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The aim of this study was to assess the impact of cardiac magnetic resonance (CMR) on the diagnosis in patients with known or suspected left ventricular noncompaction (LVNC). We retrospectively reviewed the medical charts of 12,811 consecutive patients who had CMR studies between 2008 and 2022 in a large tertiary center. We included patients referred for CMR because of known or suspected LVNC. The study sample consisted of 333 patients, 193 (58.0%) male, median age 39.0 (26.8–51.0) years. Among 74 patients fulfilling the echocardiographic LVNC criteria, the diagnosis was confirmed in 54 (73.0%) cases. In 259 patients with ultrasound-based suspicion of LVNC, CMR led to an LVNC diagnosis in 82 (31.7%) patients. In both groups, CMR led to a new diagnosis in 89 cases (10 (13.5%) and 79 (30.5%)). A quantity of 38 (5.4%) patients were diagnosed with dilated cardiomyopathy, 11 (1.4%) patients were diagnosed with hypertrophic cardiomyopathy, and 21 (4.1%) patients were diagnosed with unclassified cardiomyopathy. In four patients with suspected LVNC, a myocardial trabeculation was a secondary result of dilatation due to coronary heart disease. In five cases, valvular heart disease was found. Four patients were diagnosed with athlete's heart. Other diagnoses (arrhythmogenic right ventricular cardiomyopathy, peripartum cardiomyopathy, hypokinetic non-dilated cardiomyopathy, sarcoidosis, amyloidosis, and ventricular septum defect) were found in six patients. CMR is a valuable tool in the evaluation of cardiac muscle and in differentiating LVNC and other cardiac diseases. [ABSTRACT FROM AUTHOR]

In recent years, a variety of deep learning networks for cardiac MRI (CMR) segmentation have been developed and analyzed. However, nearly all of them are focused on cine CMR under breathold. In this work, accuracy of deep learning methods is assessed for volumetric analysis (via segmentation) of the left ventricle in real-time free-breathing CMR at rest and under exercise stress. Data from healthy volunteers (n = 15) for cine and real-time free-breathing CMR at rest and under exercise stress were analyzed retrospectively. Exercise stress was performed using an ergometer in the supine position. Segmentations of two deep learning methods, a commercially available technique (comDL) and an openly available network (nnU-Net), were compared to a reference model created via the manual correction of segmentations obtained with comDL. Segmentations of left ventricular endocardium (LV), left ventricular myocardium (MYO), and right ventricle (RV) are compared for both end-systolic and end-diastolic phases and analyzed with Dice's coefficient. The volumetric analysis includes the cardiac function parameters LV end-diastolic volume (EDV), LV end-systolic volume (ESV), and LV ejection fraction (EF), evaluated with respect to both absolute and relative differences. For cine CMR, nnU-Net and comDL achieve Dice's coefficients above 0.95 for LV and 0.9 for MYO, and RV. For real-time CMR, the accuracy of nnU-Net exceeds that of comDL overall. For real-time CMR at rest, nnU-Net achieves Dice's coefficients of 0.94 for LV, 0.89 for MYO, and 0.90 for RV and the mean absolute differences between nnU-Net and the reference are 2.9 mL for EDV, 3.5 mL for ESV, and 2.6% for EF. For real-time CMR under exercise stress, nnU-Net achieves Dice's coefficients of 0.92 for LV, 0.85 for MYO, and 0.83 for RV and the mean absolute differences between nnU-Net and reference are 11.4 mL for EDV, 2.9 mL for ESV, and 3.6% for EF. Deep learning methods designed or trained for cine CMR segmentation can perform well on real-time CMR. For real-time free-breathing CMR at rest, the performance of deep learning methods is comparable to inter-observer variability in cine CMR and is usable for fully automatic segmentation. For real-time CMR under exercise stress, the performance of nnU-Net could promise a higher degree of automation in the future. [ABSTRACT FROM AUTHOR]

Bone marrow mononuclear cells (BMMCs) have been evaluated for their ability to improve cardiac repair and benefit patients with severe ischemic heart disease and heart failure. In our single-center trial in 2006–2011 we demonstrated the safety and efficacy of BMMCs injected intramyocardially in conjunction with coronary artery bypass surgery. The effect persisted in the follow-up study 5 years later. In this study, we investigated the efficacy of BMMC therapy beyond 10 years. A total of 18 patients (46%) died during over 10-years follow-up and 21 were contacted for participation. Late gadolinium enhancement cardiac magnetic resonance imaging (CMRI) and clinical evaluation were performed on 14 patients, seven from each group. CMRIs from the study baseline, 1-year and 5-years follow-ups were re-analyzed to enable comparison. The CMRI demonstrated a 2.1-fold larger reduction in the mass of late gadolinium enhancement values between the preoperative and the over 10-years follow-up, suggesting less scar or fibrosis after BMMC treatment (− 15.1%; 95% CI − 23 to − 6.7% vs. − 7.3%; 95% CI − 16 to 4.5%, p = 0.039), compared to placebo. No differences in mortality or morbidity were observed. Intramyocardially injected BMMCs may exert long-term benefits in patients with ischemic heart failure. This deserves further evaluation in patients who have received BMMCs in international clinical studies over two decades. [ABSTRACT FROM AUTHOR]

Cardiac CINE, a form of dynamic cardiac MRI, is indispensable in the diagnosis and treatment of heart conditions, offering detailed visualization essential for the early detection of cardiac diseases. As the demand for higher-resolution images increases, so does the volume of data requiring processing, presenting significant computational challenges that can impede the efficiency of diagnostic imaging. Our research presents an approach that takes advantage of the computational power of multiple Graphics Processing Units (GPUs) to address these challenges. GPUs are devices capable of performing large volumes of computations in a short period, and have significantly improved the cardiac MRI reconstruction process, allowing images to be produced faster. The innovation of our work resides in utilizing a multi-device system capable of processing the substantial data volumes demanded by high-resolution, five-dimensional cardiac MRI. This system surpasses the memory capacity limitations of single GPUs by partitioning large datasets into smaller, manageable segments for parallel processing, thereby preserving image integrity and accelerating reconstruction times. Utilizing OpenCL technology, our system offers adaptability and cross-platform functionality, ensuring wider applicability. The proposed multi-device approach offers an advancement in medical imaging, accelerating the reconstruction process and facilitating faster and more effective cardiac health assessment. [ABSTRACT FROM AUTHOR]

Presence of left atrial (LA) fibrosis reflects underlying atrial cardiomyopathy. Interatrial block (IAB) is associated with LA fibrosis in patients with atrial fibrillation (AF). The association of IAB and LA fibrosis in the patients without history of AF is unknown. We examined association of IAB and LA fibrosis in the patients without AF history. This is a retrospective analysis of 229 patients undergoing cardiac magnetic resonance imaging (CMR). LA fibrosis was reported from spatial extent of late gadolinium enhancement of CMR. IAB was measured from 12-lead electrocardiography using digital caliper. Of 229 patients undergoing CMR, prevalence of IAB was 50.2%. Patients with IAB were older (56.9±13.9 years vs. 45.9±19.2 years, p<0.001) and had higher prevalence of co-morbidities. Left ventricular ejection fraction was lower in IAB group. LA volume index (LAVI) was greater in IAB group (54.6±24.9 ml/m2 vs. 43.0±21.1 ml/m2, p<0.001). Patients with IAB had higher prevalence of LA fibrosis than those without IAB (70.4% vs. 21.2%; p<0.001). After multivariable analysis, only IAB and LAVI were independent factors that predict LA fibrosis. Prevalence of IAB in patients undergoing CMR was high. IAB was highly associated with LA fibrosis and larger LA size in patients without AF history. [ABSTRACT FROM AUTHOR]

Background Patients requiring coronary intervention after acute myocardial infarction, with decompensated heart failure and multiple co-morbidities, present a challenging clinical scenario. Addressing such high-risk cases has been a marked increase in the simultaneous support using microaxial flow pump devices, providing a crucial haemodynamic support during procedures. Case summary We report the case of a 58-year-old man, with a non-ST-segment elevation myocardial infarction in the context of a peripheral vascular surgery. Echocardiography revealed severely reduced left ventricular function and cardiac magnetic resonance imaging demonstrated transmural scars in all but left anterior descending artery area. The patient was of extreme high surgical risk due to the multiple co-morbidities, acute decompensation heart failure, and peripheral artery disease, and, therefore, the heart team preferred protected percutaneous coronary intervention (PCI) over coronary artery bypass graft for revascularization. The peripheral artery disease included severely calcified ascending aorta, occlusions of both femoral arteries, the left subclavian artery, and the right radial artery. Taken together, the heart team agreed on a hybrid approach with surgical implantation of Impella 5.0 via the left subclavian artery, by a single-access technique. Following the intervention procedure, haemostasis of the vascular prosthesis was achieved by an angio-seal technique without complications. The patient recovered satisfactorily, with improved left ventricular function, and discharged 10 days post-procedure. Discussion The single-access high-risk PCI technique offers a standardized approach for microaxial flow pump devices such as Impella 5.0 and PCI. The subclavian artery as a single-access route for high-risk PCI has demonstrated safety and efficacy. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is characterized by abnormal growth of the myocardium with myofilament disarray and myocardial hyper-contractility, leading to left ventricular hypertrophy and fibrosis. Where culprit genes are identified, they typically relate to cardiomyocyte sarcomere structure and function. Multi-modality imaging plays a crucial role in the diagnosis, monitoring, and risk stratification of HCM, as well as in screening those at risk. Following the recent publication of the first European Society of Cardiology (ESC) cardiomyopathy guidelines, we build on previous reviews and explore the roles of electrocardiography, echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CT), and nuclear imaging. We examine each modality's strengths along with their limitations in turn, and discuss how they can be used in isolation, or in combination, to facilitate a personalized approach to patient care, as well as providing key information and robust safety and efficacy evidence within new areas of research. [ABSTRACT FROM AUTHOR]

Background: Although compressed sensing (CS) accelerated cine holds immense potential to replace conventional cardiovascular magnetic resonance (CMR) cine, how to use CS-based cine appropriately during clinical CMR examinations still needs exploring. Methods: A total of 104 patients (46.5 ± 17.1 years) participated in this prospective study. For each participant, a balanced steady state free precession (bSSFP) cine was acquired as a reference, followed by two CS accelerated cine sequences with identical parameters before and after contrast injection. Lastly, a CS accelerated cine sequence with an increased flip angle was obtained. We subsequently compared scanning time, image quality, and biventricular function parameters between these sequences. Results: All CS cine sequences demonstrated significantly shorter acquisition times compared to bSSFPref cine (p < 0.001). The bSSFPref cine showed higher left ventricular ejection fraction (LVEF) than all CS cine sequences (all p < 0.001), but no significant differences in LVEF were observed among the three CS cine sequences. Additionally, CS cine sequences displayed superior global image quality (p < 0.05) and fewer artifacts than bSSFPref cine (p < 0.005). Unenhanced CS cine and enhanced CS cine with increased flip angle showed higher global image quality than other cine sequences (p < 0.005). Conclusion: Single breath-hold CS cine delivers precise biventricular function parameters and offers a range of benefits including shorter scan time, better global image quality, and diminished motion artifacts. This innovative approach holds great promise in replacing conventional bSSFP cine and optimizing the CMR examination workflow. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is a common genetic disorder with a well described risk of sudden cardiac death; however, risk stratification has remained a challenge. Recently, novel parameters in cardiac magnetic resonance imaging (CMR) have shown promise in helping to improve upon current risk stratification paradigms. In this manuscript, we have reviewed novel CMR risk markers and their utility in HCM. The results of the review showed that T1, extracellular volume, CMR feature tracking, and other miscellaneous novel CMR variables have the potential to improve sudden death risk stratification and may have additional roles in diagnosis and prognosis. The strengths and weaknesses of these imaging techniques, and their potential utility and implementation in HCM risk stratification are discussed. [ABSTRACT FROM AUTHOR]

Cardiac MRI has made significant advances in the past decade, becoming an important technique for the evaluation of various cardiac pathologies. The aim of this document is to review the current indications for performing cardiac MRI based on the current ESC guidelines for STEMI, NSTEMI, chronic coronary artery disease, heart failure, arrhythmias, sudden cardiac death, valvular heart disease, pericardial disease and congenital heart disease. The review discusses the diagnostic and prognostic value of cMR for numerous cardiac diseases, and its important value in assessing structural heart disease and predicting arrhythmia risk. Additionally, it reflects upon the appropriateness of the guidelines and points out areas where the indications should be revised in future editions, based on the author's personal opinion. It is suggested that guideline criteria for the use of cMR should be more explicit to promote its use and lead to more specific reimbursements. However, further studies are needed to even better document the value of cMR in the future. [ABSTRACT FROM AUTHOR]

Aim: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by thickening of the heart muscle and may have serious consequences. Diversity in the distribution and degree of hypertrophy has led to the classification of HCM types. Cardiac MR (CMR) imaging is a non-invasive tool that maintains accurate and detailed data about cardiac functions and structure. The aim of the study was to observe and compare the CMR characteristics of the three HCM morphologic types (asymmetric, concentric, and apical). Materials and Methods: 56 patients (female/male: 29/58, mean age 46.31±15.12, body surface area (BSA) 1.88±0.19 m2) who were referred for HCM diagnosis or follow-up between January 2021 and January 2023 were included in this single-center retrospective study. The imaging procedure was conducted using a 1.5 T device (Aera, Siemens Medical Systems, Erlangen, Germany). Cardiac volume and functions were determined quantitatively. The location and amount of late gadolinium enhancement (LGE) were evaluated qualitatively. The statistical analyses were performed using SPSS version 25.0. A p value under 0.05 was considered statistically significant. Results: Late gadolinium enhancement revealed myocardial fibrosis in apical HCM (ApHCM), with a higher prevalence than in asymmetric and concentric HCM. Apical HCM and asymmetric HCM patients widely presented midmyocardial fibrosis, whereas most concentric HCM patients had patchy involvement. The mean native myocardial T1 values for individuals with concentric HCM were found to be higher compared to those with asymmetric and ApHCM and the healthy participants. Conclusion: Cardiac MR imaging enables the multiparametric evaluation of HCM through the utilization of native T1 and T2 mapping techniques, as well as LGE. Both T1 and T2 values have the potential to be used in conjunction with LGE to identify regions of myocardial fibrosis. [ABSTRACT FROM AUTHOR]

Ischemic heart condition is one of the most prevalent causes of death that can be treated more effectively and lead to fewer fatalities if identified early. Heart muscle fibrosis affects the diastolic and systolic function of the heart and is linked to unfavorable cardiovascular outcomes. Cardiac magnetic resonance (CMR) scarring, a risk factor for ischemic heart disease, may be accurately identified by magnetic resonance imaging (MRI) to recognize fibrosis. In the past few decades, numerous methods based on MRI have been employed to identify and categorize cardiac fibrosis. Because they increase the therapeutic advantages and the likelihood that patients will survive, developing these approaches is essential and has significant medical benefits. A brand-new method that uses MRI has been suggested to help with diagnosing. Advances in deep learning (DL) networks contribute to the early and accurate diagnosis of heart muscle fibrosis. This study introduces a new deep network known as FibrosisNet, which detects and classifies fibrosis if it is present. It includes some of 17 various series layers to achieve the fibrosis detection target. The introduced classification system is trained and evaluated for the best performance results. In addition, deep transfer-learning models are applied to the different famous convolution neural networks to find fibrosis detection architectures. The FibrosisNet architecture achieves an accuracy of 96.05%, a sensitivity of 97.56%, and an F1-Score of 96.54%. The experimental results show that FibrosisNet has numerous benefits and produces higher results than current state-of-the-art methods and other advanced CNN approaches. [ABSTRACT FROM AUTHOR]

Background: Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions. Methods: A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected. Results: Mean age of the 109 patients was 43 years (range 19–76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus. Conclusions: These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment. Author summary: Chagas cardiomyopathy is a manifestation of end-organ damage from Trypanosoma cruzi parasitic infection. Most infections occur in Mexico, Central and South America but disease is present globally due to migration. Approximately 30% of those with Chagas disease develop cardiomyopathy years after infection from persistent heart muscle and conduction system inflammation, which can be life-threatening. Unfortunately, Chagas disease remains underdiagnosed and identifying those at risk for severe disease remains challenging. The 2018 American Heart Association guidelines recommend ECG and cardiac rhythm strip, but there is no consensus on the approach to further cardiac evaluation in the US or management of Chagas cardiomyopathy. This study retrospectively analyzed symptoms and cardiac examination of migrants predominantly from endemic Central American countries who were diagnosed with Chagas disease and received care at Boston Medical Center. Most patients were asymptomatic and nearly half had evidence of cardiomyopathy. Echocardiogram abnormalities were present in approximately one-third of asymptomatic individuals with normal ECGs. Some individuals had significant abnormalities found on heart rhythm monitors or cardiac magnetic resonance imaging which led to management changes. These findings underscore the importance of routine echocardiograms, consideration of cardiac rhythm monitoring, and thorough cardiac assessment in people with Chagas disease regardless of symptoms. [ABSTRACT FROM AUTHOR]

Arrhythmogenic cardiomyopathy (ACM) is a heart disease characterized by a fibrotic replacement of myocardial tissue and a consequent predisposition to ventricular arrhythmic events, especially in the young. Post-mortem studies and the subsequent diffusion of cardiac MRI have shown that left ventricular involvement in arrhythmogenic cardiomyopathy is common and often develops early. Regarding the arrhythmic risk stratification, the current scores underestimate the arrhythmic risk of patients with arrhythmogenic cardiomyopathy with left involvement. Indeed, the data on arrhythmic risk stratification in this group of patients are contradictory and not exhaustive, with the consequence of not correctly identifying patients at a high arrhythmic risk who deserve protection from arrhythmic death. We propose a literature review on arrhythmic risk stratification in patients with ACM and left involvement to identify the main features associated with an increased arrhythmic risk in this group of patients. [ABSTRACT FROM AUTHOR]

For semantic segmentation of cardiac magnetic resonance image (MRI) with low recognition and high background noise, a fusion‐attention Swin Transformer is proposed based on cognitive science and deep learning methods. It has a U‐shaped symmetric encoding–decoding structure with an attention‐based skip connection. The encoder realizes self‐attention for deep feature representation and the decoder up‐samples global features to the corresponding input resolution for pixel‐level segmentation. By introducing a skip connection between the encoder and decoder based on fusion attention, the remote interaction of global information is realized, and the attention to local features and specific channels is enhanced. A public ACDC cardiac MRI image dataset is used for experiments. The segmentation of the left ventricle, right ventricle, and myocardial layer is realized. The method performs well on a small sample dataset, for example, the pixel accuracy obtained by the proposed model is 93.68%, the Dice coefficient is 92.28%, and HD coefficient is 11.18. Compared with the state‐of‐the‐art models, the segmentation precision has been significantly improved, especially for the low recognition and heavily occluded targets. [ABSTRACT FROM AUTHOR]

The acute myocardial infarction (AMI) present high mortality rate that may be reduced with cardiac rehabilitation. Despite its good establishment in outpatient care, few studies analyzed cardiac rehabilitation during hospitalization. Thus, this study aims to clarify the safety and efficacy of early cardiac rehabilitation after AMI. This will be a clinical, controlled, randomized trial with blind outcome evaluation and a superiority hypothesis. Twenty-four patients with AMI will be divided into two groups (1:1 allocation ratio). The intervention group will receive an individualized exercise-based cardiac rehabilitation protocol during hospitalization and a semi-supervised protocol after hospital discharge; the control group will receive conventional care. The primary outcomes will be the cardiac remodeling assessed by cardiac magnetic resonance imaging, functional capacity assessed by maximal oxygen consumption, and cardiac autonomic balance examined via heart rate variability. Secondary outcomes will include safety and the total exercise dose provided during the protocol. Statistical analysis will consider the intent-to-treat analysis. Trial registration. Trial registration number: Brazilian Registry of Clinical Trials (ReBEC) (RBR- 9nyx8hb). [ABSTRACT FROM AUTHOR]

Background: Patients with congenital heart disease (CHD) will transition to lifelong adult congenital cardiac care. However, their structural heart disease is challenging to convey via two-dimensional drawings. This study utilized a tele-educational environment, with personalized three-dimensional (3D) modeling and health Details (3D + Details = "4D"), to improve actual and perceived knowledge, both important components of transition readiness in CHD patients. Methods: Participants aged ≥13 years with a history of CHD and cardiac magnetic resonance imaging (MRI) studies were eligible. Cardiac MRI datasets were then used to segment and create 3D heart models (using Mimics, Materialize Inc.). Participants first completed the MyHeart Questionnaire, a validated survey of actual knowledge. A tele-educational session was then scheduled, during which participants were shown a 3D model of a normal heart, followed by their personal 3D heart model and specific health details. Participants then repeated the actual knowledge survey, in addition to questionnaires assessing perceived knowledge pre- and post-session, as well as a satisfaction survey. Results: Twenty-two patients were included. Actual knowledge increased from 75% ± 15% to 89% ± 20% (p = 0.00043) and perceived knowledge increased in five of seven questions. Actual knowledge correlated with perceived knowledge (r = 0.608, p < 0.0001). Ninety-one percent of participants ranked the 3D model as "very satisfactory" and ninety-five percent ranked the educational session as "very helpful" or "extremely helpful." Conclusions: The use of "4D" tele-education increased both actual and perceived knowledge and may help improve transition readiness in CHD patients. [ABSTRACT FROM AUTHOR]

Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term "chronic inflammatory cardiomyopathy" describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype–phenotype association is suspected, as this has significant implications for patients' and their family members' prognoses. Recognition of the pathophysiological pathway and clinical "red flags" and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Automated Cardiac Magnetic Resonance segmentation serves as a crucial tool for the evaluation of cardiac function, facilitating faster clinical assessments that prove advantageous for both practitioners and patients alike. Recent studies have predominantly concentrated on delineating structures on short-axis orientation, placing less emphasis on long-axis representations due to the intricate nature of structures in the latter. Taking these consideration into account, we present a robust hierarchy-based augmentation strategy coupled with the compact and fast Efficient-Net (ENet) architecture for the automated segmentation of two-chamber and four-chamber Cine-MRI images. We observed an average Dice improvement of 0.99% on the two-chamber images and of 2.15% on the four-chamber images, and an average Hausdorff distance improvement of 21.3% on the two-chamber images and of 29.6% on the four-chamber images. The practical viability of our approach was validated by computing clinical metrics such as the Left Ventricular Ejection Fraction (LVEF) and left ventricular volume (LVC). We observed acceptable biases, with a +2.81% deviation on the LVEF for the two-chamber images and a +0.11% deviation for the four-chamber images. [ABSTRACT FROM AUTHOR]

Background: Patients with repaired Tetralogy of Fallot (rTOF) often develop pulmonary regurgitation (PR) and right ventricle (RV) dysfunction, experiencing increased mortality and morbidity rates in adulthood. Pulmonary valve replacement (PVR) timing to address PR is controversial. Cardiac Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of complex cardiopathies. This study aims to identify CMR parameters predictive of adverse outcomes to help defining the best therapeutic management of rTOF patients. Methods: 130 rTOF patients who underwent CMR (2006–2019) were enrolled in this retrospective single-center study. CMR, clinical, ECG and exercise data were analyzed. Univariate and multivariate analyses identified clinical and CMR parameters predictive of adverse outcomes both individually (e.g., death, arrhythmias, heart failure (HF), pharmacological therapy, QRS ≥ 160ms) and as composite outcome. Results: Univariate analysis confirmed RV volumes and RV ejection fraction corrected for PR as adverse outcome predictors and identified interesting correlations: pulmonary artery bifurcation geometry and abnormal interventricular septum (IVS) motion with arrhythmias (p <.001; p =.037), HF (p =.049; p =.005), composite outcome (p =.039; p =.009); right atrium (RA) dimensions with the composite outcome and the outcomes individually (p <.001). The best predictive models by multivariate analysis included sex (male), RV and RA dilation for QRS ≥ 160ms, time form repair to CMR, age at TOF repair and IVS fibrosis for pharmacological therapy. Conclusions: Besides RV volumes, new adverse prognostic factors could guide rTOF therapeutic management: pulmonary arteries morphology, abnormal IVS motion, RV dysfunction, RA dilation. Perspective multicentric evaluation is needed to specify their effective role. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous multi-system syndrome with limited efficacious treatment options. The prevalence of Type 2 diabetes (T2D) continues to rise and predisposes patients to HFpEF, and HFpEF remains one of the biggest challenges in cardiovascular medicine today. Novel therapeutic targets are required to meet this important clinical need. Deep phenotyping studies including -OMIC analyses can provide important pathogenic information to aid the identification of such targets. The aims of this study were to determine; 1) the impact of a low-energy diet on plasma sphingolipid/ceramide profiles in people with T2D compared to healthy controls and, 2) if the change in sphingolipid/ceramide profile is associated with reverse cardiovascular remodelling. Methods: Post-hoc analysis of a randomised controlled trial (NCT02590822) including adults with T2D with no cardiovascular disease who completed a 12-week low-energy (∼810 kcal/day) meal-replacement plan (MRP) and matched healthy controls (HC). Echocardiography, cardiac MRI and a fasting blood for lipidomics were undertaken pre/post-intervention. Candidate biomarkers were identified from case–control comparison (fold change > 1.5 and statistical significance p < 0.05) and their response to the MRP reported. Association between change in biomarkers and change indices of cardiac remodelling were explored. Results: Twenty-four people with T2D (15 males, age 51.1 ± 5.7 years), and 25 HC (15 male, 48.3 ± 6.6 years) were included. Subjects with T2D had increased left ventricular (LV) mass:volume ratio (0.84 ± 0.13 vs. 0.70 ± 0.08, p < 0.001), increased systolic function but impaired diastolic function compared to HC. Twelve long-chain polyunsaturated sphingolipids, including four ceramides, were downregulated in subjects with T2D at baseline. Three sphingomyelin species and all ceramides were inversely associated with LV mass:volume. There was a significant increase in all species and shift towards HC following the MRP, however, none of these changes were associated with reverse cardiac remodelling. Conclusion: The lack of association between change in sphingolipids/ceramides and reverse cardiac remodelling following the MRP casts doubt on a causative role of sphingolipids/ceramides in the progression of heart failure in T2D. Trial registration: NCT02590822. Highlights: • This study sheds light on the emerging link between dysregulated sphingolipid/ceramide metabolism and the development of heart failure (HF) in individuals with type 2 diabetes (T2D). • Leveraging the gold standard assessment tool, cardiac MRI, this study is one of the first to explore plasma sphingolipid/ceramide in relation to measures of cardiovascular structure and function. • The findings reveal that working-aged adults with T2D and Stage A/B HF exhibit disrupted fatty acid metabolism, characterized by reduced levels of long-chain polyunsaturated sphingomyelin/ceramide species. • Importantly, this study challenges the notion of a causative role of sphingolipids/ceramides in the progression of heart failure in T2D. [ABSTRACT FROM AUTHOR]

This editorial discusses the advancements in diagnostic imaging technology for cardiothoracic disorders. It highlights the development of new hardware, such as spectral imaging and digital PET/CT technology, which improve image quality and reduce radiation exposure for patients. The formulation of new clinical protocols and the analysis of diagnostic images through radiomics are also discussed. The introduction of artificial intelligence and machine learning algorithms in postprocessing software is seen as a promising development. The editorial emphasizes the importance of these innovations in improving the diagnosis and treatment of cardiothoracic diseases, which have a significant impact on global mortality and healthcare costs. [Extracted from the article]

This article discusses the case of a 41-year-old man with Marfan syndrome who presented with worsening dyspnea. The patient had various complications related to Marfan syndrome, including retinal detachment, heart failure, and atrial fibrillation. Physical examination and diagnostic tests revealed a giant left atrium, left ventricular hypertrophy, and severe mitral regurgitation. The patient underwent mitral valve replacement surgery due to the decline in functional status. The article also mentions that a giant left atrium is rare and is usually associated with rheumatic mitral disease, but in this case, it was associated with Marfan syndrome. [Extracted from the article]