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Introduction Increased left ventricular mass index (LVMI) is associated with mortality in end-stage renal disease. LVMI regression may improve outcomes. Allopurinol has reduced LVMI in randomized controlled trials in chronic kidney disease, diabetes, and ischemic heart disease. This study investigated whether allopurinol would regress LVMI in hemodialysis patients. Methods This was a randomized placebo-controlled double-blind multicenter trial funded by the British Heart Foundation (PG/12/72/29743). A total of 80 patients undergoing regular maintenance hemodialysis were recruited from NHS Tayside, NHS Greater Glasgow and Clyde and NHS Ayrshire and Arran in Scotland, UK. Participants were randomly assigned on a 1:1 ratio to 12 months of therapy with allopurinol 300 mg or placebo after each dialysis session. The primary outcome was change in LVMI, as assessed by cardiac magnetic resonance imaging (CMRI) at baseline and 12 months. Secondary outcomes were change in BP, flow-mediated dilation (FMD), augmentation indices (AIx), and pulse wave velocity (PWV). Results A total of 53 patients, with a mean age of 58 years, completed the study and had CMRI follow-up data for analysis. Allopurinol did not regress LVMI (change in LVMI: placebo +3.6 ± 10.4 g/m2; allopurinol: +1.6 ± 11 g/m2; P = 0.49). Allopurinol had no demonstrable effect on BP, FMD, AIx, or PWV. Conclusion Compared with placebo, treatment with allopurinol did not regress LVMI in this trial., Graphical abstract

Cardiac magnetic resonance-derived ventricular variables are predictive of mortality in pulmonary arterial hypertension. Rodent models which emphasize ventricular function, allowing serial monitoring, are needed to identify pathophysiological features and novel therapies for pulmonary arterial hypertension. We investigated longitudinal changes in the Sugen–hypoxia model during disease progression. Sprague Dawley rats ( n = 32) were divided into two groups. (1) Sugen–hypoxia: a dose of subcutaneous Sugen-5416 and placed in hypobaric hypoxia for two weeks followed by normoxia for three weeks. (2) Normoxia: maintained at normal pressure for five weeks. Rats were examined at five or eight weeks with right-heart catheter, cardiac magnetic resonance, and autopsy. Compared to normoxic controls (23.9 ± 4.1 mmHg), right ventricular systolic pressure was elevated in Sugen–hypoxia rats at five and eight weeks (40.9 ± 15.5 mmHg, p = 0.026; 48.9 ± 9.6 mmHg, p = 0.002). Right ventricular end-systolic volume index was increased in eight weeks Sugen–hypoxia (0.28 ± 0.04 µlcm –2 , p = 0.003) compared to normoxic controls (0.18 ±0.03 mlcm –2 ). There was progressive dilatation of the right ventricular at eight weeks Sugen–hypoxia compared to normoxic controls (0.75 ± 0.13 µlcm –2 vs 0.56 ± 0.1 µlcm –2 p = 0.02). Ventricle mass index by cardiac magnetic resonance at five weeks (0.34 ± 0.06, p = 0.003) and eight weeks Sugen–hypoxia (0.34 ± 0.06, p = 0.002) were higher than normoxic controls (0.21 ± 0.04). Stroke volume, right ventricular ejection fraction, and left ventricular variables were preserved in Sugen–hypoxia. Ventricular changes during the course of illness in a pulmonary arterial hypertension rodent model can be examined by cardiac magnetic resonance. These changes including right ventricular hypertrophy and subsequent dilatation are similar to those seen in pulmonary arterial hypertension patients. Despite the persisting pulmonary hypertension, there are features of adaptive cardiac remodeling through the study duration.

Objective To assess interobserver reproducibility of different regions of interest (ROIs) on multi-parametric renal MRI using commercially available software. Materials and methods Healthy volunteers (HV), patients with heart failure (HF) and renal transplant recipients (Tx) were recruited. Localiser scans, T1 mapping and pseudo-continuous arterial spin labelling (pCASL) were performed. HV and Tx also underwent diffusion-weighted imaging to allow calculation of apparent diffusion coefficient (ADC). For T1, pCASL and ADC, ROIs were drawn for whole kidney (WK), cortex (Cx), user-defined representative cortex (rep-Cx) and medulla. Intraclass correlation coefficient (ICC) and coefficient of variation (CoV) were assessed. Results Forty participants were included (10 HV, 10 HF and 20 Tx). The ICC for renal volume was 0.97 and CoV 6.5%. For T1 and ADC, WK, Cx, and rep-Cx were highly reproducible with ICC ≥ 0.76 and CoV 0.86, but CoV up to 14.2%). While reproducible, WK values were derived from a wide spread of data (ROI standard deviation 17% to 55% of the mean value for ADC and pCASL, respectively). Renal volume differed between groups (p p = 0.009) and HF (p = 0.02). Medullary T1 values were also higher in Tx than HV (p = 0.03), while medullary pCASL values were significantly lower in Tx compared to HV and HF (p = 0.03 for both). Discussion Kidney volume calculated by manually contouring a localiser scan was highly reproducible between observers and detected significant differences across patient groups. For T1, pCASL and ADC, Cx and rep-Cx ROIs are generally reproducible with advantages over WK values.

Objectives To compare body composition in PsA with metabolic disease free (MDF) controls and type 2 diabetes and assess body-composition predicted propensity for cardiometabolic disease. Methods Detailed MRI body composition profiles of 26 PsA participants from the IMAPA study were compared with 130 age, sex and BMI-matched MDF controls and 454 individuals with type 2 diabetes from UK Biobank. The body-composition predicted propensity for coronary heart disease (CHD) and type 2 diabetes was compared between PsA and matched MDF controls. Results PsA participants had a significantly greater visceral adipose tissue (VAT) volume [mean 5.89 l (s.d. 2.10 l)] compared with matched-MDF controls [mean 4.34 l (s.d. 1.83 l)] (P Conclusion Individuals with PsA have an adverse body composition phenotype with greater visceral and ectopic liver fat and lower thigh muscle volume than matched MDF controls. Body fat distribution in PsA is more in keeping with the pattern observed in type 2 diabetes and is associated with greater propensity to cardiometabolic disease. These data support the need for greater emphasis on weight loss in PsA management to lessen CHD and type 2 diabetes risk.

Background: Sodium-glucose cotransporter 2 inhibitors reduce the risk of heart failure hospitalization and cardiovascular death in patients with heart failure and reduced ejection fraction (HFrEF). However, their effects on cardiac structure and function in HFrEF are uncertain. Methods: We designed a multicenter, randomized, double-blind, placebo-controlled trial (the SUGAR-DM-HF trial [Studies of Empagliflozin and Its Cardiovascular, Renal and Metabolic Effects in Patients With Diabetes Mellitus, or Prediabetes, and Heart Failure]) to investigate the cardiac effects of empagliflozin in patients in New York Heart Association functional class II to IV with a left ventricular (LV) ejection fraction ≤40% and type 2 diabetes or prediabetes. Patients were randomly assigned 1:1 to empagliflozin 10 mg once daily or placebo, stratified by age ( Results: From April 2018 to August 2019, 105 patients were randomly assigned: mean age 68.7 (SD, 11.1) years, 77 (73.3%) male, 82 (78.1%) diabetes and 23 (21.9%) prediabetes, mean LV ejection fraction 32.5% (9.8%), and 81 (77.1%) New York Heart Association II and 24 (22.9%) New York Heart Association III. Patients received standard treatment for HFrEF. In comparison with placebo, empagliflozin reduced LV end-systolic volume index by 6.0 (95% CI, –10.8 to –1.2) mL/m 2 ( P =0.015). There was no difference in LV global longitudinal strain. Empagliflozin reduced LV end-diastolic volume index by 8.2 (95% CI, –13.7 to –2.6) mL/m 2 ( P =0.0042) and reduced N-terminal pro-B-type natriuretic peptide by 28% (2%–47%), P =0.038. There were no between-group differences in other cardiovascular magnetic resonance measures, diuretic intensification, Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, or B-lines. Conclusions: The sodium-glucose cotransporter 2 inhibitor empagliflozin reduced LV volumes in patients with HFrEF and type 2 diabetes or prediabetes. Favorable reverse LV remodeling may be a mechanism by which sodium-glucose cotransporter 2 inhibitors reduce heart failure hospitalization and mortality in HFrEF. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03485092.

Primary tumour staging in Malignant Pleural Mesothelioma (MPM) using Computed Tomography (CT) imaging is confounded by perception errors reflecting low spatial resolution between tumour and adjacent structures. Augmentation using perfusion CT is constrained by radiation dosage. In this study, we evaluated an alternative tumour staging method using perfusion-tuned Magnetic Resonance Imaging (MRI). Consecutive patients with suspected MPM were recruited to a prospective observational study. All had MRI (T1-weighted, isotropic, contrast-enhanced 3-Tesla perfusion imaging) and CT (contrast-enhanced) pre-biopsy. Patients diagnosed with MPM underwent MRI and CT volumetry, with readers blinded to clinical data. MRI volumetry was semi-automated, using signal intensity limits from perfusion studies to grow tumour regions within a pleural volume. A similar CT method was not possible, therefore all visible tumour was manually segmented. MRI and CT volumes were compared (agreement, correlation, analysis time, reproducibility) and associations with survival examined using Cox regression. 58 patients were recruited and had MRI before biopsy. 31/58 were diagnosed with MPM and these scans were used for volumetry. Mean (SD) MRI and CT volumes were 370 cm and 302 cm , respectively. MRI volumes were larger (average bias 61.9 cm (SD 116), 95 % limits (-165.5 - 289 cm ), moderately correlated with CT (r = 0.56, p = 0.002) and independently associated with survival (HR 4.03 (95 % CI 1.5-11.55), p = 0.006). CT volumes were not associated with survival, took longer to compute than MRI volumes (mean (SD) 151 (19) v 14 (2) minutes, p=

Background Vascular calcification is an independent predictor of cardiovascular disease in patients with chronic kidney disease. Computed tomography (CT) is the gold-standard for detecting vascular calcification. Radial volumetric-interpolated breath-hold examination (radial-VIBE), a free-breathing gradient-echo cardiovascular magnetic resonance (CMR) sequence, has advantages over CT as it is ionising radiation-free. However, its capability in detecting thoracic aortic calcification (TAC) has not been investigated. This study aims to compare radial-VIBE to CT for the detection of TAC in the descending aorta of patients with end-stage renal disease (ESRD) using semi-automated methods, and to investigate the association between TAC and coronary artery calcification (CAC). Methods Paired cardiac CT and radial-VIBE CMR scans from ESRD patients participating in 2 prospective studies were obtained. Calcification volume was quantified using semi-automated methods in a 9 cm segment of the thoracic aorta. Correlation and agreement between TAC volume measured on CMR and CT were assessed with Spearman’s correlation coefficient (ρ), linear regression, Bland–Altman plots and intraclass correlation coefficient (ICC). Association between CAC Agatston score and TAC volume determined by CT and CMR was measured with Spearman’s correlation coefficient. Results Scans from 96 participants were analysed. Positive correlation was found between CMR and CT calcification volume [ρ = 0.61, 95% confidence interval (CI) 0.45–0.73]. ICC for consistency was 0.537 (95% CI 0.378–0.665). Bland–Altman plot revealed that compared to CT, CMR volumes were systematically higher at low calcification volume, and lower at high calcification volume. CT did not detect calcification in 41.7% of participants, while radial-VIBE CMR detected signal which the semi-quantitative algorithm reported as calcification in all of those individuals. Instances of suboptimal radial-VIBE CMR image quality were deemed to be the major contributors to the discrepancy. Correlations between CAC Agatston score and TAC volume measured by CT and CMR were ρ = 0.404 (95% CI 0.214–0.565) and ρ = 0.211 (95% CI 0.008–0.396), respectively. Conclusion Radial-VIBE CMR can detect TAC with strong positive association to CT, albeit with the presence of proportional bias. Quantification of vascular calcification by radial-VIBE remains a promising area for future research, but improvements in image quality are necessary.

Background and Aims Existing methods of investigating renal transplant dysfunction do not provide reliable information regarding diagnosis nor prognosis. Multi-parametric magnetic resonance imaging (MRI) may provide novel biomarkers for evaluation of transplant dysfunction. We aim to determine how MRI parameters change over the first year of transplantation, and how these relate to future renal function. Method Patients receiving a kidney transplant attended for study visits at 6, 26 and 52 weeks post operatively, comprising measurement of clinical and biochemical parameters, together with research multi-parametric MRI. Imaging measurements comprised kidney volume, arterial spin labelling (ASL) perfusion, T1 relaxation time, T2*, apparent diffusion coefficient (ADC) and fractional anisotropy (FA). Imaging was performed at 3.0 Tesla using a Siemens MAGNETOM Prisma system. Regions of interest were drawn in whole kidney (WK), cortex (Cx) and medulla (Md) (figure 1). Results 20 patients were included: 16 were male, with age 55.5±12.8 years, baseline eGFR 54.0±23.6 ml/min/1.73m2, and blood pressure 146/80 ± 15/15 mmHg. 14 received deceased, and 6 received live, donor transplants. Patients were all managed with tacrolimus, mycophenolate and low dose prednisolone, following induction therapy with either basiliximab or anti-thymocyte globulin. 6 week ADC was 1.69±0.14 in WK, 1.65±0.08 in Cx, and 1.67±0.10 ×10-3 mm2/s in Md. FA was 0.19±0.04 in WK, 0.14 ± 0.04 in Cx and 0.22 ± 0.10 in Md. T2* was 57.6±9.4 in WK, 63.9±8.7 in Cx and 45.0±8.0 ms in Md. Over the 3 visits there was reduction in FA (p=0.008) and medullary T2* (p Over 1 year the median change in eGFR was -2ml/min/1.73m2. There was correlation between baseline eGFR and the following variables: volume (r=0.29, p=0.04), whole kidney ADC (r=0.36, p=0.01), cortical ADC (r=0.46, p=0.001), representative cortex ADC (r=0.48, p Conclusion Diffusion weighted MRI measurements correlate with eGFR and may allow improved prognostication regarding future renal function. Certain MRI parameters including FA and R2* vary depending on time point of transplantation which may reflect changes in transplant microstructure in the early postoperative period. Multi-parametric MRI provides a novel method of evaluating renal transplants non-invasively and may allow more accurate prediction of future transplant function than existing biochemical measures.

BackgroundRenal transplant recipients (RTRs) exhibit increased vascular stiffness and calcification; these parameters are associated with increased cardiovascular risk. Activity of endogenous calcification inhibitors such as matrix gla protein (MGP) is dependent on vitamin K. RTRs commonly have subclinical vitamin K deficiency. The Vitamin K in kidney Transplant Organ Recipients: Investigating vEssel Stiffness (ViKTORIES) study assesses whether vitamin K supplementation reduces vascular stiffness and calcification in a diverse population of RTR.Methods and analysisViKTORIES (ISRCTN22012044) is a single-centre, phase II, parallel-group, randomised, double-blind, placebo-controlled trial of the effect of vitamin K supplementation in 90 prevalent RTR. Participants are eligible if they have a functioning renal transplant for>1 year. Those on warfarin, with atrial fibrillation, estimated glomerular filtration rate 2or contraindications to MRI are excluded. Treatment is with vitamin K (menadiol diphosphate) 5 mg three times per week for 1 year or matching placebo. All participants have primary and secondary endpoint measures at 0 and 12 months. The primary endpoint is ascending aortic distensibility on cardiac MR imaging. Secondary endpoints include vascular calcification (coronary artery calcium score by CT), cardiac structure and function on MR, carotid-femoral pulse wave velocity, serum uncarboxylated MGP, transplant function, proteinuria and quality of life. The study is powered to detect 1.0×10–3mm Hg-1improvement in ascending aortic distensibility in the vitamin K group relative to placebo at 12 months. Analyses will be conducted as between-group differences at 12 months by intention to treat.DiscussionThis trial may identify a novel, inexpensive and low-risk treatment to improve surrogate markers of cardiovascular risk in RTR.

Introduction: Fibulin-3 (F3) and SOMAscan® (SS) are blood biomarkers with reported sensitivity and specificity >90% for Malignant Pleural Mesothelioma (MPM) but results are limited by inconsistent results and retrospective study design. The primary objective of DIAPHRAGM was to determine the diagnostic performance of F3 and SS in an adequately-powered, prospective study, compared to Mesothelin. Methods: DIAPHRAGM recruited an ‘intention-to-diagnose’ suspected pleural malignancy (SPM) cohort from 22 UK/Irish centres (Dec ’13 – Dec ‘16). Biomarker sampling simulated clinical use and diagnostic assessment was robust (Figure 1). Inclusion criteria were SPM (unilateral pleural effusion/mass), fit for sampling and consent. Patients with recent or in-situ chest drain were excluded. Target sample size was 600 SPM cases (including at least 120 MPM) and 109 asbestos-exposed controls (AEC). Results: 639 SPM and 109 AEC cases were recruited. 156 (24%) SPM patients had MPM, 213 (33 had secondary pleural malignancy and 241 (38%) benign disease. Final diagnoses are awaited in 5% (n=29). Biomarker assays are in progress. Complete results will be available by ERS congress. Conclusion: DIAPHRAGM was an appropriately-designed, multi-centre study that will clearly define the diagnostic performance of F3, SS and Mesothelin in MPM. A large, well-phenotyped bioresource has been created for future biomarker studies.

Highlights • A novel MRI biomarker of pleural malignancy is described – Early Contrast Enhancement. • Early Contrast Enhancement is a semi-objective, perfusion-based biomarker. • Early Contrast Enhancement can be measured in patients with minimal pleural thickening., Introduction Pleural Malignancy (PM) is often occult on subjective radiological assessment. We sought to define a novel, semi-objective Magnetic Resonance Imaging (MRI) biomarker of PM, targeted to increased tumour microvessel density (MVD) and applicable to minimal pleural thickening. Materials and methods 60 consecutive patients with suspected PM underwent contrast-enhanced 3-T MRI then pleural biopsy. In 58/60, parietal pleura signal intensity (SI) was measured in multiple regions of interest (ROI) at multiple time-points, generating ROI SI/time curves and Mean SI gradient (MSIG: SI increment/time). The diagnostic performance of Early Contrast Enhancement (ECE; which was defined as a SI peak in at least one ROI at or before 4.5 min) was compared with subjective MRI and Computed Tomography (CT) morphology results. MSIG was correlated against tumour MVD (based on Factor VIII immunostain) in 31 patients with Mesothelioma. Results 71% (41/58) patients had PM. Pleural thickening was

Purpose To assess myocardial strain using cine displacement encoding with stimulated echoes (DENSE) using 1.5T and 3.0T MRI in healthy adults. Materials and Methods Healthy adults without any history of cardiovascular disease underwent magnetic resonance imaging (MRI) at 1.5T and 3.0T within 2 days. The MRI protocol included balanced steady‐state free‐precession (b‐SSFP), 2D cine‐echo planar imaging (EPI)‐DENSE, and late gadolinium enhancement in subjects >45 years. Acquisitions were divided into six segments; global and segmental peak longitudinal and circumferential strain were derived and analyzed by field strength, age, and gender. Results In all, 89 volunteers (mean age 44.8 ± 18.0 years, range: 18–87 years) underwent MRI at 1.5T, and 88 of these subjects underwent MRI at 3.0T (1.4 ± 1.4 days between the scans). Compared with 3.0T, the magnitudes of global circumferential (–19.5 ± 2.6% vs. –18.47 ± 2.6%; P = 0.001) and longitudinal (–12.47 ± 3.2% vs. –10.53 ± 3.1%; P = 0.004) strain were greater at 1.5T. At 1.5T, longitudinal strain was greater in females than in males: –10.17 ± 3.4% vs. –13.67 ± 2.4%; P = 0.001. Similar observations occurred for circumferential strain at 1.5T (–18.72 ± 2.2% vs. –20.10 ± 2.7%; P = 0.014) and at 3.0T (–17.92 ± 1.8% vs. –19.1 ± 3.1%; P = 0.047). At 1.5T, longitudinal and circumferential strain were not associated with age after accounting for sex (longitudinal strain P = 0.178, circumferential strain P = 0.733). At 3.0T, longitudinal and circumferential strain were associated with age (P < 0.05). Longitudinal strain values were greater in the apico‐septal, basal‐lateral, and mid‐lateral segments and circumferential strain in the inferior, infero‐lateral, and antero‐lateral LV segments. Conclusion Myocardial strain parameters as revealed by cine‐DENSE at different MRI field strengths were associated with myocardial region, age, and sex. J. Magn. Reson. Imaging 2016;44:1197–1205.

Background— T2-Weighted MRI reveals myocardial edema and enables estimation of the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright-blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI. Methods and Results— A breath-hold, bright-blood T2-weighted, Acquisition for Cardiac Unified T2 Edema pulse sequence with normalization for coil sensitivity and a breath-hold T2 dark-blood short tau inversion recovery sequence were used to depict the area at risk in 54 consecutive acute MI patients. Infarct size was measured on gadolinium late contrast enhancement images. Compared with dark-blood T2-weighted MRI, consensus agreements between independent observers for identification of myocardial edema were higher with bright-blood T2-weighted MRI when evaluated per patient ( P P P P Conclusions— Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood T2-weighted MRI. Additionally, dark-blood T2-weighted MRI may underestimate area at risk and myocardial salvage.

Background In patients with myocardial infarction (MI), an important factor in determining the long-term prognosis is the degree of regional contractile dysfunction. DENSE (Displacement ENcoding with Stimulated Echoes) is a technique which allows quantification of myocardial strain[1], and which has been shown to be more sensitive to the presence of late gadolinium enhancement (LGE) than wall thickening measured from cine images[2]. The aim of this study was to further investigate the performance of DENSE for the diagnosis and assessment of myocardial infarction. Methods 50 male patients (age 56 ± 10 years) within 7 days of MI and 30 healthy male controls (age 45 ± 18 years) underwent CMR on a 1.5T Siemens Avanto. The protocol included DENSE and LGE (patients only) obtained from a single mid-ventricular short-axis slice, which was divided into 6 segments for analysis. The percentage of each segment which contained LGE was calculated using a threshold of mean+5SD of remote myocardium intensity. DENSE images were analysed to obtain a value for peak circumferential strain (Ecc). The following analyses were performed: (i) intra- and inter-operator and inter-scan repeatability, (ii) sensitivity and specificity for the detection of LGE, using a reference range established from control data, and ROC analysis and (iii) the ability to distinguish between non-infarcted, 50% infarction, and between remote, adjacent and infarcted segments. Results along with the percentages of segments correctly identified when grouped according to extent of LGE. The reference range was calculated to be (-11.8, -27.0). Inter-operator repeatability was assessed using Levene’s test (variance) and a paired t-test (mean), and no statistically significant differences were found. A paired t-test found no statistically significant difference for inter-scan repeatability. The results of (iii) are illustrated in Figure 1. Comparisons between categories were performed using a one-way ANOVA with Tukey’s post-hoc test. Conclusions DENSE can be successfully applied in a clinical setting, and provides repeatable results. The sensitivity and specificity of the technique for detecting the presence of LGE are good, and the number of segments with LGE correctly identified increases as the extent of LGE increases. Peak

Objectives This study investigated the relationship between the index of microcirculatory resistance (IMR) and myocardial salvage as determined by T2-weighted and contrast-enhanced cardiac magnetic resonance (CMR) imaging in patients undergoing primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI). Background IMR is a simple invasive measure of microvascular function available at the time of pPCI. T2-weighted non-contrast CMR can reveal myocardial oedema, and in the post-infarct population this represents the ischaemic area at risk (AAR). Contrast-enhanced CMR delineates the area of myocardial infarction. The volume of myocardium within the AAR, but not contained within the infarct area is salvaged myocardium. Methods 108 patients with STEMI underwent invasive coronary physiology measurements during pPCI and had a subsequent CMR scan at a median of 19 h post pPCI. Short axis non-contrast T2-weighted images were acquired and delayed enhancement imaging was performed following administration of intravenous gadolinium (0.1 mmol/kg). AAR was determined and myocardial salvage was calculated as AAR—infarct area. Results IMR was 29 (21), AAR 32% (13%) and myocardial salvage 6% (9%)—all mean (SD). Spearman rank correlation between IMR and AAR was 0.27 (p 0.02) and between IMR and salvage was −0.31 (p 0.01). IMR was also a multivariate predictor of AAR (p 0.01) and a negative multivariate predictor of myocardial salvage (p 0.02). Conclusions IMR measured acutely correlates with AAR and correlates negatively with myocardial salvage as determined by MRI.

Background Myocardial infarction (MI) causes contractile dysfunction in the affected tissue, which can be assessed by using DENSE (Displacement ENcoding with Stimulated Echoes) to quantify myocardial strain[1,2]. The aim of this study was to investigate changes in strain revealed by DENSE between the occurrence of MI and a 6 month follow-up, and the relationships with other clinical measures. Methods 50 male patients (age 56 ± 10 years) underwent CMR on a 1.5T Siemens Avanto within 7 days of MI, and 47 returned for a follow-up scan after 6 months. The protocol included cine, DENSE (2D) and late gadolinium enhancement (LGE) imaging. Cine images were used to assess cardiac function by calculating LV ejection fraction (LVEF) and end-systolic volume (LVESV). DENSE and LGE were compared using a single mid-ventricular short-axis slice, which was analysed both as a whole slice and after division into 6 AHA segments. The percentage of each segment which contained LGE was calculated using a threshold of mean +5SD of remote myocardium intensity. DENSE images were analysed to obtain a value for peak circumferential strain (Ecc). Segments in the baseline scans were grouped according to the extent of LGE (non-infarcted, 50% infarcted), and the change in peak Ecc between baseline and follow-up was evaluated using a oneway ANOVA with Tukey’s post-hoc test. Individual patients were compared directly, and the correlations between change in strain and (i) change in LGE (segments) and (ii) change in cardiac function (slices) were assessed. Results Diagnostic images were obtained for 50 patients at baseline, and for 43 patients at follow-up. The results of the group comparisons and the individual patient comparisons are illustrated in Figure 1 and Figure 2 respectively. Conclusions Strain recovery was disclosed by DENSE in infarcted tissue at 6 months post-MI. An increase in peak Ecc at follow-up is associated with a reduction in LGE, and improvement in

Background T2-weighted MRI reveals myocardial oedema and enables estimation of the ischaemic area-at-risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI. Methods A breath hold bright blood T2-weighted ACUTE pulse sequence with normalisation for coil sensitivity and a breath hold T2 dark blood short τ inversion recovery (STIR) sequence were used to depict the area-at-risk in 54 consecutive acute MI patients. Infarct size was measured on gadolinium late contrast enhancement images. Results Compared with dark blood T2-weighted MRI, consensus agreements between independent observers for identification of myocardial oedema were higher with bright blood T2 -weighted MRI when evaluated per patient (p Conclusion Bright blood T2-weighted MRI has higher diagnostic accuracy than dark blood T2-weighted MRI. Additionally, dark blood T2-weighted MRI may underestimate area-at-risk and myocardial salvage.