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Background There is a lack of cardiac magnetic resonance (CMR) data regarding mid- to long-term myocardial damage due to Covid-19 in elite athletes. Objective This study investigated mid-to long-term consequences of myocardial involvement after a Covid-19 infection in elite athletes. Methods Between January 2020 and October 2021, 27 athletes of the German Olympic centre Rhineland with confirmed Covid-19 infection were analyzed. 9 healthy non-athlete volunteers served as control. CMR was performed in mean 182 days (SD 99) after initial positive test result. Results CMR did not reveal any signs of acute myocarditis in regard to the current Lake Louise criteria or myocardial damage in any of the 26 elite athletes with previous Covid-19 infection. Nevertheless, 92 % of the athletes experienced a symptomatic course and 54 % reported lasting symptoms for more than 4 weeks. In one male athlete CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC) and this athlete was excluded from the study. Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs. 91.1 ml/m 2 p=0.031; RVEDVi 104.1 vs. 86.6 ml/m 2 p=0.007; and LVMi 59.0 vs. 46.2 g/m 2 p=0.002). Conclusion Our findings suggest that the risk for mid-to long-term myocardial damage seems to be very low to negligible in elite athletes. No conclusions can be drawn regarding myocardial injury in the acute phase of infection nor about possible long-term myocardial effects in the general population.

Background Phenylketonuria is the most common inborn error of amino acid metabolism, where oxidative stress and collateral metabolic abnormalities are likely to cause cardiac structural and functional modifications. We aim herein to characterize the cardiac phenotype of adult subjects with phenylketonuria using advanced cardiac imaging. Methods and Results Thirty‐nine adult patients with phenylketonuria (age, 30.5±8.7 years; 10‐year mean phenylalanine concentration, 924±330 µmol/L) and 39 age‐ and sex‐matched healthy controls were investigated. Participants underwent a comprehensive cardiac magnetic resonance and echocardiography examination. Ten‐year mean plasma levels of phenylalanine and tyrosine were used to quantify disease activity and adherence to treatment. Patients with phenylketonuria had thinner left ventricular walls (septal end‐diastolic thickness, 7.0±17 versus 8.8±1.7 mm [ P P =0.004]), more dilated left ventricular cavity (end‐diastolic volume, 87±14 versus 80±14 mL/m 2 [ P =0.0178]; end‐systolic volume, 36±9 versus 29±8 mL/m 2 [ P P P =0.027]), and lower left ventricular mass (38.2±7.9 versus 47.8±11.0 g/m 2 [ P P 1200 µmol/L (909±48 ms). Both mean phenylalanine ( P =0.013) and tyrosine ( P =0.035) levels were independently correlated with T1; and in a multiple regression model, higher phenylalanine levels and higher left ventricular mass associate with lower T1. Conclusions Cardiac phenotype of adult patients with phenylketonuria reveals some traits of an early‐stage cardiomyopathy. Regular cardiology follow‐up, tighter therapeutic control, and prophylaxis of cardiovascular risk factors, in particular dyslipidemia, are recommended.

In this study, we used a single commercially available software solution to assess global longitudinal (GLS) and global circumferential strain (GCS) using cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) feature tracking (FT). We compared agreement and reproducibility between these two methods and the reference standard, CMR tagging (TAG). Twenty-seven patients with severe aortic stenosis underwent CMR and cardiac CT examinations. FT analysis was performed using Medis suite version 3.0 (Leiden, The Netherlands) software. Segment (Medviso) software was used for GCS assessment from tagged images. There was a trend towards the underestimation of GLS by CT-FT when compared to CMR-FT (19.4 ± 5.04 vs. 22.40 ± 5.69, respectively, p = 0.065). GCS values between TAG, CT-FT, and CMR-FT were similar (p = 0.233). CMR-FT and CT-FT correlated closely for GLS (r = 0.686, p &lt, 0.001) and GCS (r = 0.707, p &lt, 0.001), while both of these methods correlated moderately with TAG for GCS (r = 0.479, p &lt, 0.001 for CMR-FT vs. TAG, r = 0.548 for CT-FT vs. TAG). Intraobserver and interobserver agreement was excellent in all techniques. Our findings show that, in elderly patients with severe aortic stenosis (AS), the FT algorithm performs equally well in CMR and cardiac CT datasets for the assessment of GLS and GCS, both in terms of reproducibility and agreement with the gold standard, TAG.

AimTo study the effects of RD on renal artery wall function non-invasively using magnetic resonance.Methods and results32 patients undergoing RD were included. A 3.0 Tesla magnetic resonance of the renal arteries was performed before RD and after 6-month. We quantified the vessel sharpness of both renal arteries using a quantitative analysis tool (Soap-Bubble®). In 17 patients we assessed the maximal and minimal cross-sectional area of both arteries, peak velocity, mean flow, and renal artery distensibility. In a subset of patients wall shear stress was assessed with computational flow dynamics. Neither renal artery sharpness nor renal artery distensibility differed significantly. A significant increase in minimal and maximal areas (by 25.3%, p = 0.008, and 24.6%, p = 0.007, respectively), peak velocity (by 16.9%, p = 0.021), and mean flow (by 22.4%, p = 0.007) was observed after RD. Wall shear stress significantly decreased (by 25%, p = 0.029). These effects were observed in blood pressure responders and non-responders.ConclusionsRD is not associated with adverse effects at renal artery level, and leads to an increase in cross-sectional areas, velocity and flow and a decrease in wall shear stress.

Obesity has reached epidemic proportions at a global level with multiple adverse medical and societal implications [(1)][1]. It is a major determinant for the development of cardiovascular risk factors such as diabetes and hypertension, and independently predisposes to cardiac conditions such as

C-reactive protein (CRP) is a pluripotent mediator of inflammation and is present at sites of vascular injury and in atherosclerotic lesions. CRP stimulates endothelial cell adhesion molecule expression and monocyte migration, thereby contributing to the development and progression of vascular lesion formation. In addition, chronic exposure to CRP is known to inhibit angiogenesis and endothelial cell (EC) proliferation.Aim: Whether CRP also affects EC migration, however, has yet to be determined. The present study investigates how long-term exposure to CRP interacts with vascular endothelial growth factor (VEGF) -induced EC migration.Methods and Results: Using a Transwell chamber migration assay, VEGF (20 ng/mL, 5 h incubation) -induced migration of human umbilical vein EC was significantly inhibited in cells pretreated with CRP (10μg/mL) for 24 h by more than 75%. EC migration in response to VEGF is known to require activation of the proteinkinase B (Akt)/endothelial NO synthase (eNOS)- and the extracellular signal-regulated protein kinase 1/2 (ERK1/2) pathway. We therefore investigated the long-term effects of CRP on these signalling events. Immunoblotting with phosphospecific antibodies revealed rapid and transient activation/phosphorylation of the protein kinase Akt within 20 minutes after stimulation with VEGF, which was inhibited by 86% in EC pretreated with CRP (10μg/mL, 24 h, p

Background Hypertensive cardiomyopathy is characterized by myocyte hypertrophy and interstitial fibrosis. The effects of renal denervation ( RD ) on the heart are poorly understood. New magnetic resonance imaging techniques (extracellular volume fraction) permit the quantitative assessment of myocardial fibrosis. Our aim was to study the effects of RD on myocardial fibrosis. Methods and Results Twenty‐three patients with resistant hypertension undergoing RD and 5 resistant hypertensive controls were prospectively included. Cardiac magnetic resonance imaging at 1.5 T was performed before RD and at 6‐month follow‐up. Indexed left ventricular mass, septal extracellular volume fraction, and indexed absolute extracellular volume (a quantitative measure of extracellular matrix) were quantified. All data are reported as mean±SD deviation (median). Decreases in systolic (161.96±19.09 [160] versus 144.78±16.48 [143] mm Hg, P P =0.018) blood pressures and in indexed left ventricular mass (41.83±10.20 [41.59] versus 37.72±7.44 [38.49] g/m 1.7 , P =0.001) were observed at follow‐up only in RD patients. No significant differences in extracellular volume were found (26.24±3.92% [26.06%] versus 25.74±4.53% [25.63%], P =0.605). A significant decrease in absolute extracellular volume was observed after 6 months in RD patients exclusively (10.36±2.25 [10.79] versus 9.25±2.38 [9.79] mL/m 1.7 , P =0.031). This effect was observed independently of blood pressure reduction. Conclusions RD significantly decreases left ventricular mass, while extracellular volume remains stable. Our results suggest that the observed left ventricular mass decrease was due not exclusively to a reversion of myocyte hypertrophy but also to an additional reduction in collagen content, indicating interstitial myocardial fibrosis.

Background Dobutamine stress cardiovascular magnetic resonance (DS-CMR) has been established for the detection of coronary artery disease (CAD). The novel technique feature tracking (FT) analyses left ventricular circumferential strain (Ecc) thus offering detailed information about myocardial deformation. The purpose of this study was to evaluate FT based Ecc for the detection of myocardial ischemia during DS-CMR. Methods A total of 25 patients (18 males; mean age 64 ± 10 years) with suspected or known CAD underwent a standardized high-dose DS-CMR protocol at 1.5 T. For FT analysis cine short axis (SAX) views (apical, medial, basal) at rest and during maximum dobutamine stress were used. None of the patients had wall motion abnormalities (WMAs) or impaired left ventricular function at rest or scar tissue. For analysis of Ecc the three SAX planes were divided into 16 segments (n = 400 segments). During stress 15 patients (34 segments) developed WMAs as assessed by visual analysis. All patients underwent x-ray coronary angiography for clinical reasons which served as the reference standard. Patients without WMAs during DS-CMR and exclusion of stenotic CAD were defined as normal (10 patients, 160 segments). In patients with significant CAD segments that were supplied by a vessel of >70% narrowing were defined as stenotic (n = 64). The remaining segments in patients with significant CAD were considered as remote (n = 176). Results At rest no differences in Ecc were observed between normal, stenotic and remote segments. High-dose dobutamine stress revealed highly significant differences between Ecc of normal and stenotic segments (p

Aims Sympathetic stimulation induces left ventricular hypertrophy and is associated with increased cardiovascular risk. Catheter-based renal denervation (RDN) has been shown to reduce sympathetic outflow and blood pressure (BP). The present multi-centre study aimed to investigate the effect of RDN on anatomic and functional myocardial parameters, assessed by cardiac magnetic resonance (CMR), in patients with resistant hypertension. Methods and results Cardiac magnetic resonance was performed in 72 patients (mean age 66 ± 10 years) with resistant hypertension (55 patients underwent RDN, 17 served as controls) at baseline and after 6 months. Clinical data and CMR results were analysed blindly. Renal denervation significantly reduced systolic and diastolic BP by 22/8 mm Hg and left ventricular mass index (LVMI) by 7.1% (46.3 ± 13.6 g/m1.7 vs. 43.0 ± 12.6 g/m1.7, P < 0.001) without changes in the control group (41.9 ± 10.8 g/m1.7 vs. 42.0 ± 9.7 g/m1.7, P = 0.653). Ejection fraction (LVEF) in patients with impaired LVEF at baseline (

Background Phenylketonuria (PKU) is one of the most common inherited metabolic disorders. The molecular pathway of neurological damage is not yet sufficiently understood. To date, there is a lack information about cardiac involvement related to the disease. This study aims to characterize cardiac morphology and function in adult patients with PKU using cardiovascular magnetic resonance (CMR).

Background Renal Denervation (RDN) is a novel therapy for patients with resistant hypertension. Its cardiac effects at followup are currently unknown. On the other hand, T1 mapping permits the assessment of myocardial extracellular volume (ECV), a parameter proposed to quantify diffuse myocardial fibrosis and independently associated with mortality and hard cardiovascular events. Our aim was to study the effects of RDN on ECV at 6-month follow-up. Methods 14 patients with resistant hypertension undergoing RD (RD group) and 4 resistant hypertensive patients not undergoing RD (control group) were prospectively included. A 1.5T cardiac MR including T1 mapping preand post-contrast was performed before the RD procedure and at 6-month follow-up in both groups. Blood hematocrit was determined at both time points. Images were post-processed using commercial software (Qmass, Medis

Background Dobutamine stress magnetic resonance (DSMR-wall motion) has been established as a valuable tool for the detection of inducible wall motion abnormalities. Additional perfusion imaging during DSMR (DSMR-perfusion) was shown to improve sensitivity for the detection of myocardial ischemia. Current experience is based on 1.5T only, mainly due to insufficient image quality of steady state free precession (SSFP) cine imaging at higher field strengths. Recently, image quality and diagnostic accuracy of SSFP sequences was significantly improved by dual-source parallel radiofrequency (RF) transmission for 3.0T. We examined whether the addition of myocardial perfusion imaging during DSMR at 3.0T is feasible and whether it provides incremental benefit for the evaluation of CAD.

Background Several studies have demonstrated the consistently high diagnostic and prognostic value of adenosine stress perfusion imaging with cardiovascular magnetic resonance (CMR). The feasibility and diagnostic accuracy of CMR stress perfusion in patients with atrial fibrillation is unknown. The purpose of this study was to assess the utility of CMR stress perfusion imaging in patients with atrial fibrillation who had suspected and known coronary artery disease (CAD).

Background Left ventricular (LV) hypertrophy is a common finding in patients with resistant hypertension and is associated with increased sympathetic activity and high cardiovascular risk. Catheter-based renal denervation (RD) has been shown to reduce blood pressure (BP) and sympathetic tone. The present study aimed to investigate the effect of RD on left ventricular mass, assessed by cardiac magnetic resonance (CMR), in patients with resistant hypertension compared to a control group of medical treated patients. Methods CMR was performed in 37 patients at baseline and 6 months after RD in a multicenter setting with 9 subjects serving as controls. Resistant hypertension was defined as office systolic BP >160 mmHg and >150 mmHg for patients with type 2 diabetes. Clinical data and CMR results were analyzed blinded at both times. Data were analyzed using the paired or unpaired t-test. All continuous parameters are given as mean + one standard deviation (SD). For all tests, p

Late gadolinium enhancement is the technique of choice for detecting myocardial fibrosis. Although this technique is used in a wide range of cardiovascular pathologies, ischemic cardiomyopathy and the workup for myocarditis and other cardiomyopathies make up a significant proportion of the total indications. Multiple studies during the last decade have demonstrated its utility to adequately characterize myocardial tissue and offer diagnostic and prognostic information. Recent T1 mapping techniques aim to overcome the limitations of late gadolinium enhancement to assess diffuse fibrosis.19F magnetic resonance has recently emerged as a promising technique for the assessment of inflammation. In the following review we will discuss the basic aspects of fibrosis assessment with MR and its utility for diagnostic and prognostic evaluation. We will also address the topic of cardiovascular inflammation imaging with19F as a potential new development that may broaden the indications for MR in the future.

To the Editor: In the present study we sought to investigate the predictive value of resting and inducible wall motion abnormalities (WMA) and of late gadolinium enhancement (LGE) for hard cardiac outcomes and for revascularization procedures in 3,138 patients undergoing dobutamine cardiac magnetic

A 45-year-old man without cardiac risk factors was referred to our hospital 6 days after suffering from an inferior ST elevation myocardial infarction during a scuba diving holiday in Tuscany. He had already made seven eventless dives. Sixteen hours after the last scuba dive, he complained about nausea and chest pain while driving up a mountainous road. The pain increased and he called the emergency service. The first electrocardiogram (ECG) showed ST elevation in II, III, and aVF ( Panel A ), cardiac enzymes …

Anti-neutrophil antibodies (ANCA)-associated vasculitides (AAV) comprise different forms of small vessel vasculitis characterised by B-cell driven autoimmune processes and endothelial cell activation. Aim of this study was to correlate markers of B- and endothelial cell activation with clinical manifestations of disease in AAV.Consecutive serum samples of patients fulfilling the Chapel Hill Consensus Conference (CHCC) and American College of Rheumatology (ACR) criteria for AAV and healthy donors were used for the determination of ANCA, B-lymphocyte stimulator (BLyS), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin) levels using enzyme-linked immunosorbent assay (ELISA). Subset and follow-up analyses were performed in cytoplasmatic ANCA (C-ANCA) or perinuclear ANCA (P-ANCA) positive patients with respect to change in ANCA-titres during the course of disease.Levels of sVCAM-1 were elevated in all patient groups with vasculitis compared to healthy controls. In contrast, significantly increased levels of BLyS were only observed in patients with Wegener's granulomatosis (WG), but not in patients with microscopic polyangiitis (mPAN)/Churg-Strauss-syndrome (CSS). Remarkably, there were no differences in the levels of sE-selectin between the vasculitis groups and healthy controls. In follow-up analysis, a significant correlation was shown for sE-Selectin and P-ANCA titres as well as sVCAM-1 levels. Furthermore, a strong correlation was detected for sVCAM-1 and creatinine levels. Interestingly, sE-selectin levels and C-ANCA titres were negatively correlated.Enhanced levels of sVCAM-1 represent a marker for endothelial cell activation in AAV. The observed correlation between sVCAM-1 and creatinine levels might indicate the influence of the vasculitic process on renal function. Signalling pathways for B-cells provided by BLyS could play a significant role in the pathogenesis of WG.

Background Left ventricular myocardial motion analysis and the assessment of regional dysfunction are crucial for the detection and prognosis in different cardiac pathologies. Myocardial tagging (MT) is a cardiac magnetic resonance (CMR) based method for tracking myocardial motion, which has been established as reference standard for assessment of strain. Currently, strain can also be assessed by CMR using feature tracking (FT) or by echocardiography with speckle tracking (ST). Aim of our study was to evaluate intraindividually and compare myocardial circumferential strain (Ecc) using MT, FT and ST.

Background Renal denervation (RD) is a promising treatment for patients with resistant hypertension, with a good safety profile. Studies performed in animal models have demonstrated an increase in renal arteries’ velocity and flow. The hemodynamic effects of RD on renal arteries in humans remain unknown. The aim of our study is to evaluate the hemodynamic effect of RD on renal arteries non-invasively, using magnetic resonance (MR) techniques.

Background Adenosine stress magnetic resonance is highly accurate for the detection of myocardial perfusion abnormalities. Visual assessment of inducible wall motion abnormalities (IWMA) during adenosine has low sensitivity but high specificity since only high-grade perfusion defects are associated with detectable IWMAs. The novel technique Feature Tracking (FT) measures myocardial strain and gives detailed information about regional myocardial deformation. The aim of this study was to investigate FT for the detection of myocardial ischemia during adenosine stress.

Background Dobutamine stress magnetic resonance (DSMR) has been established for the detection of coronary artery disease (CAD) due to its high diagnostic accuracy and prognostic value. The novel technique feature tracking (FT) analyses regional myocardial strain and thereby offers detailed information about myocardial deformation. The purpose of this study was to examine how FT based circumferential strain (CS) compares to visually detected wall motion abnormalities (WMA) during DSMR and whether it adds beneficial information for detecting CAD. Methods A total of 25 patients (72% male; mean age 64 ± 8) with suspected or known CAD underwent a standardized high-dose DSMR protocol at 1.5 T. CMR images were acquired at rest and during stress in three short-axis views (SAX; apical, medial, basal). None of the patients had evidence for WMAs or impaired left ventricular function at rest or scar tissue based on late gadolinium enhancement (LGE). For strain analysis the SAX planes were divided into 16 segments (n = 400 segments). All patients underwent x-ray coronary angiography for clinical reasons. Patients without WMA during DSMR and exclusion of CAD by coronary angiography were defined as normal and served as control (10 patients, 160 segments). 15 patients developed WMA during DSMR (34 segments). Additionally, based on angiographic findings, segments that were supplied by a vessel with >75% were defined as stenotic (64 segments). The remaining segments, which did not develop a WMA or were supplied by a vessel

Summary We sought to assess late gadolinium enhancement (LGE) of the coronary artery wall and ascending aorta in patients with Takayasu arteritis (TA) compared to patients with stable CAD. Our findings suggest that LGE of the coronary artery wall can be demonstrated in patients with TA and seems to be similarly pronounced as in CAD patients. The observed coronary LGE seems rather unspecific and differentiation between coronary vessel wall fibrosis and inflammation still remains unclear.

Methods DSMR was performed in twenty-eight consecutive patients with suspected or known CAD scheduled for clinically indicated invasive coronary angiography. Each patient underwent routine DSMR including cine imaging at rest and during dobutamine infusion. Additionally, three standard short axis and longitudinal axis views were obtained after five, ten and fifteen minutes during the recovery period in order to detect persisting wall motion abnormalities in ischemic myocardial territories, which were assigned to coronary arteries based on the 17 segment model. Intermediate and severe coronary stenosis were defined as 50-75% and >75% luminal narrowing using invasive coronary angiography, respectively (figure 1). All patients received esmolol after stopping the dobutamine infusion to achieve a heart rate under 100bpm.

Summary We aimed to determine the prognostic value of wall motion assessment during high-dose dobutamine stress cardiac magnetic resonance imaging (DCMR) for the prediction of hard cardiac events in a large patient cohort and within a long follow-up duration. DCMR can accurately identify between patients with inducible ischemia who are at increased risk for future hard cardiac events and revascularization procedures. Within the ‘primary warranty time’ of 3 years after DCMR excellent outcomes (annual hard cardiac event rate 90 days after the MR-scans were prospectively collected at least 6 months after DCMR. Results