor of both response to CRT and long-term clinical outcome. Routine assessment of the right ventricle should be considered in the evaluation of patients for CRT.

The response of the left ventricular myocardium to aortic stenosis has been incompletely characterised. Here, we sought to investigate the correlation between the severity of aortic stenosis and the hypertrophic response and to define the patterns of remodelling and hypertrophy with CMR.

Left atrial (LA) size as assessed by echocardiography has been shown to have prognostic value in patients with dilated cardiomyopathy (DCM). More recently cardiac magnetic resonance (CMR) imaging studies have reported that the presence of left ventricular mid-wall late gadolinium enhancement (LGE), a marker of myocardial fibrosis, also predicts adverse outcome in DCM. The biplane area-length method has been validated as an accurate method for assessment of LA volumes, which echocardiography may underestimate by up to 47% compared with CMR.

In patients with hypertrophic cardiomyopathy (HCM), positron emission tomography (PET) and cardiac magnetic resonance (CMR) are potentially useful tools for risk stratification. Parameters which could be linked to clinical ourcomes are accurate measures of myocardial ischemia and fibrosis.

Methods CMR scans of patients with Noonan’s syndrome referred for imaging were analyzed. All patients were imaged on a 1.5T MRI. RV volumes were generated from SSFP cines and normalized to gender, body surface area and age. Phase contrast velocity mapping was used to assess pulmonary and aortic flow. The prevalence of concomitant cardiovascular abnormalities was also assessed. Results Thirty two consecutive patients (age 29 (20 - 50), (median (IQR); male 69%) were studied. Prior intervention for MPA or PV stenosis was performed in 15 (47%) patients and data was compared to 17 (53%) Noonan’ sp atients without MPA or PV intervention. Pulmonary regurgitation was more prevalent (73% vs. 33%, c 2 = 8.4; p = 0.037) and severe (regurgitant fraction 26.4±5% (mean ± SEM) vs. 6.5 ± 3%; p

Background Left atrial (LA) size is related to cardiovascular morbidity and mortality. Cardiovascular magnetic resonance (CMR) provides high quality images of the left atrium with high temporal resolution steady state free precession (SSFP) cine sequences. We used SSFP cines to define normal ranges for LA volumes and dimensions relative to gender, age and body surface area (BSA), and examine the relative value of 2D atrial imaging techniques in patients. For definition of normal ranges of LA volume we studied 120 healthy subjects after careful exclusion of cardiovascular abnormality (60 men, 60 women; 20 subjects per age decile from 20 to 80 years). Data were generated from 3-dimensional modeling, including tracking of the atrioventricular ring motion and time-volume curves analysis. For definition of the best 2D images-derived predictors of LA enlargement, we studied 120 patients (60 men, 60 women; age range 20 to 80 years) with a clinical indication for CMR. Results In the healthy subjects, age was associated with LA 4-chamber transverse and 3-chamber anteroposterior diameters, but not with LA volume. Gender was an independent predictor of most absolute LA dimensions and volume, but following normalization to BSA, some associations became non-significant. CMR normal ranges were modeled and are tabled for clinical use with normalization, where appropriate, for BSA and gender and display of parameter variation with age. The best 2D predictors of LA volume were the 2-chamber area and 3-chamber area (both r = 0.90, p < 0.001). Conclusions These CMR data show that LA dimensions and volume in healthy, individuals vary significantly by BSA, with lesser effects of age and gender.

There were 56 articles published in the Journal of Cardiovascular Magnetic Resonance in 2009. The editors were impressed with the high quality of the submissions, of which our acceptance rate was about 40%. In accordance with open-access publishing, the articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. We have therefore chosen to briefly summarise the papers in this article for quick reference for our readers in broad areas of interest, which we feel will be useful to practitioners of cardiovascular magnetic resonance (CMR). In some cases where it is considered useful, the articles are also put into the wider context with a short narrative and recent CMR references. It has been a privilege to serve as the Editor of the JCMR this past year. I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.

ss Open Acce Oral presentation Recanalization of coronary chronic total occlusion guided by cardiovascular magnetic resonance imaging and its relation with health outcome measures Chiara Bucciarelli-Ducci*1, Didier Locca1, Rory O'Hanlon1, Joanna Petryka1, Agata Grasso1, Wright Christine2, Ricardo Wage1, Karen Symmonds1, Eleni Asimacopoulos1, Peter Gatehouse1, Sanjay Prasad1, Carlo Di Mario2 and Dudley Pennell1

Open Access Oral presentation Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy using cardiovascular magnetic resonance Rory O'Hanlon*1, Agata Grasso1, Michael Roughton2, James C Moon3, Susan Clarke1, Ricardo Wage1, Jess Webb1, Meghana Kulkarni1, Dana Dawson1, Leena Sulaibeekh1, Bud Chandrasekaran1, Chiara BucciarelliDucci1, Ferdinando Pasquale3, Martin R Cowie4, Wiliam J McKenna3, Margaret Burke5, Mary Sheppard1, Perry M Elliot3, Dudley J Pennell1 and Sanjay K Prasad1

Methods 96 consecutive patients with sarcoidosis were referred to our centre for CMR between 2002 and 2007 (46 M, 50 F; mean age 57 years). Outcomes in two cohorts distinguished by evidence of LGE were retrospectively assessed (mean follow-up 3.5 years). Left ventricular (LV) volumes, ejection fraction (EF) and mass were evaluated using semi-automated analysis software and indexed to body surface area. Continuous variables were reported as mean ± standard deviation; groups (based on the presence or absence of LGE) were compared using a t-test or Fisher's exact test. Results LGE was observed in 31 out of 96 (32%) patients. No significant difference was seen in all-cause death or hospitalisation for a cardiovascular event between the LGE+ and LGEcohort. The LGE+ cohort had a significantly greater rate of ICD implantation (7 vs 1, p < 0.0005) and appropriate ICD discharge (4 vs 0, p < 0.005). Notably, only four patients had right ventricular LGE+; all required defibrillator (ICD) implantation and sustained appropriate ICD discharge. There was no difference in other secondary outcomes such as pre-ICD implantation sustained ventricular tachycardia, pacemaker implantation rate or escalation of heart failure therapy. Amongst LGE+ individuals, there was a significant reduction in biventricular EF (LVEF 50 ± 13.0% vs. 64 ± 10%, p < 0.05; RVEF 49 ± 13 vs. 58 ± 9%, p < 0.05). RVEDV was also significantly greater (173 ± 14 vs.137 ± 5 mls, p < 0.0065), although not LVEDV (105 ± 5.9 vs. 132 ± 7.9 mls, p < 0.0066). The distribution of LGE did not appear to correlate with outcome. The two groups did not differ in the incidence of biopsy-proven sarcoidosis (48/96 cases), pre-referral cardiac symptoms or duration of follow-up. Within this cohort, only five patients had STIR imaging clearly suggestive of active cardiac sarcoidosis.

Background ARVC is one of the commonest causes of sudden cardiac death amongst people younger than 30 years. Establishing the diagnosis still remains a difficult task, since there is as yet no single non-invasive gold standard test to confirm it. It is therefore essential to identify within a population with suspected ARVC, a subset who will indeed be at a higher risk of developing the disease, and thus at a higher risk of MACE. Imaging criteria that are most commonly studied include right ventricular volumes, ejection fraction and regional wall motion abnormalities. We sought to determine which imaging parameters were better predictors of worse clinical outcomes.

Atrial fibrillation (AF) is the most common arrhythmia observed in HCM, developing in approximately 20% of all cases, with an annual incidence of 1–3% per year. The risk of AF developing is 4–6 fold greater in HCM than in the general population. Its' development is associated with an increased risk of systemic thromoboembolism, heart failure and death. Myocardial fibrosis is an important risk factor for the development of atrial fibrillation as demonstrated in post mortem studies. Cardiovascular magnetic resonance (CMR) is the gold standard imaging tool to visualise replacement myocardial fibrosis in vivo. The presence of fibrosis has been shown to be an important predictor of cardiovascular morbidity and mortality in both ischaemic and dilated cardiomyopathies, and more recently an important predictor of arrhythmia as detected by Holter monitoring in HCM.

Cardiac complications secondary to iron overload are the leading cause of death in thalassemia major (TM). Cardiovascular magnetic resonance (CMR) can provide a noninvasive means of measuring the amount of tissue iron. With CMR, tissue iron is detected indirectly by the effect on relaxation times of hydrogen nuclei in the presence of ferritin and hemosiderin iron. The iron results in shortening of proton relaxation times and both CMR T2* and T2 have been validated as non-invasive means for assessment of myocardial iron overload. [1–4]. We have demonstrated a linear correlation between T2 and T2* in patients with iron overload [5]. However, there is currently little data on myocardial iron assessment using the longitudinal relaxation time T1 mainly due to the cardiac and respiratory problems in CMR. A modified Look-Locker Inversion recovery (MOLLI) has been recently proposed for myocardial T1 quantification [6]. It is of interest, therefore, to investigate whether T1 measurement is affected by iron overload in TM patients. For quantitatively analysis, it is important to further investigate the relationship between T1 and the more established T2* measurements in TM patient population. In this study therefore, we aimed to compare myocardial T1 [6] and T2* measurements [3]in vivo in order to establish the relationship between them. We hypothesised that T1 would correlate with T2* linearly when iron becomes dominant in the myocardium.

Background Post partum cardiomyopathy (PPCM) can occur between the last trimester of pregnancy or within 5 months post partum, in the absence of any history of heart disease. Although rare, it may become unresponsive to medical treatment and can in such cases, require mechanical support or even a heart transplant. Predicting its evolution is unfortunately not possible. Late gadolinium enhancement CMR (LGE) can identify myocardial fibrosis and has shown its prognostic significance in DCM. However, the role of LGE in PPCM as a predictor of outcome has not been reported. The purpose of this study was to assess whether LGE imaging provides prognostic information in the outcome in post partum cardiomyopathy.

Introduction In patients undergoing percutaneous coronary intervention (PCI), 15 to 26% develop elevated creatine kinase isoenzyme MB (CKMB) levels after the procedure. Troponin rise is even more frequent and is observed in 29– 48% of patients in a standard daily practice procedure. Little is known about the mechanism of this damage specifically in patient with complex PCI. Cardiovascular Magnetic Resonance (CMR) with gadolinium-based contrast media administration can non-invasively detect myocardial fibrosis. Inversion recovery preparation with segmented gradient echo readout (GRE) using recovery sequences is considered the gold standard sequence for the detection of late gadolinium myocardial enhancement (LGE).

Methods Sixteen consecutive patients with CTO were recruited in the study and 12 patients underwent a CMR MPI both before (6.3 ± 6.4 days) and after revascularization (56 ± 39 days). CMR MPI study was performed in 1.5 T Siemens Avanto scanner using a 3 slice hybrid-EPI sequence with TSENSE. First-pass stress perfusion imaging was performed after 4 minutes of 140 μg/kg/min adenosine and 0.1 mmol/Kg of Gd-DTPA injected at 7 ml/s, followed by late enhancement imaging with inversion-recovery segmented FLASH sequence. First-pass rest perfusion images were acquired > 20 minutes after stress perfusion imaging. In addition, we obtained multiple SSFP cine images to encompass the left ventricle from base to apex (8 mm slice thickness, 2 mm gap). A visual wall motion, gadolinium and perfusion score (0–4) on a 16-segment model was applied and myocardial perfusion reserve index (MPRI) was calculated in all CTO myocardial territories. Left ventricular end-diastolic (LVDV) and end-systolic volumes (LVSV), ejection fraction (LVEF) and infarcted mass were also calculated.

We used T2-STIR (Short Tau Inversion Recovery) cardiovascular magnetic resonance to demonstrate carcinoid tumor metastases to the heart and liver in a 64-year-old woman with a biopsy-proven ileal carcinoid tumor who was referred because of an abnormal echocardiogram.

Methods 15 healthy volunteers (31±5 years, 8 males) with no known medical conditions, on no medication, underwent CMR scans (Avanto, Siemens, 1.5T) on two separate attendances with an 11 heart beat MOLLI 5(3)3. Following frequency adjustment, native T1 maps were obtained twice on a basal and a mid-ventricular slice respectively. 15 mins following GBCA administration (0.1 mmol/kg, Gadobutrol, Bayer, Germany) both image planes were acquired again twice. Pixel-wise T1 maps were analyzed offline by 2 independent blinded operators. A Region Of Interest was manually drawn in the septum for myocardium and blood in native and post gad images as shown in fig 1.

Background The temporal pattern of coronary artery flow velocity through the cardiac cycle provides important information about coronary haemodynamics. The ‘gold standard’ for coronary artery velocity assessment is the Doppler flow wire which is inserted directly into the coronary artery under X-ray fluoroscopic guidance, which is invasive, uses ionising radiation and has a small but significant risk of serious complication. In this study, we perform an in vivo comparison of coronary blood flow velocities measured with breath-hold high temporal resolution spiral phase velocity mapping and Doppler flow wire measurements. Methods Breath-hold proximal coronary artery velocity maps were acquired in 5 left anterior descending (LAD) and 3 right coronary arteries (RCAs) in patients who had undergone invasive Doppler flow wire assessment as part of a clinical assessment. Acquisition parameters were: pixel size 1.4 × 1.4 mm (reconstructed to 0.7 ×0 .7 mm) ×8m m, true temporal resolution 19 ms, 1-1 water excitation (WE), 17 cardiac cycle breath-hold, velocity sensitivity 30-50cm/s, retrospective ECG gating (reconstructed 50 phases). Extraction of MR coronary artery blood flow velocitytime curves was performed using a custom MATLAB program which tracked the motion of the vessel over the cardiac cycle and corrected for the through-plane motion of the vessel using a region of adjacent tracked myocardium (LAD) or a region of surrounding epicardial fat (RCA) from a separately acquired fat-excitation acquisition. For each vessel, the mean through-plane motioncorrected MR velocities at all timepoints were plotted against the equivalent flow wire velocities. If necessary, the profiles were first time-shifted to take into account small differences in data triggering between the two techniques. The correlation between the two profiles was assessed using simple linear regression analysis. Results Figures 1 and 2 show example LAD and RCA studies. On average, the MR measured velocities were 66% less than the Flowire velocities (SD 9%, range: 50% - 78%). The correlation between the MR and flow wire data, however, was high, with R 2 values ranging from 0.6 - 0.95 in the 8 vessels studied (mean R 2 = .80).

Background Heart failure with preserved ejection fraction (HF-PEF) is common and has a poor prognosis with a 3 year mortality rate of 23%. There are currently no effective therapies for this condition. HF-PEF is characterized by symptoms of heart failure, normal or a mildly impaired ejection fraction and evidence of adverse cardiac and vascular remodelling. A feature of all heart failure is a heightened sympathetic nervous system (SNS), which can now be abrogated using renal denervation (RD). Methods We are conducting a study of patients with HF-PEF who will be randomised (2:1) to receive RD or open control. As a phase II mechanistic study we are primarily investigating the effect of RD on patient symptoms (questionnaire), cardio-pulmonary exercise function, B-type natriuretic peptide levels, left ventricular filling pressures, left ventricular mass and left atrial volume. We are also assessing macrovascular function using aorta imaging to calculate aorta distensibility, pulse wave velocity and aortic flow. Finally

Background A relationship between myocardial fibrosis and ventricular dysfunction has been demonstrated using late gadolinium enhancement (LGE) in the pressure-loaded right ventricle from congenital heart defects. In patients with Eisenmenger syndrome (ES), the presence of LGE has not been investigated. The aims of this study were to detect any myocardial fibrosis in ES and describe major clinical variables associated with the finding. Methods From 45 subjects screened, 30 subjects (age 43 ± 13 years, 20 female) underwent prospective cardiovascular magnetic resonance with LGE to quantify biventricular volume and function as well as maximal and submaximal exercise during a single visit. Standard cine acquisitions were obtained for ventricular volume and function. Further imaging was performed after administration of 0.1 mmol/kg gadolinium contrast. Regions of LGE were evaluated qualitatively and quantitatively by manual contouring of identified areas, with total area expressed as a percentage of mass. Patients were followed prospectively (mean follow up 7.4 ± 0.4 years) and any deaths recorded. Patients with LGE findings were compared to those without. Results LGE was present in 22/30 (73%) patients, specifically in RV myocardium (70%), RV trabeculae (60%), LV myocardium (33%) or LV papillary muscles (30%), though in small amounts (mean 1.4% of total ventricular mass, range 0.16 – 6.0%). Those with any LGE were not different in age, history of arrhythmia, desaturation, nor hemoglobin, nor ventricular size, mass, or function. Exercise capacity was low, but also not different between those with and without LGE. Similarly no significant associations were found with amount of fibrosis. There were five deaths among patients with LGE, versus two in patients without, but no difference in survival (log rank =0.03, P = 0.85). Conclusions Myocardial fibrosis by LGE is common in ES, though not extensive. The presence and quantity of LGE did not correlate with ventricular size, function, degree of cyanosis, exercise capacity, or survival in this pilot study. More data are clearly required before recommendations for routine use of LGE in these patients can be made.

Background Renal denervation (RDN) is an effective treatment for resistant hypertension with expanding indications in the hypertensive population [1]. The European Society of Hypertension (ESH) guidelines [2], largely based on the Symplicity trial inclusion criteria, state RDN should not be performed if the patient has multiple renal arteries, renal artery stenosis or renal arteries with a diameter of less than 4 mm or length of less than 20 mm. Imaging prior to consideration of RDN is recommended but has not been included in all RDN trial protocols. The proportion of hypertensive patients with anatomy suitable for RDN using the current guidelines is not known.

Background Myocardial fibrosis and abnormalities of the microcirculation are features of non-ischemic dilated cardiomyopathy (DCM) and may contribute to adverse remodeling. However, relationship between perfusion abnormalities and diffuse fibrosis has not been fully characterised. CMR allows quantification of the extracellular volume fraction (ECV), a marker of fibrosis, and absolute myocardial blood flow, in a single study. We hypothesised that increased ECV was associated with impaired myocardial perfusion reserve (MPR) in DCM patients. Methods

Aberrant myocardial sheetlet mobility in hypertrophic cardiomyopathy detected using in vivo cardiovascular magnetic resonance diffusion tensor imaging Pedro Ferreira, Philip J Kilner, Laura-Ann McGill, Sonia Nielles-Vallespin, Andrew D Scott, Bruce S Spottiswoode, Xiaodong Zhong, Siew Y Ho, Karen McCarthy, Tevfik Ismail, Peter Gatehouse, Ranil Silva, Alexander Lyon, Sanjay K Prasad, David Firmin, Dudley J Pennell

There were 90 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2012, which is an 8% increase in the number of articles since 2011. The quality of the submissions continues to increase. The editors are delighted to report that the 2011 JCMR Impact Factor (which is published in June 2012) has risen to 4.44, up from 3.72 for 2010 (as published in June 2011), a 20% increase. The 2011 impact factor means that the JCMR papers that were published in 2009 and 2010 were cited on average 4.44 times in 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.