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View classification is a key step toward building a fully automated system for interpretation of echocardiograms. However, compared with adult echocardiograms, creating a view classification model for pediatric echocardiograms poses additional challenges, such as greater variation in anatomy, structure size, and views. The aim of this study was to develop a computer vision model to autonomously perform view classification on pediatric echocardiographic images.Using a training set of 12,067 echocardiographic images from patients aged 0 to 19 years, a convolutional neural network model was trained to identify 27 preselected standard pediatric echocardiographic views which included anatomic sweeps, color Doppler, and Doppler tracings. A validation set of 6,197 images was used for parameter tuning and model selection. A test set of 9,684 images from 100 different patients was then used to evaluate model accuracy. The model was also evaluated on a per study basis using a second test set consisting of 524 echocardiograms from children with leukemia to identify six preselected views pertinent to cardiac dysfunction surveillance.The model identified the 27 preselected views with 90.3% accuracy. Accuracy was similar across age groups (89.3% for 0-4 years, 90.8% for 4-9 years, 90.0% for 9-14 years, and 91.2% for 14-19 years; P = .12). Examining the view subtypes, accuracy was 78.3% for the cine one location, 90.5% for sweeps with color Doppler, 82.2% for sweeps without color Doppler, and 91.1% for Doppler tracings. Among the leukemia cohort, the model identified the six preselected views on a per study basis with a positive predictive value of 98.7% to 99.2% and sensitivity of 76.9% to 94.8%.A convolutional neural network model was constructed for view classification of pediatric echocardiograms that was accurate across the spectrum of ages and view types. This work lays the foundation for automated quantitative analysis and diagnostic support to promote efficient, accurate, and scalable analysis of pediatric echocardiograms.

Background The Long-ter M O U tcomes after the Multisystem Inflammatory S yndrome I n C hildren (MUSIC) study aims to characterize the frequency and time course of acute and long-term cardiac and non-cardiac sequelae in multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C), which are currently poorly understood. Methods This multicenter observational cohort study will enroll at least 600 patients Conclusion The MUSIC study, with the largest cohort of MIS-C patients and the longest follow-up period to date, will make an important contribution to our understanding of the acute cardiac and non-cardiac manifestations of MIS-C and the long-term effects of this public health emergency.

PURPOSE CPMG spin echo acquisitions are attractive for diagnosing and monitoring liver iron concentration in iron overload disorders due to their time efficiency and potential to reveal unique information about tissue iron distribution. Clinical adoption remains low due to the insensitivity of CPMG-based R2 estimates to liver iron concentration (LIC) when common fitting techniques are applied. In this work, we demonstrate that the inclusion of a proton density estimator (PDE) derived from the CPMG acquisition increase the sensitivity of CPMG R2 estimates to LIC in both simulated and in-vivo human data. THEORY AND METHODS CPMG R2 acquisitions from 50 clinically indicated MRI studies in patients with iron overload were analyzed with and without PDE constraints. Liver regions of interest were fit to monoexpontial and nonexponential signal decay equations. LIC by R2∗ served as the reference standard. The observed calibration between CPMG R2 values and LIC were compared to results predicted from a previously validated Monte Carlo model. RESULTS The sensitivity of CPMG-derived R2 triples when a proton density constraint is applied. When compared with R2∗ -LIC estimates, both monoexponential and nonexponential models were unbiased but demonstrated broad 95% confidence intervals particularly for LIC values below 12 mg/g. Absolute error did not increase with LIC. CONCLUSION A proton density constraint can increase the sensitivity of CPMG-based models to iron. CPMG acquisitions are time-efficient and could potentially improve the dynamic range of single spin echo techniques as well as providing insight into tissue iron distribution.

BACKGROUND Several clinical and cardiac magnetic resonance (CMR)-derived parameters have been shown to be associated with death or heart transplant late after the Fontan operation.OBJECTIVES The objective of this study was to identify the relative importance and interactions of clinical and CMR-based parameters for risk stratification after the Fontan operation.METHODS Fontan patients were retrospectively reviewed. Clinical and CMR parameters were analyzed using univariable Cox regression. The primary endpoint was time to death or (listing for) heart transplant. To identify the patients at highest risk for the endpoint, classification and regression tree survival analysis was performed, including all significant variables from Cox regression.RESULTS The cohort consisted of 416 patients (62% male) with a median age of 16 years (25th, 75th percentiles: 11, 23 years). Over a median follow-up of 5.4 years (25th, 75th percentiles: 2.4, 10.0 years) after CMR, 57 patients (14%) reached the endpoint (46 deaths, 7 heart transplants, 4 heart transplant listings). Lower total indexed end-diastolic volume (EDVi) was the strongest predictor of transplant-free survival. Among patients with dilated ventricles (EDVi >= 156 ml/BSA(1.3)), worse global circumferential strain (GCS) was the next most important predictor (73% vs. 44%). In patients with smaller ventricles (EDVi = II was the next most important predictor (30% vs. 4%).CONCLUSIONS In this cohort of patients late after Fontan operation, increased ventricular dilation was the strongest independent predictor of death or transplant (listing). Patients with both ventricular dilation and worse GCS were at highest risk. These data highlight the value of integrating CMR and clinical parameters for risk stratification in this population. (C) 2021 by the American College of Cardiology Foundation.

Background In repaired tetralogy of Fallot (rTOF), abnormal left ventricular (LV) rotational mechanics are associated with adverse clinical outcomes. We performed a comprehensive analysis of LV rotational mechanics in rTOF patients using cardiac magnetic resonance (CMR) prior to and following surgical pulmonary valve replacement (PVR). Methods In this single center retrospective study, we identified rTOF patients who (1) had both a CMR ≤ 1 year before PVR and ≤ 5 years after PVR, (2) had no other intervening procedure between CMRs, (3) had a body surface area > 1.0 m2 at CMR, and (4) had images suitable for feature tracking analysis. These subjects were matched to healthy age- and sex-matched control subjects. CMR feature tracking analysis was performed on a ventricular short-axis stack of balanced steady-state free precession images. Measurements included LV basal and apical rotation, twist, torsion, peak systolic rates of rotation and torsion, and timing of events. Associations with LV torsion were assessed. Results A total of 60 rTOF patients (23.6 ± 7.9 years, 52% male) and 30 healthy control subjects (20.8 ± 3.1 years, 50% male) were included. Compared with healthy controls, rTOF patients had lower apical and basal rotation, twist, torsion, and systolic rotation rates, and these parameters peaked earlier in systole. The only parameters that were correlated with LV torsion were right ventricular (RV) end-systolic volume (r = − 0.28, p = 0.029) and RV ejection fraction (r = 0.26, p = 0.044). At a median of 1.0 year (IQR 0.5–1.7) following PVR, there was no significant change in LV rotational parameters versus pre-PVR despite reductions in RV volumes, RV mass, pulmonary regurgitation, and RV outflow tract obstruction. Conclusion In this comprehensive study of CMR-derived LV rotational mechanics in rTOF patients, rotation, twist, and torsion were diminished compared to controls and did not improve at a median of 1 year after PVR despite favorable RV remodeling.

Increasing the physical activity (PA) levels of inactive older adults to promote healthy aging and to reduce preventable health conditions is a public health priority. However, there remains uncertainty on what constitutes the most important components and characteristics of effective PA interventions for older adults, and previous research has largely focused on the cognitive and behavioral strategies they adopt to increase uptake and adherence to PA. This narrative review puts forward the novel idea, with supporting evidence, that the strength, quality, and collaborative nature of the professional–client relationship, a concept drawn from the field of psychotherapy and known as therapeutic alliance, may be a vital and foundational element of effective PA interventions. This article will offer a new understanding, and a new direction of research to aid the future conceptualization, design, and development of interventions that aim to increase the PA levels of older adults.

Strain values vary with age in children and are both vendor- and platform-specific. Philips QLab 10.8 and Tomtec AutoStrain are two widely-utilized strain analysis platforms, and both incorporate recent EACVI-ASE-Industry Strain Standardization Task Force guidelines. We sought to establish normal strain values and Z-scores for both platforms using a large dataset of healthy children and to compare values among these two platforms and a previous version-QLab 10.5-which predated the Task Force guidelines.Echocardiograms from 1,032 subjects21 years old with structurally and functionally normal hearts were included. Images were obtained on the Philips EPIQ platform. Left ventricular (LV) and right ventricular (RV) strain were analyzed using QLab 10.8 and AutoStrain and measurement reliability was assessed. Z-score equations were derived as a function of age for QLab 10.8 (LV longitudinal and circumferential strain) and AutoStrain (LV and RV longitudinal strain). A subset (n=309) was analyzed by QLab 10.5. Strain values were compared among the three platforms.For both of the newer platforms, strain varied with age, with magnitude reaching a maximum at 4-5 years. For LV longitudinal strain, the largest differences in value were observed in the youngest patients when using QLab 10.5; the other two platforms were similar. LV circumferential strain measurements (QLab 10.5 vs 10.8) were different for all ages, as were measurements of RV longitudinal strain (QLab 10.8 vs AutoStrain). Reliability was greater for AutoStrain than for QLab 10.8, and greater for LV than for RV strain.We generated normal RV and LV strain values and Z-scores from a large cohort of children for two commonly-utilized platforms in pediatric echocardiography laboratories. Following incorporation of Task Force guidelines, the greatest improvement in standardization was seen in infants. Small differences persist between modern platforms; however, these results support the cautious consideration of comparing inter-platform measurements.

Introduction: A fully automated artificial intelligence driven pipeline to perform cardiac structural and functional measurements and disease detection requires accurate identification of individual echocardiographic views. However, there are no view classification algorithms for pediatric echocardiograms where there is a broader range in body size, anatomy, view types, and sweep length than in adult studies. Hypothesis: To develop and test a machine learning model to automatically perform view classification on individual pediatric echocardiogram images. Methods: Using a derivation dataset of 12,067 echocardiogram cine and still images from patients 0 to 19 years of age, a convolutional neural network (CNN) model was trained and evaluated for the automated identification of 28 pre-selected standard pediatric echocardiogram views that included anatomic sweeps, color Doppler, and Doppler tracings. The model was validated using an additional 6,197 images and trained for 150 epochs. Classification accuracy was evaluated using a test dataset composed of 9,684 images obtained from 100 different patients equally distributed across the age range. The model was subsequently deployed on studies of 524 children with leukemia to identify 6 pre-selected views pertinent to left ventricular function. Results: The model identified the 28 preselected views with 90% accuracy. Accuracy was comparable across age groups (89% for 0-4 yr, 91% for 4-9 yr, 90% for 9-14 yr, and 91% for 14-19 yr). Accuracy was 91% for the sweeps with color Doppler, 83% for sweeps without color Doppler, and 91% for Doppler tracings. Among the leukemia cohort, the model identified the 6 preselected views on a per study basis with a positive predictive value of 99% and an accuracy of 81-97%. A second pass of the model with a threshold prioritizing sensitivity achieved 100% detection of the missing views. Conclusions: We constructed a CNN model for view classification of pediatric echocardiograms that was accurate across the age spectrum and for cine images, anatomic sweeps, color Doppler images, and Doppler traces. This model lays the groundwork for automated quantitative analysis and diagnostic support to promote more efficient, accurate, and scalable analysis of pediatric echocardiograms.

Background Cross-sectional studies have reported that ventricular dilation and dysfunction are associated with adverse clinical outcome in Fontan patients; however, longitudinal changes and their relationship with outcome are not known. Methods This was a single-center retrospective analysis of Fontan patients with at least 2 cardiovascular magnetic resonance (CMR) scans without intervening interventions. Serial measures of end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), indexed mass (massi), mass-to-volume ratio, and end-systolic wall stress (ESWS) were used to estimate within-patient change over time. Changes were compared for those with and without a composite outcome (death, heart transplant, or transplant listing) as well as between patients with left (LV) and right ventricular (RV) dominance. Results Data from 156 patients were analyzed with a mean age at 1st CMR of 17.8 ± 9.6 years. 490 CMRs were included with median of 3 CMRs/patient (range 2–9). On regression analysis with mixed effects models, volumes and ESWS increased, while mass, mass-to-volume ratio, and EF decreased over time. With a median follow-up of 10.2 years, 14% met the composite outcome. Those with the composite outcome had a greater increase in EDVI compared to those without (4.7 vs. 0.8 ml/BSA1.3/year). Compared with LV dominance, RV dominance was associated with a greater increase in ESVI (1.4 vs. 0.5 ml/BSA1.3/year), a greater decrease in EF (− 0.61%/year vs. − 0.24%/year), and a higher rate of the composite outcome (21% vs. 8%). Conclusions Ventricles in the Fontan circulation exhibit a steady decline in performance with an increase in EDVI, ESVI, and ESWS, and decrease in EF, mass index, and mass-to-volume ratio. Those with death or need for heart transplantation have a faster increase in EDVI. Patients with rapid increase in EDVI (> 5 ml/BSA1.3/year) may be at a higher risk of adverse outcomes and may benefit from closer surveillance. RV dominance is associated with worse clinical outcomes and remodeling compared to LV dominance.

Long-term development finance provided by Multilateral Development Banks (MDBs) is key to advancing the United Nations 2015 Sustainable Development Goals. However, MDBs are constrained in their lending by the availability of capital. This paper argues that Risk Transfer, as a complement to equity injections, could permit higher MDB lending by attracting a broader class of investors. We describe selected examples of actual Risk Transfer transactions and provide estimates of the potential expansion in lending these techniques could yield. But we also identify obstacles that limit investors willingness and ability to participate in these transactions. Therefore, we recommend an agenda for international policymakers to open the way for the wider use of Risk Transfer. Still, we recognize this will be a gradual process which cannot substitute for MDB expansion through additional ordinary capital resources.

Objectives: There is uncertainty around the most effective characteristics and components of interventions to increase older adults’ physical activity (PA) levels. This study aimed to explore how LiveWell Dorset (LWD), a lifestyle behaviour change support service based in Dorset, South-West England, influences older adults’ PA behaviour. Study Design: A qualitative study using a generic approach. Methods: Semi-structured telephone interviews were held with 12 individuals aged 55 to 65 who had accessed LWD’s support to increase their PA levels, to gather their views and experiences of the service. A thematic analysis of the interview data was conducted using a hybrid approach that incorporated both inductive and deductive processes. Additionally, interview content was coded for behaviour change techniques using the Behaviour Change Technique Taxonomy version 1. Results: A number of key factors were identified that highlighted how the LWD service influences older adults’ PA behaviour. These included using a broad range of promotional and behaviour change strategies to facilitate initial engagement, providing opportunities for service users to receive social support from both professionals and peers, and emphasising person-centredness and empathy in interactions with service users. Conclusions: The findings provide valuable information regarding the needs and preferences of older adults when attempting to influence their PA behaviour, and on the reportedly helpful components of interventions that aim to do so. The findings also support the need for future research into previously highlighted topics of interest such as the roles of systemic and contextual factors and professional empathy on PA intervention engagement and outcomes. https://www.sciencedirect.com/science/article/pii/S2666535221000896?via%3Dihub

Importance The BNT162b2 (Pfizer-BioNTech) messenger RNA COVID-19 vaccine was authorized on May 10, 2021, for emergency use in children aged 12 years and older. Initial reports showed that the vaccine was well tolerated without serious adverse events; however, cases of myocarditis have been reported since approval. Objective To review results of comprehensive cardiac imaging in children with myocarditis after COVID-19 vaccine. Design, setting, and participants This study was a case series of children younger than 19 years hospitalized with myocarditis within 30 days of BNT162b2 messenger RNA COVID-19 vaccine. The setting was a single-center pediatric referral facility, and admissions occurred between May 1 and July 15, 2021. Main outcomes and measures All patients underwent cardiac evaluation including an electrocardiogram, echocardiogram, and cardiac magnetic resonance imaging. Results Fifteen patients (14 male patients [93%]; median age, 15 years [range, 12-18 years]) were hospitalized for management of myocarditis after receiving the BNT162b2 (Pfizer) vaccine. Symptoms started 1 to 6 days after receipt of the vaccine and included chest pain in 15 patients (100%), fever in 10 patients (67%), myalgia in 8 patients (53%), and headache in 6 patients (40%). Troponin levels were elevated in all patients at admission (median, 0.25 ng/mL [range, 0.08-3.15 ng/mL]) and peaked 0.1 to 2.3 days after admission. By echocardiographic examination, decreased left ventricular (LV) ejection fraction (EF) was present in 3 patients (20%), and abnormal global longitudinal or circumferential strain was present in 5 patients (33%). No patient had a pericardial effusion. Cardiac magnetic resonance imaging findings were consistent with myocarditis in 13 patients (87%) including late gadolinium enhancement in 12 patients (80%), regional hyperintensity on T2-weighted imaging in 2 patients (13%), elevated extracellular volume fraction in 3 patients (20%), and elevated LV global native T1 in 2 patients (20%). No patient required intensive care unit admission, and median hospital length of stay was 2 days (range 1-5). At follow-up 1 to 13 days after hospital discharge, 11 patients (73%) had resolution of symptoms. One patient (7%) had persistent borderline low LV systolic function on echocardiogram (EF 54%). Troponin levels remained mildly elevated in 3 patients (20%). One patient (7%) had nonsustained ventricular tachycardia on ambulatory monitor. Conclusions and relevance In this small case series study, myocarditis was diagnosed in children after COVID-19 vaccination, most commonly in boys after the second dose. In this case series, in short-term follow-up, patients were mildly affected. The long-term risks associated with postvaccination myocarditis remain unknown. Larger studies with longer follow-up are needed to inform recommendations for COVID-19 vaccination in this population.

To develop and validate a new myocardial TPrior studies have shown that myocardial TIn the phantom study, MOSHA was as accurate as SASHA (P-value = 0.88) and as precise as MOLLI (P-value = 0.59). Similar trends were observed in the patient study. Compared to SASHA, MOSHA accuracy was comparable for blood pre-contrast (P-value≥0.10) and post-contrast (P-value≥0.70), and for myocardium pre-contrast (P-value = 0.70) and post-contrast (P-value = 0.09). Compared to MOLLI, MOSHA precision was lower for blood pre-contrast (P-value0.01) and higher for blood post-contrast (P-value≤0.01), and comparable for myocardium pre-contrast (P-value = 0.24) and post-contrast (P-value = 0.07). Synthetic Extracellular volume fraction (ECV) calculated by MOSHA was more precise than those of SASHA and MOLLI (P-value≤0.01).In phantom studies and patients, MOSHA has comparable accuracy as SASHA and nearly similar precision as MOLLI for T

Several circulating biomarkers have been found to play a role in the surveillance and risk stratification of heart failure without congenital heart disease, but these have not been widely studied in patients with single ventricles palliated with a Fontan operation. Imaging predictors of worse outcomes in this population include ventricular dilation and dysfunction. Patients who weighed30 kg with a Fontan circulation referred for cardiac magnetic resonance imaging were invited to participate in the study. Blood and urine samples were obtained at the time of imaging and multiple conventional and novel biomarkers were measured. A total of 82 patients with a median age of 18 years were enrolled. Among the novel biomarkers, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T had the strongest correlation with ventricular dilation and dysfunction. NT-ProBNP100 pg/ml has a sensitivity of 91% for the detection of significant ventricular dilation (end-diastolic volume120 ml/body surface area

BACKGROUND: Arrhythmogenic cardiomyopathy (ACM) is a variably penetrant disease increasingly identified in young patients. OBJECTIVES: This study sought to describe the diverse phenotype, genotype, and outcomes in pediatric and adolescent patients. METHODS: Records from 1999 to 2016 were reviewed for individuals age

Purpose: Current cardiovascular magnetic resonance (CMR) examinations require expert planning, multiple breath holds, and 2D imaging. To address this, we sought to develop and validate a comprehensive free -breathing 3D cine function and flow CMR examination using a steady-state free precession (SSFP) sequence to depict anatomy fused with a spatially registered phase contrast (PC) sequence for blood flow analysis.Methods: In a prospective study, 25 patients underwent a CMR examination which included a 3D cine SSFP sequence and a 3D cine PC (also known as 4D flow) sequence acquired during free-breathing and after the administration of a gadolinium-based contrast agent. Both 3D sequences covered the heart and mediastinum, and used retrospective vectorcardiogram gating (20 phases/beat interpolated to 30 phases/beat) and prospective respiratory motion compensation confining data acquisition to end-expiration. Cardiovascular measurements derived from the 3D cine SSFP and PC images were then compared with those from standard 2D imaging.Results: All 3D cine SSFP and PC acquisitions were completed successfully. The mean time for the 3D cine sequences including prescription was shorter than that for the corresponding 2D sequences (21 min vs. 36 min, P-value < 0.001). Left and right ventricular end-diastolic volumes and stroke volumes by 3D cine SSFP were slightly smaller than those from 2D cine SSFP (all biases

Introduction: The American Heart Association (AHA) guidelines recommend testing for inducible myocardial ischemia in all patients with a history of coronary artery aneurysm (CAA) after Kawasaki disease (KD). Because the prevalence of clinical coronary complications is exceedingly low in patients whose worst-ever CAA dimension was Methods: Retrospective study including patients Results: A total of 588 stress tests were performed in 208 patients at median age of 12.4 [IQR 8.8, 16.8] years, 8.3 [IQR 5.0, 12.9] years after diagnosis (Table). Tests were performed using either exercise stress (545 [93%] tests) or pharmacologic stress with dobutamine (43 [7%] tests). Echocardiography was the most frequently used modality (n=481, 82%), followed by nuclear imaging (n=133, 23%) and cardiac MRI (n=53, 9%). Inducible ischemia was found on 11 (2%) tests in 6 (3%) patients. All patients with inducible ischemia had a history of giant CAA with persistent CAA at time of testing (moderate CAA in 2 (18%) tests, giant CAA in 9 (82%) tests). After finding inducible ischemia on stress test, coronary artery bypass grafting was performed in 3 cases, cardiac catheterization in 4, stress testing using a different imaging modality in 1, and careful clinical monitoring without intervention in 3. Conclusions: Inducible ischemia was found in 2% of test after KD, and only in patients with a history of giant CAA. Recommendations in the 2017 AHA guidelines for KD for testing for myocardial ischemia in patients with non-giant CAA should be reconsidered in light of these findings.

The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided. ispartof: JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE vol:22 issue:1 ispartof: location:England status: published

Cardiovascular magnetic resonance (CMR) is an integral part of the evaluation and management of patients with cardiovascular disease. As a result, the interest in this modality among scientific and clinical communities continues to grow, as evidenced by a record number of attendees at the 23rd Society for Cardiovascular Magnetic Resonance (SCMR) Annual Scientific Sessions. More than 1,440 delegates from around the world experienced the meeting in Orlando, Florida, USA from February 12–15, 2020 (Fig. 1). Two thirds of attendees were from North America and a fifth from Europe. Cardiologists constituted the most prevalent professional designation which is a testament to the important role of CMR in routine clinical cardiology practice and cardiology research. The theme of the meeting was entitled, “Transforming Cardiovascular Care Through Discoveries in Imaging” (Fig. 2). A total of 112 sessions spanned the spectrum from technical developments to basic discoveries, clinical science and advocacy. The meeting was preceded by a joint workshop together with the International Society for Magnetic Resonance in Medicine (ISMRM) and several preconference courses, including a general overview of CMR techniques and applications for physicians, a course around pediatric and congenital heart disease, and a review of the fundamentals of cardiology. The theme of the SCMR/ISMRM workshop was “CMR 4.0: Autonomous and Efficient Cardiovascular Magnetic Resonance Imaging”. This 1.5 day event focused on the topics of ‘efficient and effective CMR’, ‘autonomous scanning and quantification’, ‘hardware innovations’, as well as ‘artificial intelligence (AI)’ and ‘big data’. A complete course on interventional CMR was also offered. Fifty-seven abstract and didactic sessions during the main meeting highlighted recent CMR technical and clinical developments as well as scientific discoveries. These ranged from improving quantitative precision for diagnosis of cardiovascular disease in an individual patient to identifying methods of using CMR to improve outcomes. Within this context, sessions showcased work from around the world using CMR in congenital heart disease, ischemic and non-ischemic heart disease, valvular disease, electrophysiology, systemic inflammation, cardio-oncology, heart failure, and vascular pathology. This report highlights a few of the contributions in the areas of ‘Innovative Clinical Applications of CMR’, ‘Clinical and Translational Science’, and ‘Basic Science & Technical Developments’. Table ​Table11 lists the scientistis, clinicians, and abstracts that were specifically recognized during the meeting. Open in a separate window Fig. 5 Drs. Nivedita Naresh (a) and Allan Bradley (b), winners of the 2020 SCMR Seed Grant Awards

Theory suggests both resilience and fragility in banking networks. This paper finds both, exploiting a new database of cross-border syndicated lending to developing countries from 1993 to 2017. Shocks propagate via co-lenders driven by central players, but shocks impacting fringe banks have little impact. The global financial crisis and the appearance of South-South lenders prompted a decline in network centrality, suggesting greater resilience to normal shocks. Multilateral Development Banks may play a catalytic role, but their small size limits their ability to mitigate shock propagation. The ongoing Covid-19 crisis is not a normal shock, is hitting central players and will likely provoke significant contagion.

The aim of this document is to provide general guidance and specific recommendations on the practice of cardiovascular magnetic resonance (CMR) in the era of the COVID-19 pandemic. There are two major considerations. First, continued urgent and semi-urgent care for the patients who have no known active COVID-19 should be provided in a safe manner for both patients and staff. Second, when necessary, CMR on patients with confirmed or suspected active COVID-19 should focus on the specific clinical question with an emphasis on myocardial function and tissue characterization while optimizing patient and staff safety.

Myocardial dysfunction has been implicated in gradual heart failure in transposition of the great arteries (TGA) with a systemic right ventricle (RV). Fibrosis can be assessed using the extracellular volume fraction (ECV). Our aim was to measure ECV and determine its associations with clinical findings and outcomes.We prospectively measured ECV in systemic RV subjects (either D-loop after atrial switch or L-loop) and healthy controls. TIn 53 TGA subjects (age 34.6 ± 10.3 years, 41% female) the mean ECV for the systemic RV (28.7 ± 4.4%) was significantly higher than the left ventricle in 22 controls (26.1 ± 2.8%, P = 0.0104). Those with an elevated ECV (n = 15, 28.3%) had a higher b-type natriuretic peptide (BNP) (P 0.011) and a longer 6-min walk distance (P = 0.021), but did not differ by age, arrhythmia history, ventricular volume, function, or circulating collagen byproducts. At follow-up (median 4.4 years), those experiencing major cardiovascular endpoints (new arrhythmia, arrhythmia device, heart failure hospitalization, listing for transplantation, mechanical support, or cardiovascular death, n = 14) had a higher ECV. ECV, age, and BNP were independent predictors of cardiac events in Cox-proportional hazard models.Myocardial fibrosis is common in the systemic RV and associated with a higher BNP. Elevated CMR-derived ECV was associated with adverse clinical outcome. The findings suggest a role of diffuse myocardial fibrosis in clinical deterioration of the systemic RV.