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The precise reconstruction of accelerated magnetic resonance imaging (MRI) brings about notable advantages, such as enhanced diagnostic precision and decreased examination costs. In contrast, traditional cardiac MRI necessitates repetitive acquisitions across multiple heartbeats, resulting in prolonged acquisition times. Significant strides have been made in accelerating MRI through deep learning-based reconstruction methods. However, these existing methods encounter certain limitations: (1) The intricate nature of heart reconstruction involving multiple complex time-series data poses a challenge in exploring nonlinear dependencies between temporal contexts. (2) Existing research often overlooks weight sharing in iterative frameworks, impeding the effective capturing of non-local information and, consequently, limiting improvements in model performance. In order to improve cardiac MRI reconstruction, we propose a novel temporal-spatial transformer with a strategy in this study. Based on the multi-level encoder and decoder transformer architecture, we conduct multi-level spatiotemporal information feature aggregation over several adjacent views, that create nonlinear dependencies among features and efficiently learn important information among adjacent cardiac temporal frames. Additionally, in order to improve contextual awareness between neighboring views, we add cross-view attention for temporal information fusion. Furthermore, we introduce an iterative strategy for training weights during the reconstruction process, which improves feature fusion in critical locations and reduces the number of computations required to calculate global feature dependencies. Extensive experiments have demonstrated the substantial superiority of this procedure over the most advanced techniques, suggesting that it has broad potential for clinical use. [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed to assess the safety and efficacy of cardiac contractility modulation (CCM) therapy in patients with heart failure with reduced ejection fraction (HFrEF) depending on HF etiology. Methods: We enrolled 166 patients with optimal medical therapy-resistant HFrEF (median age 59 years, 83.7% males, median NYHA class − 2, median left ventricular ejection fraction (LVEF) − 29.0%) who underwent CCM therapy device implantation from 2013 to 2019 in four medical centers in Russia. The HF etiology was determined based on invasive coronary angiography or cardiac MRI data. Transthoracic echocardiography (TTE), 6-minute walking test (6MWT), and NTproBNP-tests were performed at a baseline and 12 months after the implantation. Results: The ischemic etiology of HF was revealed in 100 patients (61.5%) (ICM group); the non-ischemic group (NICM) evolved 66 patients (38.5%). Patients in the ICM group were significantly older (61[57–69] vs. 55 [42.8–61], p < 0.001), more frequently had hypertension (79% vs. 42.4%, p < 0.001) and chronic kidney disease (43% vs. 22.7%, p = 0.012). Patients in the NICM group had significantly more often atrial fibrillation (AF) (58% vs. 74%, p = 0.048), larger end-diastolic volume (EDV) (249 [208–309] vs. 220 [192–271], p = 0.019) and end-systolic volume (ESV) (183 [147–230] vs. 154 [128–199], p = 0.003). There were no significant differences in mortality between ICM and NICM groups (14.4 vs. 10.8%, p = 0.51). In 12 months, there was a significant increase in LVEF in the NICM group (+ 2.0 [2–6] vs. +7.7 [2–12], p < 0.001), while the improvement in the 6MWT (+ 75 [22–108] vs. +80 [10–160], p = 0.851) and NYHA class did not reach the level of significance. The subanalysis between patients with improved NYHA class and those without improvement revealed that patients without improvement more frequently had AF (56% vs. 89%; p < 0.01), chronic obstructive lung disease (18% vs. 35% p = 0.047), higher blood pressure (110 [105–120] vs. 120[110–129]; p = 0.032). Conclusion: In this multicenter retrospective study, patients with non-ischemic HFrEF showed a significantly higher improvement in LVEF and LV reverse remodeling following CCM therapy device implantation. There was no significant association between HF etiology and survival in drug-resistant HFrEF patients following CCM therapy. [ABSTRACT FROM AUTHOR]

Background: Stress hyperglycemia, which is associated with poor prognosis in patients with acute myocardial infarction (AMI), can be determined using the stress hyperglycemia ratio (SHR). Impaired left ventricular function and microvascular obstruction (MVO) diagnosed using cardiac magnetic resonance (CMR) have also been proven to be linked to poor prognosis in patients with AMI and aid in risk stratification. However, there have been no studies on the correlation between fasting SHR and left ventricular function and MVO in patients with acute ST-segment elevation myocardial infarction (ASTEMI). Therefore, this study aimed to investigate the additive effect of fasting SHR on left ventricular function and global deformation in patients with ASTEMI and to explore the association between fasting SHR and MVO. Methods: Consecutive patients who underwent CMR at index admission (3–7 days) after primary percutaneous coronary intervention (PPCI) were enrolled in this study. Basic clinical, biochemical, and CMR data were obtained and compared among all patients grouped by fasting SHR tertiles: SHR1: SHR < 0.85; SHR2: 0.85 ≤ SHR < 1.01; and SHR3: SHR ≥ 1.01. Spearman's rho (r) was used to assess the relationship between fasting SHR and left ventricular function, myocardial strain, and the extent of MVO. Multivariable linear regression analysis was performed to evaluate the determinants of left ventricular function and myocardial strain impairment in all patients with AMI. Univariable and multivariable regression analyses were performed to investigate the correlation between fasting SHR and the presence and extent of MVO in patients with AMI and those with AMI and diabetes mellitus (DM). Results: A total of 357 patients with ASTEMI were enrolled in this study. Left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI) were significantly lower in SHR2 and SHR3 than in SHR1. Compared with SHR1 and SHR2 groups, left ventricular strain was lower in SHR3, as evidenced by global radial (GRS), global circumferential (GCS), and global longitudinal (GLS) strains. Fasting SHR were negatively correlated with LVEF, LVGFI, and GRS (r = − 0.252; r = − 0.261; and r = − 0.245; all P<0.001) and positively correlated with GCS (r = 0.221) and GLS (r = 0.249; all P <0.001). Multivariable linear regression analysis showed that fasting SHR was an independent determinant of impaired LVEF, LVGFI, GRS, and GLS. Furthermore, multivariable regression analysis after adjusting for covariates signified that fasting SHR was associated with the presence and extent of MVO in patients with AMI and those with AMI and DM. Conclusion: Fasting SHR in patients with ASTEMI successfully treated using PPCI is independently associated with impaired cardiac function and MVO. In patients with AMI and DM, fasting SHR is an independent determinant of the presence and extent of MVO. [ABSTRACT FROM AUTHOR]

Background: The prevalence of hypertensive heart disease (HHD) is high and there is currently no easy way to detect early HHD. Explore the application of radiomics using cardiac magnetic resonance (CMR) non-enhanced cine sequences in diagnosing HHD and latent cardiac changes caused by hypertension. Methods: 132 patients who underwent CMR scanning were divided into groups: HHD (42), hypertension with normal cardiac structure and function (HWN) group (46), and normal control (NOR) group (44). Myocardial regions of the end-diastolic (ED) and end-systolic (ES) phases of the CMR short-axis cine sequence images were segmented into regions of interest (ROI). Three feature subsets (ED, ES, and ED combined with ES) were established after radiomic least absolute shrinkage and selection operator feature selection. Nine radiomic models were built using random forest (RF), support vector machine (SVM), and naive Bayes. Model performance was analyzed using receiver operating characteristic curves, and metrics like accuracy, area under the curve (AUC), precision, recall, and specificity. Results: The feature subsets included first-order, shape, and texture features. SVM of ED combined with ES achieved the highest accuracy (0.833), with a macro-average AUC of 0.941. AUCs for HHD, HWN, and NOR identification were 0.967, 0.876, and 0.963, respectively. Precisions were 0.972, 0.740, and 0.826; recalls were 0.833, 0.804, and 0.863, respectively; and specificities were 0.989, 0.863, and 0.909, respectively. Conclusions: Radiomics technology using CMR non-enhanced cine sequences can detect early cardiac changes due to hypertension. It holds promise for future use in screening for latent cardiac damage in early HHD. [ABSTRACT FROM AUTHOR]

Increased left atrial volume and decreased left atrial function have long been associated with atrial fibrillation. The availability of large-scale cardiac magnetic resonance imaging data paired with genetic data provides a unique opportunity to assess the genetic contributions to left atrial structure and function, and understand their relationship with risk for atrial fibrillation. Here, we use deep learning and surface reconstruction models to measure left atrial minimum volume, maximum volume, stroke volume, and emptying fraction in 40,558 UK Biobank participants. In a genome-wide association study of 35,049 participants without pre-existing cardiovascular disease, we identify 20 common genetic loci associated with left atrial structure and function. We find that polygenic contributions to increased left atrial volume are associated with atrial fibrillation and its downstream consequences, including stroke. Through Mendelian randomization, we find evidence supporting a causal role for left atrial enlargement and dysfunction on atrial fibrillation risk. In this study, a deep learning-based model of left atrial size in UK Biobank enabled genome-wide association studies in 35,049 healthy participants. Several lines of evidence, including the PITX2 locus, linked left atrial dysfunction to atrial fibrillation risk. [ABSTRACT FROM AUTHOR]

Cardiac magnetic resonance (CMR) imaging allows precise non-invasive quantification of cardiac function. It requires reliable image segmentation for myocardial tissue. Clinically used software usually offers automatic approaches for this step. These are, however, designed for segmentation of human images obtained at clinical field strengths. They reach their limits when applied to preclinical data and ultrahigh field strength (such as CMR of pigs at 7 T). In our study, eleven animals (seven with myocardial infarction) underwent four CMR scans each. Short-axis cine stacks were acquired and used for functional cardiac analysis. End-systolic and end-diastolic images were labelled manually by two observers and inter- and intra-observer variability were assessed. Aiming to make the functional analysis faster and more reproducible, an established deep learning (DL) model for myocardial segmentation in humans was re-trained using our preclinical 7 T data (n = 772 images and labels). We then tested the model on n = 288 images. Excellent agreement in parameters of cardiac function was found between manual and DL segmentation: For ejection fraction (EF) we achieved a Pearson's r of 0.95, an Intraclass correlation coefficient (ICC) of 0.97, and a Coefficient of variability (CoV) of 6.6%. Dice scores were 0.88 for the left ventricle and 0.84 for the myocardium. [ABSTRACT FROM AUTHOR]

Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial fibrillation (AF) and ventricular tachycardia (VT) ablation procedures. Computed tomography more common than MR has been used to detect procedure-associated complications such as oesophageal, cerebral, and vascular injury. This clinical consensus statement summarizes the current knowledge of CT and MR to facilitate electrophysiological procedures, the current value of real-time integration of imaging-derived anatomy, and substrate information during the procedure and the current role of CT and MR in diagnosing relevant procedure-related complications. Practical advice on potential advantages of one imaging modality over the other is discussed for patients with implanted cardiac rhythm devices as well as for planning, intraprocedural integration, and post-interventional management in AF and VT ablation patients. Establishing a team of electrophysiologists and cardiac imaging specialists working on specific details of imaging for complex ablation procedures is key. Cardiac magnetic resonance (CMR) can safely be performed in most patients with implanted active cardiac devices. Standard procedures for pre- and post-scanning management of the device and potential CMR-associated device malfunctions need to be in place. In VT patients, imaging—specifically MR—may help to determine scar location and mural distribution in patients with ischaemic and non-ischaemic cardiomyopathy beyond evaluating the underlying structural heart disease. Future directions in imaging may include the ability to register multiple imaging modalities and novel high-resolution modalities, but also refinements of imaging-guided ablation strategies are expected. [ABSTRACT FROM AUTHOR]

Background One of the main causes of myocardial infarction during pregnancy is spontaneous coronary artery dissection. This is ascribed to hormonal changes during pregnancy leading to a weakening of the vessel wall and haemodynamic changes especially during childbirth. Management options include conservative medical treatment and percutaneous coronary intervention, depending on clinical presentation. Case summary A 37-year-old woman presented with typical chest pain six weeks after giving birth to her third child. Echocardiography revealed a moderate reduction in systolic function. Initial invasive coronary angiography showed no abnormalities. After cardiac magnetic resonance demonstrated extensive scar, invasive coronary angiography was repeated including intravascular imaging. A dissection of the left anterior descending artery was visualized and treated by percutaneous coronary intervention and stenting. Left ventricular function was normalized at three-month follow-up. In this educational case report, we highlight the diagnostic and therapeutic challenges when treating this special patient cohort and the importance of cardiovascular imaging. Discussion Pregnancy-associated spontaneous coronary dissection is a potential differential diagnosis when treating post-partum women with recent onset chest pain. Management is challenging and intravascular imaging to visualize dissection should be performed during invasive coronary angiography. Patients require interdisciplinary care within a pregnancy heart team. [ABSTRACT FROM AUTHOR]

Cardiomyopathies (CMPs) are a group of myocardial disorders that are characterized by structural and functional abnormalities of the heart muscle. These abnormalities occur in the absence of coronary artery disease (CAD), hypertension, valvular disease, and congenital heart disease. CMPs are an increasingly important topic in the field of cardiovascular diseases due to the complexity of their diagnosis and management. In 2023, the ESC guidelines on cardiomyopathies were first published, marking significant progress in the field. The growth of techniques such as cardiac magnetic resonance imaging (CMR) and genetics has been fueled by the development of multimodal imaging approaches. For the diagnosis of CMPs, a multimodal imaging approach, including CMR, is recommended. CMR has become the standard for non-invasive analysis of cardiac morphology and myocardial function. This document provides an overview of the role of CMR in CMPs, with a focus on tissue mapping. CMR enables the characterization of myocardial tissues and the assessment of cardiac functions. CMR sequences and techniques, such as late gadolinium enhancement (LGE) and parametric mapping, provide detailed information on tissue composition, fibrosis, edema, and myocardial perfusion. These techniques offer valuable insights for early diagnosis, prognostic evaluation, and therapeutic guidance of CMPs. The use of quantitative CMR markers enables personalized treatment plans, improving overall patient outcomes. This review aims to serve as a guide for the use of these new tools in clinical practice. [ABSTRACT FROM AUTHOR]

Aims Heart failure (HF) with preserved ejection fraction disproportionately affects women. There are no validated sex-specific tools for HF diagnosis despite widely reported differences in cardiac structure. This study investigates whether sex, as assigned at birth, influences cardiac magnetic resonance (CMR) assessment of left ventricular filling pressure (LVFP), a hallmark of HF agnostic to ejection fraction. Methods and results A derivation cohort of patients with suspected pulmonary hypertension and HF from the Sheffield centre underwent invasive right heart catheterization and CMR within 24 h of each other. A sex-specific CMR model to estimate LVFP, measured as pulmonary capillary wedge pressure (PCWP), was developed using multivariable regression. A validation cohort of patients with confirmed HF from the Leeds centre was used to evaluate for the primary endpoints of HF hospitalization and major adverse cardiovascular events (MACEs). Comparison between generic and sex-specific CMR-derived PCWP was undertaken. A total of 835 (60% female) and 454 (36% female) patients were recruited into the derivation and validation cohorts respectively. A sex-specific model incorporating left atrial volume and left ventricular mass was created. The generic CMR PCWP showed significant differences between males and females (14.7 ± 4 vs. 13 ± 3.0 mmHg, P > 0.001), not present with the sex-specific CMR PCWP (14.1 ± 3 vs. 13.8 mmHg, P = 0.3). The sex-specific, but not the generic, CMR PCWP was associated with HF hospitalization (hazard ratio 3.9, P = 0.0002) and MACE (hazard ratio 2.5, P = 0.001) over a mean follow-up period of 2.4 ± 1.2 years. Conclusion Accounting for sex improves precision and prognostic performance of CMR biomarkers for HF. [ABSTRACT FROM AUTHOR]

This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension (PH) is a leading cause of death in patients with systemic sclerosis (SSc). An important component of SSc patient management is early detection and treatment of PH. Recently the threshold for the diagnosis of PH has been lowered to a mean pulmonary artery pressure (mPAP) threshold of > 20 mmHg on right heart catheterization (RHC). However, it is unknown if PH-specific therapy is beneficial in SSc patients with mildly elevated pressure (SSc-MEP, mPAP 21–24 mmHg). Methods: The SEPVADIS trial is a randomized, double-blind, placebo-controlled phase 2 trial of sildenafil in SSc-MEP patients with a target enrollment of 30 patients from two academic sites in the United States. The primary outcome is change in six-minute walk distance after 16 weeks of treatment. Secondary endpoints include change in pulmonary arterial compliance by RHC and right ventricular function by cardiac magnetic resonance imaging at 16 weeks. Echocardiography, serum N-terminal probrain natriuretic peptide, and health-related quality of life is being measured at 16 and 52 weeks. Discussion: The SEPVADIS trial will be the first randomized study of sildenafil in SSc-MEP patients. The results of this trial will be used to inform a phase 3 study to investigate the efficacy of treating patients with mild elevations in mPAP. Trial registration: ClinicalTrials.gov Identifier NCT04797286. [ABSTRACT FROM AUTHOR]

This study aims at identifying risk-related patterns of left ventricular contraction dynamics via novel volume transient characterization. A multicenter cohort of AMI survivors (n = 1021) who underwent Cardiac Magnetic Resonance (CMR) after infarction was considered for the study. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE, n = 73), consisting of all-cause death, reinfarction, and new congestive heart failure. Cardiac function was characterized from CMR in 3 potential directions: by (1) volume temporal transients (i.e. contraction dynamics); (2) feature tracking strain analysis (i.e. bulk tissue peak contraction); and (3) 3D shape analysis (i.e. 3D contraction morphology). A fully automated pipeline was developed to extract conventional and novel artificial-intelligence-derived metrics of cardiac contraction, and their relationship with MACE was investigated. Any of the 3 proposed directions demonstrated its additional prognostic value on top of established CMR indexes, myocardial injury markers, basic characteristics, and cardiovascular risk factors (P < 0.001). The combination of these 3 directions of enhancement towards a final CMR risk model improved MACE prediction by 13% compared to clinical baseline (0.774 (0.771—0.777) vs. 0.683 (0.681—0.685) cross-validated AUC, P < 0.001). The study evidences the contribution of the novel contraction characterization, enabled by a fully automated pipeline, to post-infarction assessment. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to identify myocardial injury after COVID-19 inflammation and explore whether myocardial damage could be a possible cause of the persistent symptoms following COVID-19 infection in previously healthy individuals. This study included 139 patients who were enrolled between January and June 2021, with a mean age of 46.7 ± 15.2 years, of whom 68 were men and 71 were women without known cardiac or pulmonary diseases. All patients underwent clinical work-up, laboratory analysis, cardiac ultrasound, and CMR on a 1.5 T scanner using a recommended protocol for morphological and functional assessment before and after contrast media application with multi-parametric sequences. In 39% of patients, late gadolinium enhancement (LGE) was found as a sign of myocarditis. Fibrinogen was statistically significantly higher in patients with LGE than in those without LGE (4.3 ± 0.23 vs. 3.2 ± 0.14 g/L, p < 0.05, respectively), as well as D-dimer (1.8 ± 0.3 vs. 0.8 ± 0.1 mg/L FEU). Also, troponin was statistically significantly higher in patients with myocardial LGE (13.1 ± 0.4 ng/L) compared to those with normal myocardium (4.9 ± 0.3 ng/L, p < 0.001). We demonstrated chest pain, fatigue, and elevated troponin to be independent predictors for LGE. Septal LGE was shown to be a predictor for arrhythmias. The use of CMR is a potential risk stratification tool in evaluating outcomes following COVID-19 myocarditis. [ABSTRACT FROM AUTHOR]

Background: In clinical diagnostics, magnetic resonance imaging (MRI) technology plays a crucial role in the recognition of cardiac regions, serving as a pivotal tool to assist physicians in diagnosing cardiac diseases. Despite the notable success of convolutional neural networks (CNNs) in cardiac MRI segmentation, it remains a challenge to use existing CNNs-based methods to deal with fuzzy information in cardiac MRI. Therefore, we proposed a novel network architecture named DAFNet to comprehensively address these challenges. Methods: The proposed method was used to design a fuzzy convolutional module, which could improve the feature extraction performance of the network by utilizing fuzzy information that was easily ignored in medical images while retaining the advantage of attention mechanism. Then, a multi-scale feature refinement structure was designed in the decoder portion to solve the problem that the decoder structure of the existing network had poor results in obtaining the final segmentation mask. This structure further improved the performance of the network by aggregating segmentation results from multi-scale feature maps. Additionally, we introduced the dynamic convolution theory, which could further increase the pixel segmentation accuracy of the network. Result: The effectiveness of DAFNet was extensively validated for three datasets. The results demonstrated that the proposed method achieved DSC metrics of 0.942 and 0.885, and HD metricd of 2.50mm and 3.79mm on the first and second dataset, respectively. The recognition accuracy of left ventricular end-diastolic diameter recognition on the third dataset was 98.42%. Conclusion: Compared with the existing CNNs-based methods, the DAFNet achieved state-of-the-art segmentation performance and verified its effectiveness in clinical diagnosis. [ABSTRACT FROM AUTHOR]

Purpose of Review: To explore and highlight the important role that Cardiac MRI (CMR) plays as an imaging tool that not only facilitates the diagnosis of pericardial disease but is increasingly used to guide initiation of treatment and gauge adequacy of response to therapy in patients with acute and recurrent pericarditis is a specific focus of this review. An emphasis will be placed on the sequences that are currently utilized and novel sequences that could potentially be utilized for the diagnosis of pericarditis and pericardial disease. Recent Findings: This article focuses on the CMR characteristics of the most encountered pericardial diseases and novel CMR techniques that may play an adjunctive role in the diagnosis, management, prognosis and the assessment of adequacy of response to therapy in patients with acute pericarditis. Summary: CMR has emerged as a powerful tool in the diagnosis of pericardial disease. This is a review of the current and future roles that CMR-based sequences play in not only the diagnosis of pericardial disease, but also in evaluating the need for medical therapy and gauging adequacy of response to therapy in this cohort. [ABSTRACT FROM AUTHOR]

Background: Left atrial (LA) assessment is an important marker of adverse cardiovascular outcomes. Cardiovascular magnetic resonance (CMR) accurately quantifies LA volume and function based on biplane long-axis imaging. We aimed to validate single-plane-derived LA indices against the biplane method to simplify the post-processing of cine CMR. Methods: In this study, 100 patients from Leeds Teaching Hospitals were used as the derivation cohort. Bias correction for the single plane method was applied and subsequently validated in 79 subjects. Results: There were significant differences between the biplane and single plane mean LA maximum and minimum volumes and LA ejection fraction (EF) (all p < 0.01). After correcting for biases in the validation cohort, significant correlations in all LA indices were observed (0.89 to 0.98). The area under the curve (AUC) for the single plane to predict biplane cutoffs of LA maximum volume ≥ 112 mL was 0.97, LA minimum volume ≥ 44 mL was 0.99, LA stroke volume (SV) ≤ 21 mL was 1, and LA EF ≤ 46% was 1, (all p < 0.001). Conclusions: LA volumetric and functional assessment by the single plane method has a systematic bias compared to the biplane method. After bias correction, single plane LA volume and function are comparable to the biplane method. [ABSTRACT FROM AUTHOR]

A blood test identifying patients at increased risk of pulmonary hypertension (PH) could streamline the investigative pathway. The prospective, multicenter CIPHER study aimed to develop a microRNA‐based signature for detecting PH in breathless patients and enrolled adults with a high suspicion of PH who had undergone right heart catheterization (RHC). The CIPHER‐MRI study was added to assess the performance of this CIPHER signature in a population with low probability of having PH who underwent cardiac magnetic resonance imaging (cMRI) instead of RHC. The microRNA signature was developed using a penalized linear regression (LASSO) model. Data were modeled both with and without N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). Signature performance was assessed against predefined thresholds (lower 98.7% CI bound of ≥0.73 for sensitivity and ≥0.53 for specificity, based on a meta‐analysis of echocardiographic data), using RHC as the true diagnosis. Overall, 926 CIPHER participants were screened and 888 were included in the analysis. Of 688 RHC‐confirmed PH cases, approximately 40% were already receiving PH treatment. Fifty microRNA (from 311 investigated) were algorithmically selected to be included in the signature. Sensitivity [97.5% CI] of the signature was 0.85 [0.80–0.89] for microRNA‐alone and 0.90 [0.86–0.93] for microRNA+NT‐proBNP, and the corresponding specificities were 0.33 [0.24–0.44] and 0.28 [0.20–0.39]. Of 80 CIPHER‐MRI participants with evaluable data, 7 were considered PH‐positive by cMRI whereas 52 were considered PH‐positive by the microRNA signature. Due to low specificity, the CIPHER miRNA‐based signature for PH (either with or without NT‐proBNP in model) did not meet the prespecified diagnostic threshold for the primary analysis. [ABSTRACT FROM AUTHOR]

Background: Pericardial masses are an extremely rare group of diseases which can be classified based on etiology. The presentation of pericardial masses varies considerably from one individual to another, ranging from an asymptomatic presentation with an incidental finding on imaging, to presenting with non-specific signs and symptoms. Due to the enigmatic nature and presentation of pericardial masses, diagnostic imaging is mandatory. Case Presentation: A 69-year-old patient presented to our cardiology clinic complaining of intermittent shortness of breath upon moderate exertion in the absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, dizziness, palpitations, or lower limb edema. The patient's past medical history was significant because of his history of pericarditis associated with pericardial effusion 6 years prior to presentation at our clinic. Despite adequate medical treatment, the patient complained of a relapsing and remitting pattern of symptoms that mandated the performance of advanced cardiovascular imaging, namely, cardiac magnetic resonance imaging, which revealed the presence of a profound pericardial mass. Conclusion: Despite the fact that relapsing pericarditis is a well-established complication following acute pericarditis, the presentation of a complication such as a fibrous pericardial mass evident on cardiac MRI has essentially been unreported in the literature previously. [ABSTRACT FROM AUTHOR]

Background: Ebstein anomaly (EA) is a rare congenital heart disease characterized by the apical displacement of the tricuspid leaflets, creating an enlarged functional right atrium. Supraventricular arrhythmias (SVA) are common, and catheter ablation remains challenging. SVA is considered a risk factor for sudden cardiac death in this population. Still, there are very few real-life data on the impact of SVA treated invasively or conservatively on a patient's prognosis. We aimed to analyze the incidence of SVA in adults with EA, evaluate the effectiveness of catheter ablation, and analyze the impact of SVA and catheter ablation on survival in this population. Methods and results: 71 pts (median age 53 years; range 24–84 years) with EA were evaluated retrospectively from 1988 to 2020. Forty patients (56.3%) had SVA, and eighteen of them (45.0%) required at least one catheter ablation (35 procedures in total). Indications for ablation were mostly intra-atrial reentrant tachycardia (IART) and atrioventricular reentrant tachycardia (AVRT) (14 pts [77.8% and 9 pts [50.0%], respectively. IART and AVRT coexisted in nine pts. One patient suffered from persistent atrial fibrillation. Procedural effectiveness was reported in 28 (80%) cases; over a longer follow-up (mean 12.6 ± 5.4 years), only eight (44.4%) patients were completely free from SVA after the first ablation. In total, 10 patients (14%) died due to cardiovascular events. There was no difference in survival between patients with or without SVA (p = 0.9) and between ablated and non-ablated EA individuals (p = 0.89). Conclusions: Supraventricular arrhythmia is frequent in adults with Ebstein anomaly. Patients often require more than one catheter ablation but eventually become free from arrhythmias. The imaging parameters assessed by echocardiography or cardiac magnetic resonance do not seem to be associated with ablation outcomes. The impact of supraventricular arrhythmia itself or treatment with radiofrequency ablation is questionable and should be thoroughly investigated in this population. [ABSTRACT FROM AUTHOR]

Purpose of Review: Left ventricular arrhythmogenic cardiomyopathy (ALVC) is a rare and poorly characterized cardiomyopathy that has recently been reclassified in the group of non-dilated left ventricular cardiomyopathies. This review aims to summarize the background, diagnosis, and sudden cardiac death risk in patients presenting this cardiomyopathy. Recent Findings: Although there is currently a lack of data on this condition, arrhythmogenic left ventricular dysplasia can be considered a specific disease of the left ventricle (LV). We have collected the latest evidence about the management and the risks associated with this cardiomyopathy. Summary: Left ventricular arrhythmogenic cardiomyopathy is still poorly characterized. ALVC is characterized by fibrofatty replacement in the left ventricular myocardium, with variable phenotypic expression. Diagnosis is based on a multiparametric approach, including cardiac magnetic resonance (CMR) and genetic testing, and is important for sudden cardiac death (SCD) risk stratification and management. Recent guidelines have improved the management of left ventricular arrhythmogenic cardiomyopathy. Further studies are necessary to improve knowledge of this cardiomyopathy. [ABSTRACT FROM AUTHOR]

The application of cardiac magnetic resonance (CMR) imaging in clinical practice has grown due to technological advancements and expanded clinical indications, highlighting its superior capabilities when compared to echocardiography for the assessment of myocardial tissue. Similarly, the utilization of implantable cardiac electronic devices (CIEDs) has significantly increased in cardiac arrhythmia management, and the requirements of CMR examinations in patients with CIEDs has become more common. However, this type of exam often presents challenges due to safety concerns and image artifacts. Until a few years ago, the presence of CIED was considered an absolute contraindication to CMR. To address these challenges, various technical improvements in CIED technology, like the reduction of the ferromagnetic components, and in CMR examinations, such as the introduction of new sequences, have been developed. Moreover, a rigorous protocol involving multidisciplinary collaboration is recommended for safe CMR examinations in patients with CIEDs, emphasizing risk assessment, careful monitoring during CMR, and post-scan device evaluation. Alternative methods to CMR, such as computed tomography coronary angiography with tissue characterization techniques like dual-energy and photon-counting, offer alternative potential solutions, although their diagnostic accuracy and availability do limit their use. Despite technological advancements, close collaboration and specialized staff training remain crucial for obtaining safe diagnostic CMR images in patients with CIEDs, thus justifying the presence of specialized centers that are equipped to handle these type of exams. [ABSTRACT FROM AUTHOR]

In cardiac cine imaging, acquiring high-quality data is challenging and time-consuming due to the artifacts generated by the heart's continuous movement. Volumetric, fully isotropic data acquisition with high temporal resolution is, to date, intractable due to MR physics constraints. To assess whole-heart movement under minimal acquisition time, we propose a deep learning model that reconstructs the volumetric shape of multiple cardiac chambers from a limited number of input slices while simultaneously optimizing the slice acquisition orientation for this task. We mimic the current clinical protocols for cardiac imaging and compare the shape reconstruction quality of standard clinical views and optimized views. In our experiments, we show that the jointly trained model achieves accurate high-resolution multi-chamber shape reconstruction with errors of <13 mm HD95 and Dice scores of >80%, indicating its effectiveness in both simulated cardiac cine MRI and clinical cardiac MRI with a wide range of pathological shape variations. [ABSTRACT FROM AUTHOR]

In 1900, Fiedler first reported autopsy cases with peculiar inflammation of the myocardium, which he named interstitial myocarditis. He postulated an isolated cardiac inflammation of the myocardium in the absence of multiorgan involvement and with a poor prognosis due to invisible microorganisms, which years later would have been identified as viruses. The revision of original histologic sections by Schmorl showed cases with lymphocytes and others with giant-cell inflammatory histotypes. The in vivo diagnosis of myocarditis became possible thanks to right cardiac catheterization with endomyocardial biopsy (EMB). The gold standard for diagnosis was achieved with the employment of immunohistochemistry and molecular investigation by Polymerase Chain Reaction (PCR), which allows for the detection of viruses as causal agents. Both RNA and DNA were revealed to be cardiotropic, with a common receptor (CAR). A protease, coded by coxsackie virus, disrupts the cytoskeleton and accounts for cell death. Unfortunately, vaccination, despite having been revealed to be effective in animal experiments, has not yet entered the clinical field for prevention. Cardiac Magnetic Resonance turned out to be a revolutionary tool for in vivo diagnosis through the detection of edema (inflammatory exudate). Myocarditis may be fulminant in terms of clinical presentation but not necessarily fatal. The application of ExtraCorporeal Membrane Oxygenation (ECMO) allows for relieving the overloaded native heart. [ABSTRACT FROM AUTHOR]

Amyloidosis is a rare infiltrative condition resulting from the extracellular accumulation of amyloid fibrils at the cardiac level. It can be an acquired condition or due to genetic mutations. With the progression of imaging technologies, a non-invasive diagnosis was proposed. In this study, we discuss the role of CMR in cardiac amyloidosis, focusing on the two most common subtypes (AL and ATTR), waiting for evidence-based guidelines to be published. [ABSTRACT FROM AUTHOR]

Aims: To assess the different imaging characteristics between corticosteroid‐sensitive (CS) and corticosteroid‐refractory (CR) immune checkpoint inhibitor‐associated myocarditis (ICIaM) with cardiac magnetic resonance (CMR) and the potential CMR parameters in the early detection of CR ICIaM. Methods and results: Thirty‐five patients diagnosed with ICIaM and 30 age and gender‐matched cancer patients without a history of ICI treatment were enrolled. CMR with contrast was performed within 2 days of clinical suspicion. Left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) were assessed by CMR. LV sub‐endocardial (GLSendo) and sub‐epicardial (GLSepi) global longitudinal strains were quantified by offline feature tracking analysis. CS and CR ICIaM were defined based on the trend of Troponin I and clinical course during corticosteroid treatment. All 35 patients presented with non‐fulminant symptoms upon initial assessment. Twenty patients (57.14%) were sensitive, and 15 (42.86%) were refractory to corticosteroids. Compared with controls, 22 patients (62.86%) with ICIaM developed LGE. LVEF decreased in CR ICIaM compared with the CS group and controls. GLSendo (−14.61 ± 2.67 vs. −18.50 ± 2.53, P < 0.001) and GLSepi (−14.75 ± 2.53 vs. −16.68 ± 2.05, P < 0.001) significantly increased in patients with CR ICIaM compared with the CS ICIaM. In patients with CS ICIaM, although GLSepi (−16.68 ± 2.05 vs. −19.31 ± 1.80, P < 0.001) was impaired compared with the controls, GLSendo was preserved. There was no difference in CMR parameters between LGE‐positive and negative groups. LVEF, GLSendo, and GLSepi were predictors of CR ICIaM. When LVEF, GLSendo, and GLSepi were included in multivariate analysis, only GLSendo remained an independent predictor of CR ICIaM (OR: 2.170, 95% CI: 1.189–3.962, P = 0.012). A GLSendo of ≥−17.10% (sensitivity, 86.7%; specificity, 80.0%; AUC, 0.860; P < 0.001) could predict CR ICIaM in the ICIaM cohort. Kaplan–Meier analysis showed that in patients with impaired GLSendo of ≥−17.10%, cardiovascular adverse events (CAEs) occurred much earlier than in patients with preserved GLSendo of <−17.10% (Log‐rank test P = 0.017). Conclusions: CR and CS ICIaM demonstrated different functional and morphological characteristics in different myocardial layers. An impaired GLSendo could be a helpful parameter in early identifying corticosteroid‐refractory individuals in the ICIaM population. [ABSTRACT FROM AUTHOR]

We present a case involving a young individual who developed acute myocarditis on the fourth day following administration of a COVID-19 mRNA vaccine. The patient's condition was managed conservatively, resulting in a favorable outcome. This paper extensively discusses the pathogenesis, clinical manifestations, imaging characteristics of COVID-19 mRNA vaccine-related myocarditis and includes a comprehensive review of pertinent literature. Additionally, a systematic review of COVID-19 mRNA vaccine-related myocarditis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) principles, is presented. Healthcare professionals should maintain a clinical suspicion for COVID-19 mRNA vaccine-related myocarditis when encountering patients with confirmed myocarditis who have received recent COVID-19 mRNA vaccination, after ruling out other potential causes. The diagnosis of acute myocarditis primarily relies on adherence to the Lake Louise Criteria (LLC) for cardiac magnetic resonance (CMR). Nevertheless, specific CMR features or distinctive patterns indicative of COVID-19 mRNA vaccine-related myocarditis are currently undefined. Among patients with vaccine-related myocarditis, common CMR findings encompass subepicardial late gadolinium enhancement and T2-based myocardial edema, although these findings lack specificity and may resemble other medical conditions. Supportive care involving a short-term regimen of NSAIDs, colchicine, and steroids represents the cornerstone of treatment for this variant of myocarditis, which tends to be self-limiting with favorable short-term prognoses. Timely diagnosis is paramount for optimizing patient care.

Models that utilize self-attention mechanisms, including but not limited to Vision Transformers (ViTs), have shown promising performance in visual tasks like semantic segmentation. This is attributed to their capacity to capture global features of images, enabling them to learn more comprehensive representations. However, transformer-based models typically demand a considerable amount of training data to achieve satisfactory performance, while being deficient in the ability to efficiently extract local image features. As a result, these models may not be as effective in some computer vision tasks that involve small-scale datasets, like medical image segmentation. To address these issues, this paper proposes a dual-stream encoding-based transformer dubbed as Dual-stream Transformer (DS-Former). The dual-stream module in DS-Former can simultaneously acquire local and global features in the image and construct relation between the two kinds of features via self-attention. Compared with the simple splicing or serial connection, the dual-stream module can extract more comprehensive and hierarchical feature information from the fusion interaction of the two features. Our method is evaluated on the UK Biobank (UKBB) cardiac magnetic resonance imaging (CMR) dataset and The Beyond the Cranial Vault (BTCV) abdominal challenge dataset. The experimental results indicate that our DS-Former outperforms other state-of-the-art approaches on both datasets, indicating its potential for medical images semantic segmentation. [ABSTRACT FROM AUTHOR]

Purpose: The temporal evolution of ventricular trabecular complexity and its correlation with major adverse cardiovascular events (MACE) remain indeterminate in patients presenting with acute ST elevation myocardial infarction (STEMI). Methods: This retrospective analysis enrolled patients undergoing primary percutaneous coronary intervention (pPCI) for acute STEMI, possessing cardiac magnetic resonance (CMR) data in the acute (within 7 days), subacute (1 month after pPCI), and chronic phases (6 months after pPCI) from January 2015 to January 2020 at the three participating sites. Fractal dimensions (FD) were measured for the global, infarct, and remote regions of left ventricular trabeculae during each phase. The potential association of FD with MACE was analyzed using multivariate Cox regression. Results: Among the 200 analyzed patients (182 men; median age, 61 years; age range, 50–66 years), 37 (18.5%) encountered MACE during a median follow-up of 31.2 months. FD exhibited a gradual decrement (global FD at acute, subacute, and chronic phases: 1.253 ± 0.049, 1.239 ± 0.046, 1.230 ± 0.045, p < 0.0001), with a more pronounced decrease observed in patients subsequently experiencing MACE (p < 0.001). The global FD at the subacute phase correlated with MACE (hazard ratio 0.89 (0.82, 0.97), p = 0.01), and a global FD value below 1.26 was associated with a heightened risk. Conclusion: In patients post-STEMI, the global FD, serving as an indicator of left ventricular trabeculae complexity, independently demonstrated an association with subsequent major adverse cardiovascular events, beyond factors encompassing left ventricular ejection fraction, indexed left ventricular end-diastolic volume, infarct size, heart rate, NYHA class, and post-pPCI TIMI flow. Critical relevance statement: In patients who have had an ST-segment elevation myocardial infarction, global fractal dimension, as a measure of left ventricular trabeculae complexity, provided independent association with subsequent major adverse cardiovascular event. Key points: • Global and regional FD decreased after STEMI, and more so in patients with subsequent MACE. • Lower global FD at the subacute phase and Δglobal FD from acute to subacute phase were associated with subsequent MACE besides clinical and CMR factors. • Global FD at the subacute phase independently correlated with MACE and global FD value below 1.26 was associated with higher risk. [ABSTRACT FROM AUTHOR]

Introduction: Transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) are the most important modalities used in clinical practice to assess cardiac chambers. However, different imaging techniques may affect their results and conclusions. The aim of our study was to compare left-ventricle (LV) remodeling assessed using TTE and CMR in the context of various cardiovascular diseases. Methods: A total of 202 consecutive patients sent for an elective cardiovascular diagnosis were scheduled for a 2D TTE and CMR, performed within 2 weeks. The study group was divided and analyzed based on the clinical indications for CMR, including coronary artery disease, heart failure, native aortic valve regurgitation or paravalvular leak after aortic valve replacement, or cardiomyopathies. Results: The mean LV mass index (LVMi) values calculated using TTE were significantly larger (127.1 ± 44.5 g/m²) compared to the LVMi assessed using CMR (77.1 ± 26.2 g/m²; p < 0.001). The LV end-diastolic volumes assessed using TTE were underestimated for all the study patients (78.6 ± 43 mL vs. 100.5 ± 39 mL; p < 0.0001) and subgroups, but a statistical trend was observed in patients with cardiomyopathy. Those differences in single parameters led to differences in LV remodeling and the final treatment decision. CMR and TTE provided similar conclusions on LV systolic dysfunction in 68% of the patients. Conclusions: Our results showed that the greater the degree of LV remodeling and dysfunction, the greater the difference between the modalities. Therefore, CMR should be introduced into routine clinical practice, especially for patients undergoing LV remodeling, which may change clinical decisions in a considerable number of cases. [ABSTRACT FROM AUTHOR]

The purpose of the study was to identify factors characterizing a decrease in LV global systolic function in patients with ST-segment elevation myocardial infarction (STEMI) after revascularization using cardiac magnetic resonance imaging (MRI)-based ischemic injury pattern and laboratory parameters sensu left ventricular global systolic function. A total of 109 STEMI patients were examined. The patients underwent contrast-enhanced cardiac MRI with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th–10th days from the onset of the disease. According to cardiac MRI analysis, the patients were divided into the following groups with regard to left ventricular ejection fraction (LVEF) values: Group 1—patients with LVEF ≥ 50%; group 2—patients with mildly reduced LVEF 40–49%; group 3—patients with low LVEF < 40%. A predominance of most parameters of the ischemic injury pattern was noted in patients with mildly reduced and low LVEF versus patient group with LVEF ≥ 50%. Some risk factors for a decrease in LVEF < 50% systolic function in STEMI patients after revascularization were revealed: male gender; time from the onset of the anginal attack to revascularization; coronary artery status; several LV parameters; ischemic injury characteristics; natriuretic peptide and troponin I levels. [ABSTRACT FROM AUTHOR]

In vivo cardiac diffusion tensor imaging (cDTI) is a promising Magnetic Resonance Imaging (MRI) technique for evaluating the microstructure of myocardial tissue in living hearts, providing insights into cardiac function and enabling the development of innovative therapeutic strategies. However, the integration of cDTI into routine clinical practice poses challenging due to the technical obstacles involved in the acquisition, such as low signal-to-noise ratio and prolonged scanning times. In this study, we investigated and implemented three different types of deep learning-based MRI reconstruction models for cDTI reconstruction. We evaluated the performance of these models based on the reconstruction quality assessment, the diffusion tensor parameter assessment as well as the computational cost assessment. Our results indicate that the models discussed in this study can be applied for clinical use at an acceleration factor (AF) of × 2 and × 4 , with the D5C5 model showing superior fidelity for reconstruction and the SwinMR model providing higher perceptual scores. There is no statistical difference from the reference for all diffusion tensor parameters at AF × 2 or most DT parameters at AF × 4 , and the quality of most diffusion tensor parameter maps is visually acceptable. SwinMR is recommended as the optimal approach for reconstruction at AF × 2 and AF × 4 . However, we believe that the models discussed in this study are not yet ready for clinical use at a higher AF. At AF × 8 , the performance of all models discussed remains limited, with only half of the diffusion tensor parameters being recovered to a level with no statistical difference from the reference. Some diffusion tensor parameter maps even provide wrong and misleading information. [ABSTRACT FROM AUTHOR]

Myocardial involvement was shown to be associated with an unfavorable prognosis in patients with COVID-19, which could lead to fatal outcomes as in myocardial injury-induced arrhythmias and sudden cardiac death. We hypothesized that magnetic resonance imaging (MRI) myocardial strain parameters are sensitive markers for identifying subclinical cardiac dysfunction associated with myocardial involvement in the post-acute sequelae of COVID-19 (PASC). This study evaluated 115 subjects, including 65 consecutive COVID-19 patients, using MRI for the assessment of either post-COVID-19 myocarditis or other cardiomyopathies. Subjects were categorized, based on the results of the MRI exams, as having either 'suspected' or 'excluded' myocarditis. A control group of 50 matched individuals was studied. Along with parameters of global cardiac function, the MRI images were analyzed for measurements of the myocardial T1, T2, extracellular volume (ECV), strain, and strain rate. Based on the MRI late gadolinium enhancement and T1/T2/ECV mappings, myocarditis was suspected in 7 out of 22 patients referred due to concern of myocarditis and in 9 out of 43 patients referred due to concern of cardiomyopathies. The myocardial global longitudinal, circumferential, and radial strains and strain rates in the suspected myocarditis group were significantly smaller than those in the excluded myocarditis group, which in turn were significantly smaller than those in the control group. The results showed significant correlations between the strain, strain rate, and global cardiac function parameters. In conclusion, this study emphasizes the value of multiparametric MRI for differentiating patients with myocardial involvement in the PASC based on changes in the myocardial contractility pattern and tissue structure. [ABSTRACT FROM AUTHOR]

Paraganglioma (PGL) is a rare extra-adrenal neuroendocrine tumor, and intrapericardial PGL is extremely rare. We report a rare case of intrapericardial nonfunctional PGL, which may be used as a reference for further analysis. This article presents the case of a 65-year-old woman with a 2-year history of lower extremity pain. Ultrasound revealed a hypoechoic mass adjacent to the right atrium, compressing and narrowing the right atrium. Computed tomography (CT) showed a low-density mass with marked enhancement suggestive of a solitary fibrous tumor or a vasogenic tumor of pericardial origin. Cardiac magnetic resonance imaging (MRI) confirmed the location and provided a primary diagnosis of solitary fibrous tumor, hemangioma, or hemangiosarcoma. The patient eventually underwent pericardial tumor resection, and the diagnosis of PGL was confirmed by postoperative histopathology. Pathology is considered the gold standard for the diagnosis of PGL. Imaging examinations can provide valuable information for the diagnosis and management of intrapericardial PGL, and surgery remains the treatment of choice. [ABSTRACT FROM AUTHOR]

B 0 field inhomogeneity is a long-lasting issue for Cardiac MRI (CMR) in high-field (3T and above) scanners. The inhomogeneous B 0 fields can lead to corrupted image quality, prolonged scan time, and false diagnosis. B 0 shimming is the most straightforward way to improve the B 0 homogeneity. However, today's standard cardiac shimming protocol requires manual selection of a shim volume, which often falsely includes regions with large B 0 deviation (e.g., liver, fat, and chest wall). The flawed shim field compromises the reliability of high-field CMR protocols, which significantly reduces the scan efficiency and hinders its wider clinical adoption. This study aims to develop a dual-channel deep learning model that can reliably contour the cardiac region for B 0 shim without human interaction and under variable imaging protocols. By utilizing both the magnitude and phase information, the model achieved a high segmentation accuracy in the B 0 field maps compared to the conventional single-channel methods (Dice score: 2D-mag = 0.866, 3D-mag = 0.907, and 3D-mag-phase = 0.938, all p < 0.05). Furthermore, it shows better generalizability against the common variations in MRI imaging parameters and enables significantly improved B 0 shim compared to the standard method (SD( B 0 Shim): Proposed = 15 ± 11% vs. Standard = 6 ± 12%, p < 0.05). The proposed autonomous model can boost the reliability of cardiac shimming at 3T and serve as the foundation for more reliable and efficient high-field CMR imaging in clinical routines. [ABSTRACT FROM AUTHOR]

Objective: Systemic lupus erythematosus (SLE) is a multisystem‐involved, highly heterogeneous autoimmune disease with diverse clinical manifestations. We report an extremely rare case of SLE with severe diffuse myocardial hypertrophy. Methods: The patientʼs echocardiography and cardiac magnetic resonance imaging (CMR) results indicated diffuse myocardial hypertrophy. After excluding coronary atherosclerosis, hypertensive cardiomyopathy, drug toxicity, and other causes, the patient was diagnosed with SLE‐specific cardiomyopathy. Medications such as hormones, antimalarials, immunosuppressants, and biologics were administered. Results: Ancillary test results were as follows: hs‐cTnI: 0.054 ng/mL (0–0.016); NTproBNP: 1594.0 pg/mL (<150); A contrast‐enhanced CMR revealed the diffuse thickening of the left ventricular wall with multiple abnormal enhancements, reduced left ventricular systolic and diastolic function, and moderate amount of pericardial effusion. Endomyocardial myocardial biopsy was performed, showing cardiomyocyte hypertrophy and degeneration, and no changes in myocarditis or amyloidosis. The pathology viewed by electron microscopy showed increased intracellular glycogen in the myocardium, and no hydroxychloroquine‐associated damage in the myocardium. The 24‐h ambulatory blood pressure and contrast‐enhanced computed tomography of coronary arteries were normal. The diagnosis of SLE‐specific cardiomyopathy was clear. The myocardial hypertrophy showed reversible alleviation following treatment with high‐dose corticosteroids. CMR results before and after treatment were as follows: interventricular septum, pretreatment (28) versus post‐treatment (22) mm; left ventricular inferior wall, pretreatment (18–21) versus post‐treatment (12–14) mm; left ventricular lateral wall, pretreatment (17–18) versus post‐treatment (10–12) mm; pericardial effusion (left ventricular lateral wall), pretreatment (25) versus post‐treatment (12) mm; left ventricular ejection fraction, pretreatment (38.9%) versus post‐treatment (66%). Conclusion: Myocardial hypertrophy may be an important sign of active and prognostic assessment in SLE diagnosis and management. Similarly, when encountering cases of myocardial hypertrophy, the possibility of autoimmune disease should be considered in addition to common causes. Highlights: We report a rare case of severe diffuse myocardial hypertrophy directly caused by systemic lupus erythematosus (SLE), secondary to severe heart failure.Reversible improvement in myocardial hypertrophy occurred after high‐dose corticosteroid therapy.SLE is associated with a reversible form of cardiomyopathy.Myocardial hypertrophy may be an important sign of active and prognostic assessment of SLE.When encountering cases of myocardial hypertrophy, the possibility of autoimmune disease should be considered in addition to the common causes. [ABSTRACT FROM AUTHOR]

Background: This study assesses the temporal responses of cardiovascular function, fibro-inflammation, and glucometabolic profiles in asymptomatic adults with type 2 diabetes, following a low-energy meal replacement plan (MRP) or exercise training. Methods: Secondary analysis of DIASTOLIC: a randomised, open-label, blinded-endpoint trial of 12 weeks MRP (~810 kcal/day) or exercise training. Cardiac magnetic resonance, plasma fibroinflammatory, and metabolic markers were undertaken at baseline, 4, and 12 weeks. Results: Out of 24 participants in the MRP group and 22 in exercise training, 18 and 11 completed all three visits. MRP resulted in early (0–4 weeks) improvement in insulin resistance (HOMA-IR: 10.82 to 4.32), decrease in FABP-4 (4.87 ± 0.19 to 5.15 ± 0.32 mg/L), and improvement in left ventricular remodelling LV mass: volume (0.86 ± 0.14 to 0.78 ± 0.11), all with large effect sizes. MMP8 levels increased moderately at 4–12 weeks. Peak early diastolic strain rate (cPEDSR) initially decreased, then improved. Exercise training led to minor improvements in insulin resistance and MMP-8 levels, with no significant changes in cPEDSR or LV remodelling. Conclusions: MRP resulted in early improvements in insulin resistance, cardiac remodelling, and inflammation, but with an initial decrease in diastolic function, improving by 12 weeks. Exercise training showed minor early benefits in insulin resistance and inflammation, but no significant cardiac changes. [ABSTRACT FROM AUTHOR]

Prediction of major arrhythmic events (MAEs) in dilated cardiomyopathy represents an unmet clinical goal. Computational models and artificial intelligence (AI) are new technological tools that could offer a significant improvement in our ability to predict MAEs. In this proof-of-concept study, we propose a deep learning (DL)-based model, which we termed Deep ARrhythmic Prevention in dilated cardiomyopathy (DARP-D), built using multidimensional cardiac magnetic resonance data (cine videos and hypervideos and LGE images and hyperimages) and clinical covariates, aimed at predicting and tracking an individual patient's risk curve of MAEs (including sudden cardiac death, cardiac arrest due to ventricular fibrillation, sustained ventricular tachycardia lasting ≥30 s or causing haemodynamic collapse in <30 s, appropriate implantable cardiac defibrillator intervention) over time. The model was trained and validated in 70% of a sample of 154 patients with dilated cardiomyopathy and tested in the remaining 30%. DARP-D achieved a 95% CI in Harrell's C concordance indices of 0.12–0.68 on the test set. We demonstrate that our DL approach is feasible and represents a novelty in the field of arrhythmic risk prediction in dilated cardiomyopathy, able to analyze cardiac motion, tissue characteristics, and baseline covariates to predict an individual patient's risk curve of major arrhythmic events. However, the low number of patients, MAEs and epoch of training make the model a promising prototype but not ready for clinical usage. Further research is needed to improve, stabilize and validate the performance of the DARP-D to convert it from an AI experiment to a daily used tool. [ABSTRACT FROM AUTHOR]

Background: Myocardial bridging (MB) is common in patients with hypertrophic cardiomyopathy (HCM). There are sparse data on the impact of MB on myocardial fibrosis in HCM. This study was designed to evaluate the relationship between MB and myocardial fibrosis in patients with obstructive HCM. Methods: In this cohort study, retrospective data were collected from a high-volume HCM center. Patients with obstructive HCM who underwent septal myectomy and preoperative cardiac magnetic resonance (CMR) were screened from 2011 to 2018. Results: Finally, 492 patients were included in this study, with an average age of 45.7 years. Of these patients, 76 patients had MB. MB occurred mostly in the left anterior descending artery (73/76). The global extent of late gadolinium enhancement (LGE) was correlated with the degree of systolic compression (r = 0.33, p = 0.003). Multivariable linear regression analysis revealed that the degree of systolic compression was an independent risk factor for LGE (β = 0.292, p = 0.007). The LGE fraction of basal and mid anteroseptal segments in patients with severe MB (compression ratio ≥ 80%) was significantly greater than that in patients with mild to moderate MB (compression ratio < 80%). During a median follow-up of 28 (IQR: 15–52) months, 15 patients died. Kaplan–Meier analysis did not identify differences in all-cause death (log-rank p = 0.63) or cardiovascular death (log-rank p = 0.72) between patients undergoing MB-related surgery and those without MB. Conclusions: MB with severe systolic compression was significantly associated with a high extent of fibrosis in patients with obstructive HCM. Concomitant myotomy or coronary artery bypass grafting might provide excellent survival similar to that of patients without MB. Identification of patients with severe MB and providing comprehensive management might help improve the prognosis of patients with HCM. [ABSTRACT FROM AUTHOR]

A right heart tumor can be identified by transthoracic echocardiography during a routine examination or due to cardiac symptoms. The first step is the assessment by echocardiography, with its multiple techniques, and the obtained information must be judged in a clinical and biological context. The second step comprises one, sometimes even two, of the more complex modality imaging methods. The choice is driven not only by the advantages of each imaging technique but also by local expertise or the preferred imaging modality in the center. This step is followed by staging, follow-up, and/or imaging-guided excision or biopsy, which is performed in selected cases in order to obtain anatomopathological confirmation. In the presence of features suggestive of malignancy or causing hemodynamic impairment, a transvenous biopsy is essential before the more complex imaging modalities (which are still relevant in the staging process). Using a structured imaging approach, it is possible to reach an appropriate diagnosis without a biopsy. Frequently, these imaging techniques have a complementary role, so an integrated imaging approach is recommended. This proposed algorithm for appropriate diagnosis of right heart tumors could serve as a practical guide for clinicians (not only imaging specialists). [ABSTRACT FROM AUTHOR]