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Background: With multifaceted imaging capabilities, cardiovascular magnetic resonance (CMR) is playing a progressively increasing role in the management of various cardiac conditions. A global registry that harmonizes data from international centers, with participation policies that aim to be open and inclusive of all CMR programs, can support future evidence-based growth in CMR. Methods: The Global CMR Registry (GCMR) was established in 2013 under the auspices of the Society for Cardiovascular Magnetic Resonance (SCMR). The GCMR team has developed a web-based data infrastructure, data use policy and participation agreement, data-harmonizing methods, and site-training tools based on results from an international survey of CMR programs. Results: At present, 17 CMR programs have established a legal agreement to participate in GCMR, amongst them 10 have contributed CMR data, totaling 62,456 studies. There is currently a predominance of CMR centers with more than 10 years of experience (65%), and the majority are located in the United States (63%). The most common clinical indications for CMR have included assessment of cardiomyopathy (21%), myocardial viability (16%), stress CMR perfusion for chest pain syndromes (16%), and evaluation of etiology of arrhythmias or planning of electrophysiological studies (15%) with assessment of cardiomyopathy representing the most rapidly growing indication in the past decade. Most CMR studies involved the use of gadolinium-based contrast media (95%). Conclusions: We present the goals, mission and vision, infrastructure, preliminary results, and challenges of the GCMR. Trial registration: Identification number on ClinicalTrials.gov: NCT02806193. Registered 17 June 2016. [ABSTRACT FROM AUTHOR]

Magnetic resonance spectroscopy (MRS) is the only noninvasive, nonradiation exposure technique for the investigation of cardiac metabolism in vivo. MRS uses magnetic resonance signals from nuclei, such as 31phosphorus, 1hydrogen, and 23sodium, to provide comprehensive metabolic and biochemical information about cardiac muscle. This method is highly versatile and can provide metabolic insights into the role of cardiac metabolism, in particular, cardiac energetics, in a wide number of conditions, including hypertensive, valvular, and ischemic heart disease, heart failure, and cardiac transplantation, as well as cardiomyopathies. This method can also be used to monitor patient responses to therapeutic interventions: pharmacologic, surgical, or interventional. When combined with cardiovascular magnetic resonance imaging, MRS enables detailed pathophysiologic insights into the inter-relations among cardiac structure, function, perfusion, and metabolism. However, MRS is currently used primarily as a research tool because of low temporal and spatial resolution and low reproducibility. It is hoped that future technical developments and use of higher magnetic field strengths (such as 7-T) may enable application of cardiac MRS in clinical practice. [Copyright &y& Elsevier]

The article discusses the changes and developments of the Society for Cardiovascular Magnetic Resonance (SCMR) in the U.S. Regional study groups in Europe, Asia, Australia/New Zealand and South America have been organized as well as the task forces on CMR Image Acquisition and Reporting. Terms of officers and board of trustees are reduced, while the Dudley Pennell and Warren Manning were appointed as editor-in-chief and deputy director of the journal.

Objectives: This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy., Background: Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping., Methods: All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event., Results: Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk., Conclusions: The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted., Competing Interests: Funding Support and Author Disclosures This work was supported by the National Institutes of Health, the National Heart, Lung, and Blood Institute (U01HL117006-01A1) and the Oxford NIHR Biomedical Research Centre. Dr. Kramer has received research grants from MyoKardia and Cytokinetics; and has been consultant for MyoKardia and Cytokinetics. Dr. DiMarco has been a consultant to Novartis, Galmed, and Celgene. Dr. Ho has been consultant for and has received research support from MyoKardia. Dr. Kwong has received research support from Siemens Healthineers, Bayer AG, and Myokardia. Dr. Maron has received consulting and research support from iRhythm; and has been a consultant for Celltrion and Cytokinetics. Dr. Friedrich has been a board member, shareholder, and consultant of Circle Cardiovascular Imaging Inc. Dr. Schulz-Menger has been a consultant for Bayer; has received research grants from Bayer, Siemens Healthineers, and Circle Cardiovascular Imaging. Dr. Piechnik holds U.S. patent 9,285,446 B2: “Systems and methods for shortened look locker inversion recovery (Sh-MOLLI) cardiac gated mapping of T1.” Dr. Jacoby has been consultant for and has received a research grant from MyoKardia. Dr. White holds shares in Cohesic; and has received a research grant from Siemens Healthineers. Dr. Chiribiri has received research grants from Philips Healthcare and Siemens Healthineers. Dr. Helms has received research support from MyoKardia. Dr. Bradlow has received honoraria from Daichi-Sankyo. Dr. Salerno has received research support from Siemens Healthineers and Heartflow. Dr. Dawson has received research grant from Philips Healthcare. Dr. Nagueh has been a consultant for MyoKardia. Dr. Casadei has received research support from Roche Diagnostics and iRhythm. Dr. Watkins has been a consultant for Cytokinetics. Dr. Neubauer has received research grants from Boehringer Ingelheim and Cytokinetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Large prospective studies to establish the prevalence of non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH), are lacking. We prospectively assessed the prevalence and severity of NAFLD/NASH in a cohort of asymptomatic middle-aged Americans attending a colonoscopy class at a gastroenterology clinic., Methods: Screening for NAFLD was performed using magnetic resonance (MR)-based LiverMultiScan® proton density fat fraction (LMS-PDFF). MR exams also included corrected T1 and elastography for liver stiffness measurement (LSM). FibroScan® was also used to measure LSM. Participants with predetermined abnormal imaging parameters were offered a liver biopsy. Biopsies were read in a blinded fashion with results based on the consensus by 2 expert pathologists. The prevalence of NAFLD was determined by PDFF ≥5% or by histological diagnosis of NAFLD (if biopsy data were available). The prevalence of NASH was defined by biopsy., Results: Of 835 participants, 664 met the inclusion and exclusion criteria. The mean age was 56 ± 6.4 years, 50% were male, the mean BMI was 30.48 ± 5.46 kg/m 2 , and 52% were obese. The prevalence of NAFLD was 38% (95% CI 34-41%) and the prevalence of NASH was 14% (95% CI 12-17%). While no patient had cirrhosis on biopsy, significant fibrosis (F ≥2) was present in 5.9% (95% CI 4-8%) and bridging fibrosis in 1.6% (95% CI 1-3%). In a multivariable analysis, factors associated with the presence of NASH were race, obesity, and diabetes., Conclusion: Using state-of-the-art liver imaging modalities and reference biopsy, this study establishes an overall prevalence of NAFLD of 38% and NASH by biopsy of 14% in this cohort of asymptomatic middle-aged US adults., Lay Summary: There are no prospective studies to determine how common is nonalcoholic steatohepatitis (NASH), the severe form of non-alcoholic fatty liver disease (NAFLD). In a large number of asymptomatic middle-aged Americans, we used a combination of state-of-the-art liver imaging methods and liver biopsy to prospectively determine the prevalence of NAFLD and NASH. NAFLD was diagnosed in 38%, NASH in 14%, and significant liver fibrosis in 6% of asymptomatic middle-aged Americans., Competing Interests: Conflict of interest Dr. Harrison-SAH reports grants from Bristol Myers Squibb, Pfizer, Second Genome, Tobira/Allergan, and Genentech; grants, personal fees, and stock/equity from Akero, Axcella Health, Cirius Therapeutics, Galectin Therapeutics, Genfit, Madrigal Pharmaceuticals, Metacrine, NGM Biopharmaceuticals, and NorthSea Therapeutics; grants and personal fees from Cirius Therapeutics, CiVi Biopharma, CymaBay Therapeutics, Conatus Pharmaceuticals, Galmed Pharmaceuticals, Gilead Sciences, Hepion Pharmaceuticals, High Tide Therapeutics, Intercept Pharmaceuticals, Novartis, Novo Nordisk, Sagimet Biosciences, and Viking Therapeutics; personal fees and stock/equity from HistoIndex; and personal fees from Altimmune, Blade Therapeutics, Chronic Liver Disease Foundation, Corcept Therapeutics, Echosens, Foresite Labs, Gelesis, Indalo Therapeutics, Innovate Pharma, IQVIA, Lipocine, Medpace, Perspectum, Poxel, Prometheus, Prometic, Terns Pharmaceuticals, and Ridgeline Therapeutics outside the submitted work. Dr. Gawrieh consulting: TransMedics, research grant support: Cirius, Galmed, Viking and Zydus. Dr. Roberts has nothing to disclose. Dr. Lisanti receives royalties for the book MRI: The Basics, from Wolters Kluwer. Dr. Schwope has nothing to disclose. Dr. Cebe has nothing to disclose. Dr. Paradis consulting: Servier. Dr. Bedossa reports personal fees from Genfit, Intercept Pharmaceuticals, Allergan, Inventiva Pharma, Echosens, HistoIndex, Madrigal Pharmaceuticals, Cymabay, Pfizer, Cirius Therapeutics, Histoindex and Diafir outside the submitted work. Ms. Aldridge Whitehead has nothing to disclose A. Labourdette is a full-time employee of Echosens. Dr. Miette is a full-time employee of Echosens. Dr. Neubauer is a current shareholder and previous non-executive director and consultant for Perspectum. Outside the submitted work: Research grants from Cytokinetics and Boehringer Ingelheim, consultancy from Cytokinetics, shareholder, consultant and non-executive director, Caristo Diagnostics. Dr. Fournier is a full-time employee of Echosens. Dr. Paredes has nothing to disclose. Dr. Alkhouri serves on advisory boards for Allergan, Gilead, Intercept, Pfizer, and Zydus; he serves as a speaker for AbbVie, Alexion, Gilead, Intercept, and Simply Speaking; and has received research support from Akero, Albireo, Allergan, Axcella, BI, BMS, Celgene, Gilead, Galmed, Galectin, Genfit, Enanta, Enyo, Hanmi, Inventiva, Madrigal, Merck, Novartis, Novo Nordisk, Pfizer, Poxel and Zydus. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2021 European Association for the Study of the Liver. All rights reserved.)

Background: The HCMR (Hypertrophic Cardiomyopathy Registry) is a National Heart, Lung, and Blood Institute-funded, prospective registry of 2,755 patients with hypertrophic cardiomyopathy (HCM) recruited from 44 sites in 6 countries., Objectives: The authors sought to improve risk prediction in HCM by incorporating cardiac magnetic resonance (CMR), genetic, and biomarker data., Methods: Demographic and echocardiographic data were collected. Patients underwent CMR including cine imaging, late gadolinium enhancement imaging (LGE) (replacement fibrosis), and T1 mapping for measurement of extracellular volume as a measure of interstitial fibrosis. Blood was drawn for the biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (cTnT), and genetic analysis., Results: A total of 2,755 patients were studied. Mean age was 49 ± 11 years, 71% were male, and 17% non-white. Mean ESC (European Society of Cardiology) risk score was 2.48 ± 0.56. Eighteen percent had a resting left ventricular outflow tract (LVOT) gradient ≥30 mm Hg. Thirty-six percent had a sarcomere mutation identified, and 50% had any LGE. Sarcomere mutation-positive patients were more likely to have reverse septal curvature morphology, LGE, and no significant resting LVOT obstruction. Those that were sarcomere mutation negative were more likely to have isolated basal septal hypertrophy, less LGE, and more LVOT obstruction. Interstitial fibrosis was present in segments both with and without LGE. Serum NT-proBNP and cTnT levels correlated with increasing LGE and extracellular volume in a graded fashion., Conclusions: The HCMR population has characteristics of low-risk HCM. Ninety-three percent had no or only mild functional limitation. Baseline data separated patients broadly into 2 categories. One group was sarcomere mutation positive and more likely had reverse septal curvature morphology, more fibrosis, but less resting obstruction, whereas the other was sarcomere mutation negative and more likely had isolated basal septal hypertrophy with obstruction, but less fibrosis. Further follow-up will allow better understanding of these subgroups and development of an improved risk prediction model incorporating all these markers., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)