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A 61-year-old woman presented with a 12-month history of progressive muscle weakness, especially involving the proximal limb muscles. Her symptoms were associated with muscular fatigue such that she was compelled to sit and rest after walking only 30–50 m. She reported difficulty climbing stairs and standing from a sitting position. There was no rash or Raynaud phenomenon but she did report some episodes of feeling hot and perspiring. She denied any paresthesia, headache, or chest pain. Her past history included sigmoid diverticular disease, osteoarthritis of the cervical spine, and depression for over 20 years with psychotic features in the last 2–3 years. Her medications were aripiprazole 5 mg daily, irbesartan 150 mg daily, amisulpride 150 mg daily, imipramine 50 mg nocte, lercanidipine 10 mg daily, and sertraline 300 mg daily. She had also recently started replacement therapies for B12 and vitamin D deficiencies. Salient examination findings included a general reduction in muscle power, proximal greater than distal, with intact reflexes and sensation.

Background: Ultra-high-field (B0 ≥7 Tesla) cardiovascular magnetic resonance (CMR) offers increased resolution, but cardiac imaging requiring ECG gating is significantly impacted from the magneto-hydrodynamic (MHD) effect, distorts the ECG trace (1–3). Previously, 7T CMR was constrained to using pulse oximetry for triggering, We explored the technical feasbility of a 7 T research MR scanner using of-the-art ECG trigger algorithm to assess left and right ventricular volumes, aortic and pulmonary valve flow. Methods: 7T CMR scans were performed on 10 healthy volunteers on whole-body research MRI scanner (Siemens Healthcare, Erlangen, Germany) with 8 channel Tx/32 channel Rx cardiac coil (MRI Tools GmbH, Berlin, Germany) under institutional review board approval. Vectorcardiogram ECG was successfully performed using a learning phase outside of the magnetic field, with a trigger algorithm with sufficient accuracy for CMR despite severe ECG signal distortions from the 7T field. Cine CMR was performed after 3rd-order B0 shimming using a high-resolution breath-held ECG-retro-gated segmented two-dimensional spoiled gradient echo sequence, and 2-dimensional phase contrast flow imaging. Analysis was performed using Cmr42 software (Circle CVi, Calgary). Results: Successful 7T CMR scans were acquired in all patients (100%) using the Vectorcardiogram 3-lead ECG method. Image quality was sufficient to quantitate both left and right ventricular volumes, ejection fraction, aortic and pulmonary blood flow and regurgitant fractions in 9/10 (90%) of volunteers (figure 1), with one volunteer having difficulty with breath-holding and ventricular ectopy causing gating artefacts.

Aims In 30–40% of patients with acute ischaemic stroke, the cause remains undefined (cryptogenic stroke). Contrast transoesophageal echocardiography (TEE) is considered the gold standard for patent foramen ovale (PFO) detection. Recently, however, cardiac magnetic resonance (CMR) has also been applied to detect PFO. In this study, we compared the diagnostic value of CMR and TEE in detecting PFO in a group of patients with apparently cryptogenic stroke. Methods and results Twenty-five patients (age 50 ± 13 years, 16 males) with apparently cryptogenic ischaemic stroke underwent contrast-enhanced TEE and contrast CMR for detection of possible PFO. Both imaging studies were performed during Valsalva manoeuvre. PFO grading results were assessed visually both for TEE and for CMR, according to the entity of contrast passage in the left atrium (grade 0 = no PFO; grades 1, 2, and 3 = mild, medium, and wide PFO, respectively). TEE detected PFO in 16 patients (64%). Contrast-enhanced CMR identified a PFO in 7 (44%) of these patients. TEE showed a grade 1 PFO in five patients, a grade 2 PFO in eight patients, and a grade 3 PFO in three patients. Of these patients, CMR failed to identify PFO in all five patients with a grade 1 PFO, in one patient with a grade 2 PFO, and one patient with grade 3 PFO according to TEE. None of the nine patients without PFO at TEE was shown to have a PFO at CMR. When compared with TEE, the present methodology of CMR had a sensitivity of 50%, specificity of 100%, negative predictive value of 31%, and a positive predictive value of 100%. Conclusion Our data suggest that TEE is the cornerstone imaging diagnostic test to detect and characterize PFO in patients with ischaemic stroke, and is shown to be better compared with the current CMR sequences.

Aims We aimed to assess intervendor agreement of global (GLS) and regional longitudinal strain by vendor-specific software after EACVI/ASE Industry Task Force Standardization Initiatives for Deformation Imaging. Methods and results Fifty-five patients underwent prospective dataset acquisitions on the same day by the same operator using two commercially available cardiac ultrasound systems (GE Vivid E9 and Philips iE33). GLS and regional peak longitudinal strain were analyzed offline using corresponding vendor-specific software (EchoPAC BT13 and QLAB version 10.3). Absolute mean GLS measurements were similar between the two vendors (GE −17.5 ± 5.2% vs. Philips −18.9 ± 5.1%, P = 0.15). There was excellent intervendor correlation of GLS by the same observer [ r = 0.94, P < 0.0001; bias −1.3%, 95% CI limits of agreement (LOA) −4.8 to 2.2%). Intervendor comparison for regional longitudinal strain by coronary artery territories distribution were: LAD: r = 0.85, P < 0.0001; bias 0.5%, LOA −5.3 to 6.4%; RCA: r = 0.88, P < 0.0001; bias −2.4%, LOA −8.6 to 3.7%; LCX: r = 0.76, P < 0.0001; bias −5.3%, LOA −10.6 to 2.0%. Intervendor comparison for regional longitudinal strain by LV levels were: basal: r = 0.86, P < 0.0001; bias −3.6%, LOA −9.9 to 2.0%; mid: r = 0.90, P < 0.0001; bias −2.6%, LOA −7.8 to 2.6%; apical: r = 0.74; P < 0.0001; bias −1.3%, LOA −9.4 to 6.8%. Conclusions Intervendor agreement in GLS and regional strain measurements have significantly improved after the EACVI/ASE Task Force Strain Standardization Initiatives. However, significant wide LOA still exist, especially for regional strain measurements, which remains relevant when considering vendor-specific software for serial measurements.

A 72-year-old lady was referred to our Pulmonary Hypertension Unit with WHO Class IV dyspnoea. Previous computed tomography pulmonary angiography had revealed chronic thrombo-embolism. The degree and distribution of disease was confirmed with gadolinium-enhanced cardiac magnetic resonance (CMR) pulmonary angiography ( Panel A , see also Supplementary material online, Movie 1 ). The right ventricle was severely dilated with an ejection fraction of 32% by CMR. Functional testing demonstrated reduced 6 min walk …