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Abstract Background Recent studies have demonstrated the consistently high diagnostic and prognostic value of dobutamine stress cardiovascular magnetic resonance (DCMR). The value of DCMR for clinical decision making still needs to be defined. Hence, the purpose of this study was to assess the utility of DCMR regarding clinical management of patients with suspected and known coronary artery disease (CAD) in a routine setting. Methods and Results We prospectively performed a standard DCMR examination in 1532 consecutive patients with suspected and known CAD. Patients were stratified according to the results of DCMR: DCMR-positive patients were recommended to undergo invasive coronary angiography and DCMR-negative patients received optimal medical treatment. Of 609 (40%) DCMR-positive patients coronary angiography was performed in 478 (78%) within 90 days. In 409 of these patients significant coronary stenoses ≥50% were present (positive predictive value 86%). Of 923 (60%) DCMR-negative patients 833 (90%) received optimal medical therapy. During a mean follow-up period of 2.1 ± 0.8 years (median: 2.1 years, interquartile range 1.5 to 2.7 years) 8 DCMR-negative patients (0.96%) sustained a cardiac event. In 131 DCMR-positive patients who did not undergo invasive angiography, 20 patients (15%) suffered cardiac events. In 90 DCMR-negative patients (10%) invasive angiography was performed within 2 years (range 0.01 to 2.0 years) with 56 patients having coronary stenoses ≥50%. Conclusion In a routine setting DCMR proved a useful arbiter for clinical decision making and exhibited high utility for stratification and clinical management of patients with suspected and known CAD.

Abstract Background The evaluation, verification and comparison of different numerical heart models are difficult without a commonly available database that could be utilized as a reference. Our aim was to compile an exemplary dataset. Methods The following methods were employed: Magnetic Resonance Imaging (MRI) of heart and torso, Body Surface Potential Maps (BSPM) and MagnetoCardioGraphy (MCG) maps. The latter were recorded simultaneously from the same individuals a few hours after the MRI sessions. Results A training dataset is made publicly available; datasets for blind testing will remain undisclosed. Conclusions While the MRI data may provide a common input that can be applied to different numerical heart models, the verification and comparison of different models can be performed by comparing the measured biosignals with forward calculated signals from the models.

Abstract Background The purpose of this study was to determine the ability of Blood Oxygen Level Dependent (BOLD) cardiovascular magnetic resonance (CMR) to detect stress-inducible myocardial ischemic reactions in the presence of angiographically significant coronary artery disease (CAD). Methods Forty-six patients (34 men; age 65 ± 9 years,) with suspected or known coronary artery disease underwent CMR at 3Tesla prior to clinically indicated invasive coronary angiography. BOLD CMR was performed in 3 short axis slices of the heart at rest and during adenosine stress (140 μg/kg/min) followed by late gadolinium enhancement (LGE) imaging. In all 16 standard myocardial segments, T2* values were derived at rest and under adenosine stress. Quantitative coronary angiography served as the standard of reference and defined normal myocardial segments (i.e. all 16 segments in patients without any CAD), ischemic segments (i.e. supplied by a coronary artery with ≥50% luminal narrowing) and non-ischemic segments (i.e. supplied by a non-significantly stenosed coronary artery in patients with significant CAD). Results Coronary angiography demonstrated significant CAD in 23 patients. BOLD CMR at rest revealed significantly lower T2* values for ischemic segments (26.7 ± 11.6 ms) compared to normal (31.9 ± 11.9 ms; p < 0.0001) and non-ischemic segments (31.2 ± 12.2 ms; p = 0.0003). Under adenosine stress T2* values increased significantly in normal segments only (37.2 ± 14.7 ms; p < 0.0001). Conclusions Rest and stress BOLD CMR at 3Tesla proved feasible and differentiated between ischemic, non-ischemic, and normal myocardial segments in a clinical patient population. BOLD CMR during vasodilator stress identified patients with significant CAD.

Aims High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study aims to investigate incidence and predictors of thermal injuries, employing machine learning. Methods and results A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index-guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Between February 2021 and August 2023, 238 patients were enrolled, of whom 18 (7.6%; nine oesophagus, eight vagus nerve, one both) developed thermal injuries, including eight oesophageal erythemata, two ulcers, and no fistula. Higher mean force (15.8 ± 3.9 g vs. 13.6 ± 3.9 g, P = 0.022), ablation point quantity (61.50 ± 20.45 vs. 48.16 ± 19.60, P = 0.007), and total and maximum Ablation Index (24 114 ± 8765 vs. 18 894 ± 7863, P = 0.008; 499 ± 95 vs. 473 ± 44, P = 0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0 ± 1.5 mm vs. 4.4 ± 2.1 mm, P = 0.012) and smaller atrial surface areas (24.9 ± 6.5 cm2 vs. 29.5 ± 7.5 cm2, P = 0.032). Conclusion The low thermal lesion's rate (7.6%) during Ablation Index-guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety. [ABSTRACT FROM AUTHOR]

Background: In congenital heart disease (CHD) patients, detailed three-dimensional anatomy depiction plays a pivotal role for diagnosis and therapeutical decision making. Hence, the present study investigated the applicability of an advanced cardiovascular magnetic resonance (CMR) whole heart imaging approach utilizing nonselective excitation and compressed sensing for anatomical assessment and interventional guidance of CHD patients in comparison to conventional dynamic CMR angiography. Methods: 86 consecutive pediatric patients and adults with congenital heart disease (age, 1 to 74 years; mean, 35 years) underwent CMR imaging including a freebreathing, ECG-triggered 3D nonselective SSFP whole heart acquisition using compressed SENSE (nsWHcs). Anatomical assessability and signal intensity ratio (SIR) measurements were compared with conventional dynamic 3D-/4D-MR angiography. Results: The most frequent diagnoses were partial anomalous pulmonary venous drainage (17/86, 20%), transposition of the great arteries (15/86, 17%), tetralogy of Fallot (12/86, 14%), and a single ventricle (7/86, 8%). Image quality of nsWHcs was rated as excellent/good in 98% of patients. nsWHcs resulted in a reliable depiction of all large thoracic vessels (anatomic assessability, 99%–100%) and the proximal segments of coronary arteries and coronary sinus (>90%). nsWHcs achieved a homogenously distributed SIR in all cardiac cavities and thoracic vessels without a significant difference between pulmonary and systemic circulation (10.9 ± 3.5 and 10.6 ± 3.4; p = 0.15), while 3D angiography showed significantly increased SIR for targeted vs. non-targeted circulation (PA-angiography, 15.2 ± 8.1 vs. 5.8 ± 3.6, p < 0.001; PV-angiography, 7.0 ± 3.9 vs. 17.3 ± 6.8, p < 0.001). Conclusions: The proposed nsWHcs imaging approach provided a consistently high image quality and a homogeneous signal intensity distribution within the pulmonary and systemic circulation in pediatric patients and adults with a wide spectrum of congenital heart diseases. nsWHcs enabled detailed anatomical assessment and three-dimensional reconstruction of all cardiac cavities and large thoracic vessels and can be regarded particularly useful for preprocedural planning and interventional guidance in CHD patients. [ABSTRACT FROM AUTHOR]