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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.03.022 Byline: Joanne D. Schuijf (a)(b), Jeroen J. Bax (c), Leslee J. Shaw (d), Albert de Roos (b), Hildo J. Lamb (b), Ernst E. van der Wall (a), William Wijns (d) Abstract: Magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) have emerged as potential noninvasive coronary imaging techniques. The objective of the present study was to clarify the current accuracy of both modalities in the detection of significant coronary artery lesions (compared to conventional angiography as the gold standard) by means of a comprehensive meta-analysis of the presently available literature. Author Affiliation: (a) Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands (b) Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (c) Atlanta Cardiovascular Research Institute, Atlanta, GA (d) Cardiovascular Center, Aalst, Belgium Article History: Received 7 December 2004; Accepted 15 March 2005 Article Note: (footnote) This work was financially supported by The Netherlands Heart Foundation, The Hague, The Netherlands, grant number 2002B105., Guest Editor for this manuscript was George A. Beller, MD, Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Va.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.03.058 Byline: Thomas Oosterhof (a)(c), Barbara J.M. Mulder (c), Hubert W. Vliegen (b), Albert de Roos (a) Abstract: Cardiovascular magnetic resonance (CMR) is becoming an important tool in the clinical management of patients with congenital heart disease. Because of the diverse problems patients may face after initial correction for tetralogy of Fallot and the large amount of CMR techniques that can be applied, creating a patient-orientated imaging protocol is a difficult issue. Although it is still not certain what the impact of some parameters, provided by CMR, should be on clinical decision making, new techniques are being developed and applied. In this report, we review the current clinical issues in patients with tetralogy of Fallot and review the current implication and limitations of CMR in this patient category. Author Affiliation: (a) Department of Radiology, Leiden University Medical Center, Leyden, The Netherlands (b) Department of Cardiology, Leiden University Medical Center, Leyden, The Netherlands (c) Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Article History: Received 10 February 2005; Accepted 26 March 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.07.033 Byline: Theodorus A.M. Kaandorp (a), Hildo J. Lamb (a), Jeroen J. Bax (b), Ernst E. van der Wall (b), Albert de Roos (a) Author Affiliation: (a) Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands (b) Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands Article History: Received 4 February 2004; Accepted 27 July 2004

Byline: Paul Dendale, Philippe R. Franken, Pierre Block, Yiannis Pratikakisc, Albert De Roos Abstract: Purpose Viable myocardium after acute myocardial infarction may be characterized by magnetic resonance imaging (MRI) either by demonstration of recovery of wall motion under dobutamine stress or by perfusion patterns after contrast medium administration. This study examines the relation between the two techniques. Materials and Methods Gradient-echo MRI at rest and under low-dose dobutamine stress was performed in 28 patients within the first 2 weeks after acute myocardial infarction. In addition, spin-echo MRI was performed after gadolinium-DOTA administration. Wall motion at rest and under stress was scored to assess the contractile reserve of the infarct regions. Infarct enhancement patterns were classified as subendocardial, transmural, or as a doughnut pattern. Result Subendocardial or absent infarct enhancement was related to functional recovery under stress in 31 of 37 infarct segments. Transmural infarct enhancement was correlated with the absence of functional recovery in 10 of 17 infarct segments (p < 0.002), indicating nonviability. The doughnut pattern was exclusively associated with the absence of viability (five of five). Conclusion Contrast enhancement patterns are related to residual myocardial viability. (Am Heart J 1998:135:875-80.) Author Affiliation: Brussels, Belgium, and Leiden, The Netherlands Article History: Received 20 June 1997; Accepted 17 December 1997 Article Note: (footnote) [star] From the Departments of aCardiology, bNuclear Medicine, and cElectronics, Free University of Brussels (VUB); and the dDepartment of Radiology, University Hospital Leiden., [star][star] This work was supported by a grant from the Belgische Cardiologische Liga and the Nationaal Fonds voor Wetenschappelijk Onderzoek., a The Gadolinium contrast (Dotarem R) was provided by Guerbet., aa Reprint requests: Paul Dendale, MD, Heart Centre, Virga Jesse Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium., acents 4/1/88881

Coronary artery disease (CAD) is a condition that occurs when the arteries supplying blood to the heart become narrowed (stenotic), usually with fatty atherosclerotic deposits which block the flow of blood, causing myocardial ischemia (a diminution of cardiac blood flow). This condition may cause chest pain, weakness, heart damage, and other symptoms; patients with CAD are also at greater risk for cardiovascular emergencies such as acute myocardial infarction (AMI; heart attack). Assessing whether the coronary arteries are patent (open, enabling normal blood flow) is an important for determining a proper diagnosis in cardiovascular medicine. Methods commonly used to do this, such as the X-ray technique known as coronary angiography, are often unpleasant for the patient, expensive, and invasive. The use of echocardiography for the purpose of evaluating coronary artery function is fraught with interpretive difficulties. Nuclear magnetic resonance imaging (NMR or MRI) is a relatively new imaging methodology that appears to offer the best anatomic resolution of not only the coronary arteries, but also the heart. Three-dimensional imaging is possible, allowing highly detailed analysis of cardiac function. There are four main areas in which NMR may offer a valuable addition to the diagnostic arsenal: evaluation of coronary artery function, evaluation of coronary artery bypass grafts, assessment of AMI and infarction (the damage resulting from AMI), and plotting the course of recovery from AMI. Certain precautions must be taken in the application of NMR (the powerful magnets in the machine preclude the use of the technique in patients with implanted metal devices, for example), but for the most part, NMR imaging represents a significant technical advance in the diagnosis and treatment of patients with cardiovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: Fatty liver is the leading cause of chronic liver diseases and increases the risk of cardiovascular disease. Besides alcohol consumption, energy-containing nonalcoholic beverages may contribute to liver fat accumulation.Objective: We aimed to study the consumption of alcoholic and nonalcoholic beverages and their mutual replacement in relation to hepatic triglyceride content (HTGC) in middle-aged men and women.Methods: In this cross-sectional analysis, HTGC was assessed by proton magnetic resonance spectroscopy. Habitual consumption of alcoholic and nonalcoholic beverages was assessed using a validated food-frequency questionnaire. All beverages were converted to standard servings and to percentage of total energy intake (En%). We performed linear regression to examine the association of alcoholic and nonalcoholic beverages with HTGC, adjusted for age, sex, smoking, education, ethnicity, physical activity, total energy intake, and total body fat. We studied replacement of alcoholic beverages with nonalcoholic beverages per 1 serving/d and per 5 En%/d.Results: After exclusion of individuals with missing values, 1966 participants (47% men) were analyzed, with a mean ± SD age of 55 ± 6 y, BMI of 26 ± 4 kg/m2, and HTGC of 5.7% ± 7.9%. Each extra alcoholic serving per day was associated with more liver fat (1.09 times; 95% CI: 1.05, 1.12). Replacing 5 En% of alcoholic beverages with milk was associated with less liver fat (0.89 times; 95% CI: 0.81, 0.98), whereas replacement with 5 En% of sugar-sweetened beverages was associated with liver fat to an extent similar to alcoholic beverages (1.00 times; 95% CI: 0.91, 1.09).Conclusion: In a population-based cohort, consumption of each extra daily alcoholic beverage was associated with more liver fat. In isocaloric replacement of alcoholic beverages, milk was associated with less liver fat, whereas sugar-sweetened beverages were equally associated with liver fat. This suggests that intake of alcohol and sugars may contribute to liver fat accumulation. This trial was registered at clinicaltrials.gov as NCT03410316. [ABSTRACT FROM AUTHOR]

Background: Visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) are major risk factors for cardiometabolic diseases.Objective: We aimed to investigate the association of dietary intake of the main food groups with VAT and HTGC in middle-aged men and women.Methods: We used data from the Netherlands Epidemiology of Obesity study, a population-based study including 6671 participants aged 45-65 y at baseline. In this cross-sectional analysis, VAT and HTGC were assessed by magnetic resonance imaging and spectroscopy, respectively, as the primary outcomes. Habitual intake of main food groups (dairy, meat, fish, fruits and vegetables, sweet snacks, and fats and oils) was estimated through the use of a food-frequency questionnaire. We examined associations of intake of different food groups with VAT and HTGC by linear regression analysis stratified by sex and adjusted for age, smoking, education, ethnicity, physical activity, basal metabolic rate, energy-restricted diet, menopausal state, and total energy intake.Results: In women, a 100-g/d higher intake of dairy was associated with 2.0 cm2 less VAT (95% CI: -3.4, -0.7 cm2) and a 0.95-fold lower HTGC (95% CI: 0.90-, 0.99-fold). Moreover, a 100-g/d higher intake of fruit and vegetables was associated with 1.6 cm2 less VAT (95% CI: -2.9, -0.2 cm2) in women. Fruit and vegetables were negatively associated (0.95; 95% CI: 0.91, 1.00) with HTGC, and sweet snacks were positively associated (1.29; 95% CI: 1.03, 1.63). Patterns were weaker but similar in men. Fish intake was not associated with VAT or HTGC and plant-based fat and oil intake were only associated with VAT after adjustment for total body fat.Conclusions: Despite some variation in the strength of the associations between men and women, dietary intake of sweet snacks was positively associated with HTGC, and fruit and vegetable intake were negatively associated with visceral and liver fat content. Prospective studies are needed to confirm these results. The Netherlands Epidemiology of Obesity study is registered at clinicaltrials.gov with identifier NCT03410316. [ABSTRACT FROM AUTHOR]

Background: Aortic stiffness, assessed through pulse wave velocity (PWV), is an independent predictor for cardiovascular disease risk. However, the scarce availability of normal and reference values for cardiovascular magnetic resonance imaging (CMR) based PWV is limiting clinical implementation. The aim of this study was to determine normal and reference values for CMR assessed PWV in the general population. Methods: From the 2,484 participants of the Netherlands Epidemiology of Obesity (NEO) study that have available CMR-PWV data, 1,394 participants free from cardiovasculard disease, smokers or treatment for diabetes, hypertension or dyslipidaemia were selected (45–65 years, 51% female). Participants were divided into sex, age and blood pressure (BP) subgroups. Normal values were specified for participants with a BP < 130/80 mmHg and reference values for elevated BP subgroups (≥ 130/80 and < 140/90 mmHg; and ≥ 140/90 mmHg). Differences between groups were tested with independent samples t-test or ANOVA. Due to an oversampling of obese individuals in this study, PWV values are based on a weighted analysis making them representative of the general population. Results: Normal mean PWV was 6.0 m/s [95% CI 5.8–6.1]. PWV increased with advancing age and BP categories (both p < 0.001). There was no difference between sex in normal PWV, however in the BP > 140/90 mmHg women had a higher PWV (p = 0.005). The interpercentile ranges were smaller for participants < 55 years old compared to participants ≥ 55 years, indicating an increasing variability of PWV with age. PWV upper limits were particularly elevated in participants ≥ 55 years old in the high blood pressure subgroups. Conclusion: This study provides normal and reference values for CMR-assessed PWV per sex, age and blood pressure category in the general population. [ABSTRACT FROM AUTHOR]

This study sought to investigate the extent of hypertensive exposure as assessed by cardiovascular magnetic resonance imaging (MRI) in relation to cerebral small vessel disease (CSVD) and cognitive impairment, with the aim of understanding the role of hypertension in the early stages of deteriorating brain health. Preserving brain health into advanced age is one of the great challenges of modern medicine. Hypertension is thought to induce vascular brain injury through exposure of the cerebral microcirculation to increased pressure/pulsatility. Cardiovascular MRI provides markers of (subclinical) hypertensive exposure, such as aortic stiffness by pulse wave velocity (PWV), left ventricular (LV) mass index (LVMi), and concentricity by mass-to-volume ratio. A total of 559 participants from the Heart-Brain Connection Study (431 patients with manifest cardiovascular disease and 128 control participants), age 67.8 ± 8.8 years, underwent 3.0-T heart-brain MRI and extensive neuropsychological testing. Aortic PWV, LVMi, and LV mass-to-volume ratio were evaluated in relation to presence of CSVD and cognitive impairment. Effect modification by patient group was investigated by interaction terms; results are reported pooled or stratified accordingly. Aortic PWV (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 1.05 to 1.30 in patient groups only), LVMi (in carotid occlusive disease, OR: 5.69; 95% CI: 1.63 to 19.87; in other groups, OR: 1.30; 95% CI: 1.05 to 1.62]) and LV mass-to-volume ratio (OR: 1.81; 95% CI: 1.46 to 2.24) were associated with CSVD. Aortic PWV (OR: 1.07; 95% CI: 1.02 to 1.13) and LV mass-to-volume ratio (OR: 1.27; 95% CI: 1.07 to 1.51) were also associated with cognitive impairment. Relations were independent of sociodemographic and cardiac index and mostly persisted after correction for systolic blood pressure or medical history of hypertension. Causal mediation analysis showed significant mediation by presence of CSVD in the relation between hypertensive exposure markers and cognitive impairment. The extent of hypertensive exposure is associated with CSVD and cognitive impairment beyond clinical blood pressure or medical history. The mediating role of CSVD suggests that hypertension may lead to cognitive impairment through the occurrence of CSVD. [ABSTRACT FROM AUTHOR]

Obesity is a well-established risk factor of vitamin D deficiency. However, it is unclear which fat deposit is most strongly related to serum 25-hydroxyvitamin D (25(OH)D) concentrations. Our aim was to distinguish the specific contributions of total body fat (TBF), abdominal subcutaneous adipose tissue (aSAT), visceral adipose tissue (VAT) and hepatic fat on 25(OH)D concentrations. We performed a cross-sectional analysis of the Netherlands Epidemiology of Obesity study, a population-based cohort study. We used linear regression analyses to examine associations of TBF, aSAT, VAT (n = 2441) and hepatic fat (n = 1980) with 25(OH)D concentrations. Standardized values were used to compare the different fat deposits. Mean (SD) age and 25(OH)D concentrations of the study population was 56 (6) years and 70.8 (24.2) nmol/L, respectively. TBF was inversely associated with 25(OH)D concentrations in women, but not in men. One percent higher TBF was associated with 0.40 nmol/L (95%CI: −0.67 to −0.13) lower 25(OH)D. aSAT was not associated with 25(OH)D concentrations. One cm2 higher VAT was associated with 0.05 nmol/L (−0.09 to −0.02) lower 25(OH)D in men, and 0.06 nmol/L (−0.10 to −0.01) lower 25(OH)D in women. Hepatic fat was only associated with 25(OH)D in men. A tenfold increase in hepatic fat was associated with 6.21 nmol/L (−10.70 to −1.73) lower 25(OH)D. Regressions with standardized values showed VAT was most strongly related to 25(OH)D. In women, TBF and VAT were inversely related to 25(OH)D concentrations. In men, VAT and hepatic fat were inversely related to 25(OH)D concentrations. In both groups, VAT was most strongly associated with 25(OH)D concentrations. [ABSTRACT FROM AUTHOR]

Background: To characterize and directly quantify regurgitant jets of left atrioventricular valve (LAVV) in patients with corrected atrioventricular septal defect (AVSD) by four-dimensional (4D)Flow Cardiovascular Magnetic Resonance (CMR), streamline visualization and retrospective valve tracking. Methods: Medical ethical committee approval and informed consent from all patients or their parents were obtained. In 32 corrected AVSD patients (age 26 ± 12 years), echocardiography and whole-heart 4DFlow CMR were performed. Using streamline visualization on 2- and 4-chamber views, the angle between regurgitation and annulus was followed throughout systole. On through-plane velocity-encoded images reformatted perpendicular to the regurgitation jet the cross-sectional jet circularity index was assessed and regurgitant volume and fraction were calculated. Correlation and agreement between different techniques was performed with Pearson's r and Spearman's rho correlation and Bland-Altman analysis. Results: In 8 patients, multiple regurgitant jets over the LAVV were identified. Median variation in regurgitant jet angle within patients was 36°(IQR 18-64°) on the 2-chamber and 30°(IQR 20-40°) on the 4-chamber. Regurgitant jets had a circularity index of 0.61 ± 0.16. Quantification of the regurgitation volume was feasible with 4DFlow CMR with excellent correlation between LAVV effective forward flow and aortic flow (r = 0.97, p < 0.001) for internal validation and moderate correlation with planimetry derived regurgitant volume (r = 0.65, p < 0.001) and echocardiographic grading (rho = 0.51, p = 0.003). Conclusions: 4DFlow CMR with streamline visualization revealed multiple, dynamic and eccentric regurgitant jets with non-circular cross-sectional shape in patients after AVSD correction. 4DFlow with retrospective valve tracking allows direct and accurate quantification of the regurgitation of these complex jets. [ABSTRACT FROM AUTHOR]

Background: Vascular disease expression in one location may not be representative for disease severity in other vascular territories, however, strong correlation between disease expression and severity within the same vascular segment may be expected. Therefore, we hypothesized that aortic stiffening is more strongly associated with disease expression in a vascular territory directly linked to that aortic segment rather than in a more remote segment. We prospectively compared the association between aortic wall stiffness, expressed by pulse wave velocity (PWV), sampled in the distal aorta, with the severity of peripheral arterial occlusive disease (PAOD) as compared to atherosclerotic markers sampled in remote vascular territories such as PWV in the proximal aorta and the normalized wall index (NWI), representing the vessel wall thickness, of the left common carotid artery. Methods: Forty-two patients (23 men; mean age 64±10 years) underwent velocity-encoded cardiovascular magnetic resonance (CMR) in the proximal and distal aorta, whole-body contrast-enhanced MR angiography (CE-MRA) and carotid vessel wall imaging with black-blood CMR in the work-up for PAOD. Strength of associations between aortic stiffness, carotid NWI and peripheral vascular stenosis grade were assessed and evaluated with multiple linear regression. Results: Stenosis severity correlated well with PWV in the distal aorta (Pearson rP=0.64, p<0.001, Spearman rS=0.65, p<0.001) but to a lesser extent with PWV in the proximal aorta (rP=0.48, p=0.002, rS=0.22, p=0.18). Carotid NWI was not associated with peripheral stenosis severity (rP=0.17, p=0.28, rS=0.14, p=0.37) nor with PWV in the proximal aorta (rP=0.22, p=0.17) nor in the distal aorta (rP=0.21, p=0.18). Correlation between stenosis severity and distal aortic PWV remained statistically significant after correction for age and gender. Conclusions: Distal aortic wall stiffness is more directly related to peripheral arterial stenosis severity than markers from more remote vascular territories such as proximal aortic wall stiffness or carotid arterial wall thickness. Site-specific evaluation of vascular disease may be required for full vascular risk estimation. [ABSTRACT FROM AUTHOR]

Background: Several studies have reported a positive relationship between lung function impairment and the metabolic syndrome. This is most usually explained by abdominal adiposity. We hypothesized that the main determinant of the association between lung function impairment and abdominal obesity is the presence of visceral fat. Methods: The present study is a cross-sectional analysis of 98 non-diabetic men aged between 50 and 70 years with the metabolic syndrome. The amount of visceral and subcutaneous adipose tissue was determined by an MRI scan. The association between visceral fat and measures of lung function (FEV1, FVC, exhaled and NO) was assessed using linear regression. Results: 98 participants were included in this analysis. There was a linear inverse association between visceral fat and both FEV1 and FVC. None of the other different fat-related measurements (subcutaneous fat, waist circumference and BMI) or features of the metabolic syndrome were found to be associated with these lung function measurements. Conclusion: In non-diabetic subjects with the metabolic syndrome and a lung function that is within the normal range, visceral fat is negatively correlated with FEV1 and FVC. [ABSTRACT FROM AUTHOR]

Background: Angiopoietin-like protein 4 (ANGPTL4) has been identified as all inhibitor of lipoprotein lipase. Preliminary data suggest that plasma nonesterified fatty acids (NEFAs) raise plasma ANGPTL4 concentrations in humans. Objective: The objective was to assess plasma ANGPTL4 concentrations after various nutritional interventions that increase NEFA concentrations in healthy subjects and in patients with type 2 diabetes mellitus. Design: We studied 4 groups, both at baseline and after 3 d of either fasting (n = 22 healthy men), a very-low-calorie diet (VLCD; n = 10 healthy men and n = 10 patients with diabetes), or a high-fat, high-energy diet (HFED; n = 15 healthy men). Plasma ANGPTL4, NEFA, and triglyceride concentrations were measured. Results: In healthy men, a VLCD increased ANGPTL4 from 13.2 (IQR: 8.1-24.2) at baseline to 18.2 (16.7-33.4) ng/mL (P < 0.05), lasting increased ANGPTL4 from 10.6 (7.6-17.6) to 28.0 (23.1-35.0) ng/mL (P < 0.05), and an HFED increased ANGFFL4 from 13.9 (8.2-22.0) to 17.2 (11.2-23.6) ng/mL (P < 0.05). In men with diabetes, a VLCD also increased ANGPTL4, from 10.9 ± 2.4 to 19.2 ± 3.2 ng/mL (P < 0.05). All interventions significantly increased plasma NEFAs in both healthy men and patients with diabetes. The change in ANGPTL4 positively correlated with the change in NEFA concentrations (β = 0.048, P < 0.001) and negatively correlated with the change in plasma triglycerides (β = -0.051, P = 0.01). Conclusions: Three days of either fasting, a VLCD, or an HFED increased plasma ANGPTL4 concentrations in healthy men, concomitantly with increased plasma NEFA concentrations. Similarly, a VLCD in patients with diabetes increased ANGPTL4 concentrations, concomitantly with increased NEFA concentrations. [ABSTRACT FROM AUTHOR]

Background: We recently demonstrated in a randomized, double-blind, placebo-controlled trial that intramyocardial bone marrow cell (BMC) injection is associated with improvements in myocardial perfusion and anginal symptoms in chronic myocardial ischemia patients. In the present study the results of the crossover phase of this trial, in which patients previously treated with placebo received autologous BMC injections are reported. This allows a unique intra-patient comparison on the effect of BMC versus placebo injection with elimination of patient-related confounding factors. Methods: In 16 patients (14 male, 64 ± 10 years), who previously received intramyocardial placebo injections in the setting of a randomized trial, 100 × 106 BMC were injected using the NOGA-system. Canadian Cardiovascular Society angina score and quality of life were evaluated at baseline, 3 and 6 months. Tc-99m single photon emission computed tomography and magnetic resonance imaging were performed at baseline and 3 months to assess myocardial perfusion and left ventricular (LV) function. Results: Canadian Cardiovascular Society score and quality of life improved significantly after BMC injection as compared to placebo (P = 0.01 and P = 0.02, respectively). Single photon emission computed tomography revealed a significant greater improvement (P = 0.03) in summed stress score after BMC injection as compared to placebo. LV end-systolic volume significantly decreased after BMC injection but not after placebo injection. LV end-diastolic volume and LV ejection fraction did not change. Conclusion: Intramyocardial BMC injection in patients with chronic myocardial ischemia who previously received intramyocardial placebo treatment resulted in significant improvement in angina symptoms and myocardial perfusion. These results confirm the outcome of our previously reported randomized trial. [Copyright &y& Elsevier]

Background: The basal ganglia, hippocampus, and thalamus are involved in the regulation of human feeding behavior. Recent studies have shown that obesity [body mass index (BMI; in kg/m²) > 30] is associated with loss of gray and white matter. Objective: It is unknown whether the subcortical brain structures that are actually involved in feeding behavior also show volume changes in obesity. Therefore, the purpose of this study was to evaluate the volumes of the basal ganglia, hippocampus, and thalamus in obesity. Design: Three-dimensional T1-weighted magnetic resonance imaging scans of the brain were analyzed by using automatic segmentation to measure volumes of the nucleus accumbens, globus pallidus, amygdala, putamen, caudate nucleus, thalamus, and hippocampus in 471 subjects (mean age: 74.4 y; 56% men). Results: Obese subjects had larger left (P = 0.013) and right (P = 0.003) amygdalar volumes and a larger left hippocampal volume (P = 0.040) than did normal-weight subjects (BMI < 25). None of the other subcortical structures differed in size between these groups. After correction for age, sex, smoking, hypertension, and pravastatin use, BMI was associated with left (β = 0.175, P = 0.001) and right (β = 0.157, P = 0.001) amygdalar volumes and with left hippocampal volume (β = 0.121, P = 0.016). Conclusions: This study showed that the amygdala and hippocampus are enlarged in obesity. In consideration of the function of these structures, this finding may indicate that hedonic memories could be of major importance in the regulation of feeding. Because of the cross-sectional design, cause and effect could not be discriminated in this study. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to demonstrate the feasibility of multidetector row computed tomography (CT) for assessment of diastolic function in comparison with 2-dimensional (2D) echocardiography using tissue Doppler imaging (TDI). Background: Diastolic left ventricular (LV) function plays an important role in patients with cardiovascular disease. 2D echocardiography using TDI has been used most commonly to evaluate diastolic LV function. Although the role of cardiac CT imaging for evaluation of coronary atherosclerosis has been explored extensively, its feasibility to evaluate diastolic function has not been studied. Methods: Patients who had undergone 64-multidetector row CT and 2D echocardiography with TDI were enrolled. Diastolic function was evaluated using early (E) and late (A) transmitral peak velocity (cm/s) and peak mitral septal tissue velocity (Ea; cm/s). Peak transmitral velocity (cm/s) was calculated by dividing peak diastolic transmitral flow (ml/s) by the corresponding mitral valve area (cm2). Mitral septal tissue velocity was calculated from changes in LV length per cardiac phase. Subsequently, the estimation of LV filling pressures (E/Ea) was determined. Results: Seventy patients (46 men; mean age 55 ± 11 years) who had undergone cardiac CT and 2D echocardiography with TDI were included. Good correlations were observed between cardiac CT and 2D echocardiography for assessment of E (r = 0.73; p < 0.01), E/A (r = 0.87; p < 0.01), Ea (r = 0.82; p < 0.01), and E/Ea (r = 0.81; p < 0.01). Moreover, a good diagnostic accuracy (79%) was found for detection of diastolic dysfunction using cardiac CT. Finally, the study showed a low intraobserver and interobserver variability for assessment of diastolic function on cardiac CT. Conclusions: Cardiac CT imaging showed good correlations for transmitral velocity, mitral septal tissue velocity, and estimation of LV filling pressures when compared with 2D echocardiography. Additionally, cardiac CT and 2D echocardiography were comparable for assessment of diastolic dysfunction. Accordingly, cardiac CT may provide information on diastolic dysfunction. [Copyright &y& Elsevier]

Background: Accurate aortic root measurements and evaluation of spatial relationships with coronary ostia are crucial in preoperative transcatheter aortic valve implantation assessments. Standardization of measurements may increase intraobserver and interobserver reproducibility to promote procedural success rate and reduce the frequency of procedurally related complications. This study evaluated the accuracy and reproducibility of a novel automated multidetector row computed tomography (MDCT) imaging postprocessing software, 3mensio Valves (version 4.1.sp1, Medical Imaging BV, Bilthoven, The Netherlands), in the assessment of patients with severe aortic stenosis candidates for transcatheter aortic valve implantation. Methods: Ninety patients with aortic valve disease were evaluated with 64-row and 320-row MDCT. Aortic valve annular size, aortic root dimensions, and height of the coronary ostia relative to the aortic valve annular plane were measured with the 3mensio Valves software. The measurements were compared with those obtained manually by the Vitrea2 software (Vital Images, Minneapolis, MN). Results: Assessment of aortic valve annulus and aortic root dimensions were feasible in all the patients using the automated 3mensio Valves software. There were excellent agreements with minimal bias between automated and manual MDCT measurements as demonstrated by Bland-Altman analysis and intraclass correlation coefficients ranging from 0.97 to 0.99. The automated 3mensio Valves software had better interobserver reproducibility and required less image postprocessing time than manual assessment. Conclusions: Novel automated MDCT postprocessing imaging software (3mensio Valves) permits reliable, reproducible, and automated assessments of the aortic root dimensions and spatial relations with the surrounding structures. This has important clinical implications for preoperative assessments of patients undergoing transcatheter aortic valve implantation. [ABSTRACT FROM AUTHOR]

Abstract: Diabetic heart disease is currently defined as left ventricular dysfunction that occurs independently of coronary artery disease and hypertension. Its underlying etiology is likely to be multifactorial, acting synergistically together to cause myocardial dysfunction. Multimodality cardiac imaging, such as echocardiography, nuclear, computed tomography, and magnetic resonance imaging, can provide invaluable insight into different aspects of the disease process, from imaging at the cellular level for altered myocardial metabolism to microvascular and endothelial dysfunction, autonomic neuropathy, coronary atherosclerosis, and finally, interstitial fibrosis with scar formation. Furthermore, cardiac imaging is pivotal in diagnosing diabetic heart disease. Thus, the aim of the present review is to illustrate the role of multimodality cardiac imaging in elucidating the underlying pathophysiologic mechanisms of diabetic heart disease. [ABSTRACT FROM AUTHOR]

Background: Surgical ventricular reconstruction has been proposed as a treatment option in heart failure patients with left ventricular (LV) aneurysm. The feasibility of this procedure has some limitations, and extensive preoperative evaluation is necessary to give the correct indication. For this purpose, magnetic resonance imaging (MRI) is currently considered the gold standard, providing accurate quantification of LV shape, size, and global and regional function together with the assessment of myocardial scar and mitral regurgitation severity. The aim of this study was to evaluate the accuracy of real-time three-dimensional echocardiography (RT3DE) as a potential alternative to MRI for this evaluation. Methods: A total of 52 patients with ischemic cardiomyopathy and LV aneurysm underwent a comprehensive analysis with two-dimensional echocardiography, RT3DE, and MRI. Results: Excellent correlation (r = 0.97, p < 0.001) and agreement were found between RT3DE and MRI for quantification of LV volumes, ejection fraction, and sphericity index; in a segment-to-segment comparison, RT3DE was shown to be accurate also for the analysis of wall motion abnormalities (k = 0.62) and LV regional thickness (k = 0.56) as a marker of myocardial scar. In contrast, two-dimensional echocardiography significantly underestimated these variables. Furthermore, mitral regurgitant volume assessed by RT3DE showed excellent correlation (r = 0.93) with regurgitant volume measured by MRI, without significant bias (= −0.7 mL/beat). Conclusions: In the management of heart failure patients with LV aneurysm, RT3DE provides an accurate and comprehensive assessment, including quantification of LV size, shape, global systolic function, regional wall motion, and myocardial scar together with precise evaluation of the severity of mitral regurgitation. [Copyright &y& Elsevier]

Objective: Proof of concept study evaluating CMR as screening tool for chronic thromboembolic pulmonary hypertension (CTEPH) in patients treated for acute pulmonary embolism (PE). Materials and methods: Right and left ventricular function of 15 consecutive patients treated for PE and 10 consecutive patients in whom PE was excluded was estimated at baseline by cardiac CT and at 6 months follow-up by CMR. Additionally, during the follow-up visit, pulmonary artery (PA) hemodynamics were studied by CMR and the presence of pulmonary hypertension by echocardiography. Results: CT measured right ventricular ejection fraction (RVEF) was lower in patients with PE compared to patients without PE at time of diagnosis (median 47%, interquartile range 39-53 vs. 55%, 52-58; p = 0.014). After 6 months follow up, the RVEF between patients treated for PE and patients without PE were not statistically significant different (55%, 52-60 versus 54%, 51-57; p = 0.57), as were distensibility index (0.18 ± 0.18 versus 0.25 ± 0.18, p = 0.20), mean velocity (14.1 ± 3.9 cm/s versus 14.0 ± 2.5 cm/s, p = 0.81), peak velocity (86.5 ± 22 cm/s versus 89.6 ± 13 cm/s, p = 0.43) and time to peak PA blood flow velocity (142 ± 49 ms versus 161 ± 29 ms, p = 0.14). One patient was diagnosed with CTEPH and CMR revealed poor right systolic function, decreased PA distensibility and flow velocity, and a systolic notch in the PA flow profile consistent with persistent PA obstruction. Conclusion: In this small series, right ventricular performance and PA flow profiles of patients treated for 6 months after PE are equivalent to those parameters in normal patients. [ABSTRACT FROM AUTHOR]

Background: Advances in the minimally invasive mitral valve repair techniques increase the demands on accurate and reliable morphologic assessment of the mitral valve using three-dimensional imaging modalities. The present study compared mitral valve geometry measurements obtained by three-dimensional transesophageal echocardiography (TEE) to those obtained with multidetector row computed tomography (MDCT) used as a standard reference. Methods: Clinical preoperative MDCT and intraoperative three-dimensional TEE were performed in 43 patients (mean age 81.0 ± 7.7 years) considered for transcatheter valve implantation procedure. Various measurements of mitral valve geometry were obtained from three-dimensional TEE datasets using mitral valve quantification software, and compared with those obtained from MDCT images using multiplanar reformation planes. Results: Moderate and severe mitral regurgitation was present in 48.9% of patients. There was good agreement in mitral valve geometry measurements between three-dimensional TEE and MDCT without significant overestimation or underestimation and tight 95% limits of agreement. For linear dimensions, angles and areas, the 95% limits of agreement were less than 1 cm, less than 15 degrees, and less than 2 cm2, respectively. In addition, the intraclass correlation coefficients were more than 0.8 for all parameters. Finally, the measurements were highly reproducible, with low intraobserver and interobserver variability (nonsignificant overestimation or underestimation and narrow 95% limits of agreement). Conclusions: The present study demonstrates the accuracy and clinical feasibility of the assessment of the mitral valve geometry with three-dimensional TEE that is comparable to the MDCT measurements. Three-dimensional TEE and MDCT provide accurate and complementary information in the evaluation of patients with mitral valve disease. Its potential incremental clinical value in the field of transcatheter mitral repair procedures needs further assessment in the future studies. [Copyright &y& Elsevier]

Background: Previous studies demonstrated that ventricular response to stress cardiovascular magnetic resonance (CMR) is frequently abnormal in patients with a systemic right ventricle (RV). However, the clinical implications of these findings remained unknown. We sought to evaluate whether abnormal response to stress CMR predicts adverse outcome in patients with a systemic RV. Methods: Thirty-nine adult patients (54% male; mean age 26, range 18-65 years) with a systemic RV underwent stress CMR to determine the response of RV volumes and ejection fraction (EF). During follow-up, cardiac events, defined as hospitalization for heart failure, cardiac surgery, aborted cardiac arrest, or death, were recorded. The prognostic value of an abnormal response to stress, defined as lack of a decrease in RV end-systolic volume (ESV) or lack of an increase in RV EF, was assessed. Results: We frequently observed an abnormal response to stress, as RV ESV did not decrease in 17 patients (44%), and RV EF did not increase in 15 patients (38%). After a mean follow-up period of 8.1 years, 8 (21%) patients had reached the composite end point. The inability to decrease RV ESV during stress was predictive for cardiac events with a hazard ratio of 2.3 (95% CI 1.19-88.72, P = .034), as was the inability to increase RV EF with a hazard ratio of 2.3 (95% CI 1.31-81.59, P = .027). Conclusions: Stress CMR potentially has important prognostic value in patients with a systemic RV. Patients with a systemic RV who show abnormal cardiac response to stress have a substantially higher risk of adverse outcome. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to demonstrate the feasibility of a dedicated algorithm for automated quantification of stenosis severity on multislice computed tomography in comparison with quantitative coronary angiography (QCA). Background: Limited information is available on quantification of coronary stenosis, and previous attempts using semiautomated approaches have been suboptimal. Methods: In patients who had undergone 64-slice computed tomography and invasive coronary angiography, the most severe lesion on QCA was quantified per coronary artery using quantitative coronary computed tomography (QCCTA) software. Additionally, visual grading of stenosis severity using a binary approach (50% stenosis as a cutoff) was performed. Diameter stenosis (percentage) was obtained from detected lumen contours at the minimal lumen area, and corresponding reference diameter values were obtained from an automatic trend analysis of the vessel areas within the artery. Results: One hundred patients (53 men; 59.8 ± 8.0 years) were evaluated, and 282 (94%) vessels were analyzed. Good correlations for diameter stenosis were observed for vessel-based (n = 282; r = 0.83; p < 0.01) and patient-based (n = 93; r = 0.86; p < 0.01) analyses. Mean differences between QCCTA and QCA were −3.0% ± 12.3% and −6.2% ± 12.4%. Furthermore, good agreement was observed between QCCTA and QCA for semiquantitative assessment of diameter stenosis (accuracy of 95%). Diagnostic accuracy for assessment of ≥50% diameter stenosis was higher using QCCTA compared with visual analysis (95% vs. 87%; p = 0.08). Moreover, a significantly higher positive predictive value was observed with QCCTA when compared with visual analysis (100% vs. 78%; p < 0.05). Although the visual approach showed a reduced diagnostic accuracy for data sets with moderate image quality, QCCTA performed equally well in patients with moderate or good image quality. However, in data sets with good image quality, QCCTA tended to have a reduced sensitivity compared with visual analysis. Conclusions: Good correlations were found for quantification of stenosis severity between QCCTA and QCA. QCCTA showed an improved positive predictive value when compared with visual analysis. [Copyright &y& Elsevier]

Objectives: The aim of this study was to evaluate feasibility and accuracy of real-time 3-dimensional (3D) echocardiography for quantification of mitral regurgitation (MR), in a head-to-head comparison with velocity-encoded cardiac magnetic resonance (VE-CMR). Background: Accurate grading of MR severity is crucial for appropriate patient management but remains challenging. VE-CMR with 3D three-directional acquisition has been recently proposed as the reference method. Methods: A total of 64 patients with functional MR were included. A VE-CMR acquisition was applied to quantify mitral regurgitant volume (Rvol). Color Doppler 3D echocardiography was applied for direct measurement, in “en face” view, of mitral effective regurgitant orifice area (EROA); Rvol was subsequently calculated as EROA multiplied by the velocity-time integral of the regurgitant jet on the continuous-wave Doppler. To assess the relative potential error of the conventional approach, color Doppler 2-dimensional (2D) echocardiography was performed: vena contracta width was measured in the 4-chamber view and EROA calculated as circular (EROA-4CH); EROA was also calculated as elliptical (EROA-elliptical), measuring vena contracta also in the 2-chamber view. From these 2D measurements of EROA, the Rvols were also calculated. Results: The EROA measured by 3D echocardiography was significantly higher than EROA-4CH (p < 0.001) and EROA-elliptical (p < 0.001), with a significant bias between these measurements (0.10 cm2 and 0.06 cm2, respectively). Rvol measured by 3D echocardiography showed excellent correlation with Rvol measured by CMR (r = 0.94), without a significant difference between these techniques (mean difference = −0.08 ml/beat). Conversely, 2D echocardiographic approach from the 4-chamber view significantly underestimated Rvol (p = 0.006) as compared with CMR (mean difference = 2.9 ml/beat). The 2D elliptical approach demonstrated a better agreement with CMR (mean difference = −1.6 ml/beat, p = 0.04). Conclusions: Quantification of EROA and Rvol of functional MR with 3D echocardiography is feasible and accurate as compared with VE-CMR; the currently recommended 2D echocardiographic approach significantly underestimates both EROA and Rvol. [Copyright &y& Elsevier]

Background: Percutaneous pulmonary valve implantation (PPVI) has been introduced as therapy for right ventricular (RV) to pulmonary artery conduit dysfunction in patients with congenital heart disease. It has been shown that RV systolic function improved early after PPVI. The effects of PPVI on RV diastolic function and RV hypertrophy have not yet been studied. Purpose: The objective of this study is to assess early and late changes in systolic and diastolic RV function and RV mass after PPVI. Materials and Methods: Fourteen patients underwent PPVI (7 male, median age 15 years). Cardiac magnetic resonance imaging was performed before and at 2 time points after PPVI (at 1 and 16 months). Right ventricular volume and systolic and diastolic function as well as RV mass were assessed. Results: At 1 and 16 months after PPVI, the RV mass decreased from 28.6 ± 2.1 to 25.6 ± 2.2 g/m2 (P = .03) and to 22.3 ± 2.1 g/m2 (P = .002). E/A volume ratio increased from 1.91 ± 0.4 to 2.6 ± 0.4 (not significant [NS]) and to 3.3 ± 0.4 (P = .01). E/A peak flow ratio increased from 1.34 ± 0.14 to 1.48 ± 0.16 (NS) and to 1.73 ± 0.14 (P = .04). E-wave deceleration time increased from 142 ± 25 to 160 ± 27 milliseconds (NS) and to 211 ± 26 milliseconds (P = .007). At 1 month, RV end-diastolic volume decreased from 124 ± 8 to 113 ± 8 mL (P = .01) and RV ejection fraction increased from 36% ± 2% to 46% ± 2% (P = .001) without further improvement at 16 months. Conclusion: After PPVI, in contrast to rapid improvement of RV systolic function, the improvement of RV diastolic function is delayed. The reduction of RV mass appears to be the underlying mechanism for improvement of RV diastolic function. Long follow-up for patients with PPVI is recommended. [Copyright &y& Elsevier]

Abstract: Cardiac computed tomography (CT) has evolved into a valuable clinical tool for cardiac evaluation. Cardiac CT is increasingly used for imaging of the coronary arteries for the evaluation of (suspected) coronary artery disease, but many other cardiac structures may be the topic for CT investigation. This article reviews general indications for cardiac CT imaging. Common variants and pathologies of the cardiovascular system are illustrated by clinical examples. [Copyright &y& Elsevier]

Objectives: The purpose of the present study was to assess the anatomy and geometry of the mitral valve by using 64-slice multislice computed tomography (MSCT). Background: Because it yields detailed anatomic information, MSCT may provide more insight into the underlying mechanisms of functional mitral regurgitation (FMR). Methods: In 151 patients, including 67 patients with heart failure (HF) and 29 patients with moderate to severe FMR, 64-slice MSCT coronary angiography was performed. The anatomy of the subvalvular apparatus of the mitral valve was assessed; mitral valve geometry, comprising the mitral valve tenting height and leaflet tethering, was evaluated at the anterolateral, central, and posteromedial levels. Results: In the majority of patients, the anatomy of the subvalvular apparatus was highly variable because of multiple anatomic variations in the posterior papillary muscle (PM): the anterior PM had a single insertion, whereas the posterior PM showed multiple heads and insertions (n = 114; 83%). The assessment of mitral valve geometry demonstrated that patients with HF with moderate to severe FMR had significantly increased posterior leaflet angles and mitral valve tenting heights at the central (44.4° ± 11.9° vs. 37.1° ± 9.0°, p = 0.008; 6.6 ± 1.4 mm/m2 vs. 5.3 ± 1.3 mm/m2, p < 0.0001, respectively) and posteromedial levels (35.9° ± 10.6° vs. 26.8° ± 10.1°, p = 0.04; 5.4 ± 1.6 mm/m2 vs. 4.1 ± 1.2 mm/m2, p < 0.0001, respectively), as compared with patients with HF without FMR. In addition, a more outward displacement of the PMs, reflected by a higher mitral valve sphericity index, was observed in patients with HF with FMR (1.4 ± 0.3 vs. 1.2 ± 0.3, p = 0.004). Mitral valve tenting height at the central level and mitral valve sphericity index were the strongest determinants of FMR severity. Conclusions: MSCT provides anatomic and geometric information on the mitral valve apparatus. In patients with HF with moderate to severe FMR, a more pronounced tethering of the mitral leaflets at the central and posteromedial levels was demonstrated using MSCT. [Copyright &y& Elsevier]

Abstract: Background: Visceral obesity (VO) is associated with an increased risk of cardiovascular disease. Elevated C-reactive protein (CRP) levels are associated with VO and cardiovascular disease. After exploring the relation between CRP and VO, we aimed to evaluate the VO independent relation between CRP and carotid atherosclerosis. Methods and results: The prevalence of inflammation was evaluated in 439 male subjects with VO without type 2 diabetes and manifest cardiovascular disease. Waist circumference significantly correlated with CRP (r: 0.20, p <0.001). However, 18.2% of patients in the waist circumference group 94–102 had elevated CRP levels while 9.6% of patients in the waist circumference group >118cm had low CRP levels. From the 439 subjects, 40 subjects were prospectively selected for MRI assessment of carotid atherosclerosis and visceral and subcutaneous adipose tissue distribution in a case–control setting matching for age and waist circumference. Twenty male subjects with age >50 years with CRP levels >2.5mg/L (CRP+) were compared to 20 controls with CRP levels <1.8mg/L (CRP−). Maximum vessel wall thickness in CRP+ was significantly higher both in the common carotid artery (15%, p <0.01) and the bulb region (18%, p <0.01). The distribution of fat in visceral and subcutaneous deposits was not significantly different between CRP+ and CRP−. Conclusion: Elevated CRP levels are associated with significantly increased maximum vessel wall thickness independent of VO and of MRI measured adipose tissue distribution, both in the common carotid artery and the carotid bulb. [Copyright &y& Elsevier]

Objective: Magnetic resonance imaging was used to evaluate left ventricular reverse remodeling at long-term follow-up (3–4 years) after restrictive mitral annuloplasty in patients with early stages of nonischemic, dilated cardiomyopathy, and severe mitral regurgitation. Methods: Twenty-two selected patients (eligible to undergo magnetic resonance imaging) with mild to moderate heart failure (mean New York Heart Association class 2.2 ± 0.4), dilated cardiomyopathy (left ventricular ejection fraction 37% ± 5%, left ventricular end-diastolic volume 215 ± 34 mL), and severe mitral regurgitation (grade 3–4+) underwent restrictive mitral annuloplasty. Magnetic resonance imaging was performed 1 week before surgery and repeated after 3 to 4 years. Results: There was no hospital mortality or major morbidity. Two patients died during follow-up (9%), and 2 patients could not undergo repeat magnetic resonance imaging because of comorbidity. New York Heart Association class improved from 2.2 ± 0.4 to 1.2 ± 0.4 (P < .05). Mitral regurgitation was minimal at late echocardiographic follow-up. There were significant decreases in indexed (to body surface area) left atrial end-systolic volume (from 84 ± 20 mL/m2 to 68 ± 12 mL/m2, P < .01), left ventricular end-systolic volume (from 42 ± 14 mL/m2 to 31 ± 12 mL/m2, P < .01), left ventricular end-diastolic volume (from 110 ± 18 mL/m2 to 80 ± 17 mL/m2, P < .01), and left ventricular mass (from 76 ± 21 g/m2 to 66 ± 12 g/m2, P = .03). Forward left ventricular ejection fraction improved from 37% ± 5% to 55% ± 10% (P < .01). Indexed left atrial end-diastolic volume did not show a significant decrease (from 48 ± 16 mL/m2 to 44 ± 10 mL/m2, P = .15). Conclusion: Magnetic resonance imaging confirms sustained significant reverse left atrial and ventricular remodeling at late (3–4 years) follow-up in patients with nonischemic, dilated cardiomyopathy, and mild to moderate heart failure after restrictive mitral annuloplasty. [Copyright &y& Elsevier]

Background: Predicting changes in right ventricular (RV) size and function after pulmonary valve replacement (PVR) is important for timely reintervention in adult tetralogy of Fallot patients. Methods: We analyzed the influence of pulmonary regurgitation severity and RV size and function before PVR on the outcome of RV size and function after PVR in 27 adult Fallot patients who had cardiac magnetic resonance imaging before and after PVR. RV dimensions were indexed for body surface area. Results: Pulmonary regurgitation (48% ± 11% of RV stroke volume) was not related to RV dimensions and function before PVR. Moreover, severity of pulmonary regurgitation did not influence changes in RV dimensions after PVR. The indexed RV end-systolic volume before PVR (mean, 98 mL/m2; range, 52 to 235 mL/m2) best predicted the indexed RV end-systolic volume after PVR (mean, 59 mL/m2; range, 24 to 132 mL/m2, r = 0.78, p < 0.001) and the indexed RV end-diastolic volume after PVR (mean, 107 mL/m2; range, 70 to 170 mL/m2, r = 0.73, p < 0.001). Baseline RV ejection fraction corrected for valvular insufficiencies and shunting (21% ± 7%) best predicted the RV ejection fraction after PVR (43% ± 10%, r = 0.77, p < 0.001). Conclusions: Timing of PVR should be based on indexed RV end-systolic volume and corrected RV ejection fraction rather than on severity of pulmonary regurgitation. [Copyright &y& Elsevier]

Objectives: This research was intended to determine the feasibility of tissue magnetic resonance (MR) imaging in comparison with tissue Doppler imaging and its potential implications for the estimation of filling pressure, in comparison with invasive measurement. Background: Evaluation of diastolic function using MR imaging is commonly confined to the study of transmitral flow. However, transmitral flow is unreliable for the estimation of left ventricular (LV) filling pressures in hypertrophy and normal systolic function. Normalizing early mitral velocity (E) for the influence of myocardial relaxation by combining E with early diastolic mitral septal tissue velocity (Ea) provides better Doppler estimates of filling pressures. Methods: Eighteen patients with hypertensive heart disease (LV mass index: 114 ± 21 g/m2), absence of valvular regurgitation, and with normal or mildly reduced systolic function (LV ejection fraction: 57.6 ± 6.5%) referred for cardiac catheterization, underwent consecutive measurement of mitral flow and septal tissue velocities with phase-contrast MR and Doppler. These data were compared with mean pulmonary capillary wedge pressure (PCWP). Results: There was a strong relation between MR (11.6 ± 4.3) and Doppler-assessed (12.1 ± 3.5) E/Ea (95% confidence interval of −1.5 to 0.5) (r = 0.89, p < 0.0001). In addition, E/Ea related strongly to invasively measured PCWP (MR: r = 0.80, p < 0.0001 and Doppler: r = 0.85, p < 0.0001). Conclusions: Tissue MR imaging is a feasible method to assess Ea. Combining E and Ea allowed similar estimation of filling pressure by MR and Doppler, in good agreement with invasive measurement. The potential confounding effect of valvular regurgitation needs further study. [Copyright &y& Elsevier]

An abstract of the article "Leveling of arterial wall stiffness between aortic arch and left carotid artery due to aging is associated with reduced volume flow towards the brain: pulse wave velocity evaluation with high-field velocity-encoded MRI," by Eleanore Kroner and Hildo J. Lamb is presented.

An abstract of the conference paper "3T versus 1.5T MR angiography in peripheral arterial occlusive disease: an equivalence trial in comparison with digital subtraction angiography," by Harrie van den Bosch and colleagues is presented.

An abstract of the conference paper "Association between aortic stiffness, carotid vessel wall thickness and stenosis severity in peripheral arterial occlusive disease: a comprehensive MRI study," by Harrie van den Bosch and colleagues is presented.

An abstract of the paper "Accuracy of Aortic Pulse Wave Velocity Assessment With Velocity-Encoded MRI: Validation in Patients With Marfan syndrome," by Arthur J. Scholte and colleagues is presented.

An abstract of the paper "High Field MR Carotid Vessel Wall Imaging: Reproducibility of Five Different MR-Weightings," by Eleanore S. Kroner and colleagues is presented.

Background: Aortic pulse wave velocity (PWV) is an indicator of aortic stiffness and is used as a predictor of adverse cardiovascular events. PWV can be non-invasively assessed using magnetic resonance imaging (MRI). PWV computation requires two components, the length of the aortic arch and the time taken for the systolic pressure wave to travel through the aortic arch. The aortic length is calculated using a multi-slice 3D scan and the transit time is computed using a 2D velocity encoded MRI (VE) scan. In this study we present and evaluate an automatic method to quantify the aortic pulse wave velocity using a large population-based cohort. Methods: For this study 212 subjects were retrospectively selected from a large multi-center heart-brain connection cohort. For each subject a multi-slice 3D scan of the aorta was acquired in an oblique-sagittal plane and a 2D VE scan acquired in a transverse plane cutting through the proximal ascending and descending aorta. PWV was calculated in three stages: (i) a multi-atlas-based segmentation method was developed to segment the aortic arch from the multi-slice 3D scan and subsequently estimate the length of the proximal aorta, (ii) an algorithm that delineates the proximal ascending and descending aorta from the time-resolved 2D VE scan and subsequently obtains the velocity-time flow curves was also developed, and (iii) automatic methods that can compute the transit time from the velocity-time flow curves were implemented and investigated. Finally the PWV was obtained by combining the aortic length and the transit time. Results: Quantitative evaluation with respect to the length of the aortic arch as well as the computed PWV were performend by comparing the results of the novel automatic method to those obtained manually. The mean absolute difference in aortic length obtained automatically as compared to those obtained manually was 3.3 ± 2.8 mm (p < 0.05), the manual inter-observer variability on a subset of 45 scans was 3.4 ± 3.4 mm (p = 0.49). Bland-Altman analysis between the automataic method and the manual methods showed a bias of 0.0 (-5.0,5.0) m/s for the foot-to-foot approach, -0.1 (-1.2, 1.1) and -0.2 (-2.6, 2.1) m/s for the half-max and the cross-correlation methods, respectively. Conclusion: We proposed and evaluated a fully automatic method to calculate the PWV on a large set of multi-center MRI scans. It was observed that the overall results obtained had very good agreement with manual analysis. Our proposed automatic method would be very beneficial for large population based studies, where manual analysis requires a lot of manpower. [ABSTRACT FROM AUTHOR]

An abstract of the article "Site specific coupling between aortic pulse wave velocity, carotid vessel wall thickness and peripheral stenosis severity in peripheral arterial occlusive disease at 3T MRI," by Harrie van den Bosch, Jos J. Westenberg, Lucien E. Duijm, and Joep A. Teijink is presented..

An abstract of the article "Left ventricular inflow propagation velocity for diastolic function testing: head-to-head comparison between velocity-encoded MRI and color M-mode Doppler echocardiography," by Pieter J. van den Boogaard and colleagues is presented.

An abstract of the conference paper "7T clinical cardiovascular MR imaging: Initial experience," by Hildo J. Lamb and colleagues is presented.