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Objective: The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients. Methods: Fifty patients aged ≥18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E’, left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI. Results: ST2 levels showed statistically significant and positive correlation with E/E’ (r = 0.837), peak TR velocity (r = 0.373), LAVI (r = 0.74), E/A (r = 0.420), and T1 values in milliseconds (r = 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r = 0.145). The median ST2 levels in patients with E/E’ > 14 and E/E’ ≤ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3). Conclusions: Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF.

Cardiovascular diseases are leading cause of death worldwide. Timely and accurate detection of disease is required to reduce load on healthcare system and number of deaths. For this, accurate and fast segmentation of Cardiac Magnetic Resonance Images is required. In this study, we propose to develop a transfer learning-based end-to-end trainable method to segment left ventricle, myocardium, and right ventricle of heart. In the presented work, Feature Pyramid Network and U-Net architecture are used where encoder is modified with networks like DenseNet, ResNet, and VGG. Performance evaluation is done using dice score, Jaccard index, and Hausdorff distance according to which U-Net with VGG encoder gives best results. The mean dice score obtained is 0.958, 0.914, and 93.4 for LV, MYO, and RV respectively. Also, Hausdorff distance for the proposed methods is 1.69, 2.28, and 1.90 for LV, MYO, and RV respectively. The p-value for the obtained results is less than 0.05 (=0.0313) which shows the statistical significance of the proposed method. This automatic end-to-end trainable computer-based method requires less time and resources while giving better results than state-of-art methods. It can save the time of medical practitioners in analyzing cardiac diseases. [ABSTRACT FROM AUTHOR]

Synchronization of human vital signs, namely the cardiac cycle and respiratory excursions, is necessary during magnetic resonance imaging of the cardiovascular system and the abdominal cavity to achieve optimal image quality with minimized artifacts. This review summarizes techniques currently available in clinical practice, as well as methods under development, outlines the benefits and disadvantages of each approach, and offers some unique solutions for consideration. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling. Method RV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax > 1 for uncoupling patients. Results Ninety patients were uncoupled (Ea/Emax: 1.55 ± 0.46) and 45 were coupled (Ea/Emax: 0.81 ± 0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV (P = 0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65 ± 63.57 vs. 154.28 ± 50.07, P = 0.001), RVESVi (121.19 ± 51.47 vs. 83.94 ± 20.43, P = 0.001), RVSVi (67.19 ± 19.87 vs. 106.31 ± 33.44, P = 0.001), and RVEF (40.90 ± 8.73 vs. 54.63 ± 4.76, P = 0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi (P =

BackgroundCurrent European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (

This study describes a pilot clinical validation of a new low-cost system for the continuous monitoring of the human body's cardiorespiratory activities within the magnetic resonance examination area. This study primarily focuses on monitoring cardiac activity and the related cardiac triggering. The patented system tested by the authors is based on seismocardiography (SCG). The study was conducted on 18 subjects on a Siemens Prisma 3T MR scanner. Standard anatomical and diffusion sequences were used to test cardiac activity monitoring. A wide range of commonly used diagnostic sequences were used to test imaging of the heart by means of cardiac triggering. System functionality was verified against a commercially available electrocardiography (ECG) system. Monitoring of cardiac activity (detection of the R-R interval in ECG and the AO-AO interval in SCG) was objectively evaluated by determining the overall probability of correct detection (ACC), sensitivity (SE), positive predictive value (PPV), and harmonic mean between SE and PPV, i.e. F1. Imaging quality control using Cardiac Triggering was performed by subjective evaluation of images by the physicians. The study conducted clearly confirmed the functionality of the system in terms of continuous cardiac activity monitoring. In all 18 subjects, a mean PPV > 99 % was achieved; F1 > 99 %; SE > 99 %; ACC > 98 %; 1.96σ

Left ventricular thrombus (LVT) has historically been reported as a complication of acute left ventricular (LV) myocardial infarction. It is most commonly observed in cases of LV systolic dysfunction attributed to ischemic or nonischemic etiologies. Conversely, the occurrence of LVT in normal LV systolic function is an exceptionally rare presentation and is predominantly associated with conditions such as hypereosinophilic syndrome (HES), cardiac amyloidosis, left ventricular noncompaction, hypertrophic cardiomyopathy (HCM), hypercoagulability states, immune-mediated disorders, and malignancies. Notably, hypereosinophilia (HE) has been linked with thrombotic events. Intracardiac thrombus is a well-known complication of eosinophilic myocarditis (EM) or Loeffler endomyocarditis, both of which are considered clinical manifestations of HES. We present a case of a 63-year-old male with normal LV systolic function, HE, and noncontributory hypercoagulability workup, who presented with thromboembolic complications arising from LVT. Interestingly, the diagnostic evaluation for EM and Loeffler endocarditis was nonconfirmatory. Additionally, we performed a literature review to delineate all similar cases. This article also outlines the pathophysiology, diagnosis, and treatment approaches for hypereosinophilic cardiac involvement with a specific focus on LVT., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khachatryan et al.)

PURPOSE: Segmentation of magnetic resonance images (MRI) of the left ventricle (LV) plays a key role in quantifying the volumetric functions of the heart, such as the area, volume, and ejection fraction. Traditionally, LV segmentation is performed manually by experienced experts, which is both time-consuming and prone to subjective bias. This study aims to develop a novel capsule-based automated segmentation method to automatically segment the LV from images obtained by cardiac MRI. METHOD: The technique applied for segmentation uses Fourier analysis and the circular Hough transform (CHT) to indicate the approximate location of the LV and a network capsule to precisely segment the LV. The neurons of the capsule network output a vector and preserve much of the information about the input by replacing the largest pooling layer with convolutional strides and dynamic routing. Finally, the segmentation result is postprocessed by threshold segmentation and morphological processing to increase the accuracy of LV segmentation. RESULTS: We fully exploit the capsule network to achieve the segmentation goal and combine LV detection and capsule concepts to complete LV segmentation. In the experiments, the tested methods achieved LV Dice scores of 0.922±0.05 end-diastolic (ED) and 0.898±0.11 end-systolic (ES) on the ACDC 2017 data set. The experimental results confirm that the algorithm can effectively perform LV segmentation from a cardiac magnetic resonance image. To verify the performance of the proposed method, visual and quantitative comparisons are also performed, which show that the proposed method exhibits improved segmentation accuracy compared with the traditional method. CONCLUSIONS: The evaluation metrics of medical image segmentation indicate that the proposed method in combination with postprocessing and feature detection effectively improves segmentation accuracy for cardiac MRI. To the best of our knowledge, this study is the first to use a deep learning model based on capsule networks to systematically evaluate end-to-end LV segmentation. [ABSTRACT FROM AUTHOR]

A dedicated, novel, multichannel transmit/receive (Tx/Rx) coil array was designed, simulated, and tested for cardiac magnetic resonance imaging (cMRI) of pigs at 7 T. The cardiac array was composed of 16 elements with physically independent anterior and posterior parts. The array was connected to the MRI scanner in the parallel transmit (pTx) mode forming an 8-channel transmit and 16-channel receive (8Tx/16Rx) coil configuration. The anterior array was composed of four central octagonal elements, which were decoupled using a common central ring (CCR) and shared decoupling capacitors. The surrounding four triangular elements were decoupled from the central four elements using gaps and capacitive decoupling. In total, the eight elements of the anterior array resembled a coil with a symmetrical circular shape. Due to the advantageous arrangement of the elements in conjunction with the novel decoupling method of a CCR, the coupling between the adjacent loop elements was minimized. The posterior array was built using a $4 \times 2$ standard rectangular, symmetric element configuration. The dedicated cardiac array was tested in phantom and in ex vivo MR measurements with a female pig of 46 kg. The dedicated coil array enhanced the signal-to-noise ratio (40 ± 27) in ex vivo measurements of the pig heart by about three times compared to a coil prototype for cardiac human imaging (11.8 ± 7). High-resolution, ex vivo cardiac images were acquired with an in-plane resolution of up to 0.3 mm $\times0.3$ mm using the dedicated pig coil array. The novel cardiac array supports parallel imaging with an acceleration factor (R) of 4 without increasing the mean $g$ -factor within the heart region beyond 1.15. [ABSTRACT FROM AUTHOR]

Purpose: Delayed enhancement imaging is an essential component of cardiac MRI, which is used widely for the evaluation of myocardial scar and viability. The selection of an optimal inversion time (TI) or null point (TINP) to suppress the background myocardial signal is required. The purpose of this study was to assess the feasibility of automated selection of TINP using a convolutional neural network (CNN). We hypothesized that a CNN may use spatial and temporal imaging characteristics from an inversion‐recovery scout to select TINP, without the aid of a human observer. Methods: We retrospectively collected 425 clinically acquired cardiac MRI exams performed at 1.5 T that included inversion‐recovery scout acquisitions. We developed a VGG19 classifier ensembled with long short‐term memory to identify the TINP. We compared the performance of the ensemble CNN in predicting TINP against ground truth, using linear regression analysis. Ground truth was defined as the expert physician annotation of the optimal TI. In a backtrack approach, saliency maps were generated to interpret the classification outcome and to increase the model's transparency. Results: Prediction of TINP from our ensemble VGG19 long short‐term memory closely matched with expert annotation (ρ = 0.88). Ninety‐four percent of the predicted TINP were within ±36 ms, and 83% were at or after expert TI selection. Conclusion: In this study, we show that a CNN is capable of automated prediction of myocardial TI from an inversion‐recovery experiment. Merging the spatial and temporal characteristics of the VGG‐19 and long short‐term‐memory CNN structures appears to be sufficient to predict myocardial TI from TI scout. [ABSTRACT FROM AUTHOR]

A simultaneous acquisition technique of image and navigator signals (simultaneously acquired navigator, SIMNAV) is proposed for cardiac magnetic resonance imaging (CMRI) in Cartesian coordinates. To simultaneously acquire both image and navigator signals, a conventional balanced steady‐state free precession (bSSFP) pulse sequence is modified by adding a radiofrequency (RF) pulse, which excites a supplementary slice for the navigator signal. Alternating phases of the RF pulses make it easy to separate the simultaneously acquired magnetic resonance data into image and navigator signals. The navigator signals of the proposed SIMNAV were compared with those of current gating devices and self‐gating techniques for seven healthy subjects. In vivo experiments demonstrated that SIMNAV could provide cardiac cine images with sufficient image quality, similar to those from electrocardiogram (ECG) gating with breath‐hold. SIMNAV can be used to acquire a cardiac cine image without requiring an ECG device and breath‐hold, whilst maintaining feasible imaging time efficiency. [ABSTRACT FROM AUTHOR]

Debate on the proper timing of pulmonary valve replacement (PVR) after repair of tetralogy of Fallot is still continuing. We aim to clarify how the different components of right ventricle (RV) changed with relieved volume overload in the remodeling process after pulmonary valve replacement and gain a clear idea of the relationship between different right ventricle components function and exercise capacity after PVR in these patients. The medical records and results of cardiac magnetic resonance imaging and cardiopulmonary exercise testing of 25 consecutive eligible patients were reviewed. End-diastolic, end-systolic, and ejection fraction (EF) were determined for the total RV and its components before and after PVR. There was a marked increase in EF for the outlet after PVR (39.5 ± 11.4 vs. 45.6 ± 12.7, P = 0.04); however, EF and volume change for the other components showed no significant difference. Peak oxygen consumption (VO) correlated better with the RV outflow tract EF than with the EF of other components of the RV or the global EF ( r = 0.382, P = 0.018), and the time interval between initial repair and PVR showed a significant correlation with peak VO ( r = −0.339, P = 0.037). Multivariate analysis showed the RV outflow tract EF to be the only independent predictor of exercise capacity ( β = 0.479; P = 0.046). The systolic function of the RV outflow tract could be a reliable determinant of intrinsic RV performance in repaired TOF (rTOF) patients and a promising parameter for deciding timing of pulmonary valve replacement so as to achieve the best possible exercise capacity in repaired TOF patients. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) are considered the first cause of mortality and the major health concern according to recent statistics worldwide. Most CVDs are preventable by early prediction and detection to avoid the risk factors. Accurate early detection can strongly lower the death rate caused by CVDs. Image processing in field of biomedical analysis plays a major role in the detection of CVDs through the cardiac segmentation. The accurate and fast segmentation of left ventricle cavity and myocardium have a major effect on the quantification and diagnosis of the cardiac function. This research paper tackles the cardiac segmentation problem and presents a hybrid random walk segmentation technique for helping cardiologists and physicians to detect CVDs early. The proposed segmentation framework utilizes the toboggan segmentation algorithm, mixes the characteristics of the high speed random walk with pre-computation model and extended random walk with prior model to improve the segmentation. To assess the achievement of the suggested cardiac segmentation technique, a course of experiments is conducted using a 3D multi-slice short axis CMR database. The performance of the proposed technique is assessed and compared with that of other medical image segmentation techniques using various performance metrics such as similarity Dice coefficient, PSNR and Hausdorff distance. Compared to the other studied techniques, the results demonstrated that, the proposed technique is a powerful and accurate methodology in delineating the Left Ventricle (LV) endocardium and epicardium for segmenting the myocardium and cavity of LV. The LV parameters are then estimated using the obtained segments. The results also demonstrated that, the proposed technique improves the segmentation time significantly. [ABSTRACT FROM AUTHOR]

We report the case of a 53-year-old woman admitted for typical chest pain and a diagnosis of Takotsubo syndrome (TTS). Initial echocardiographic presentation was characterized by apical and mid-ventricular akinesis and basal hyper-kinesis. Unexpectedly, later after admission, echocardiography showed recovered apical akinesis with an apparent 'migration' of systolic dysfunction to mid-ventricular segment and hyper-kinesis of apical and basal segments. One week after admission, left ventricular contractility completely recovered and cardiac magnetic resonance imaging did not show signs of subendocardial late-enhancement and myocardial edema. Cases of TTS may therefore occasionally rapidly 'wander' within left ventricular segments, raising doubts over the so far used classification of left ventricular patterns of ballooning in subjects with TTS (typical/atypical). Apparently, different patterns can rapidly evolve into each other. The absence of late-enhancement at cardiac magnetic resonance imaging could hypothetically identify rapidly 'wandering' cases. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). Materials and methods: Fourteen patients with coronary artery stenosis underwent rest and adenosine stress imaging by 1.5-Tesla MR Scanner and a mCT/PET 64-slice Scanner. CMRI were analyzed based on Tikhonov's procedure of deconvolution without specifying an explicit compartment model using our own software. PET images were analyzed using standard clinical software. CMRI and PET data was compared with Spearman's rho and Bland–Altman analysis. Results: CMRI results were strongly and significantly correlated with PET results for the absolute global myocardial perfusion differences (r =0.805, p =0.001) and for global myocardial perfusion reserve (MPR) (r =0.886, p <0.001). At vessel territorial level, CMRI results were also significantly correlated with absolute PET myocardial perfusion differences (r =0.737, p <0.001) and MPR (r =0.818, p <0.001). Each vessel territory had similar strong correlation for absolute myocardial perfusion differences (right coronary artery (RCA): r =0.787, p =0.001; left anterior descending artery (LAD): r =0.796, p =0.001; left circumflex artery (LCX): r =0.880, p <0.001) and for MPR (RCA: r =0.895, p <0.001; LAD: r =0.886, p <0.001; LCX: r =0.886, p <0.001). Conclusion: On a global and vessel territorial basis, CMRI-measured absolute myocardial perfusion differences and MPR were strongly and significantly correlated with the Rb-82 PET findings. [Copyright &y& Elsevier]

Objectives: The study aimed to assess the diagnostic properties of electrocardiographic (ECG) criteria for right ventricular hypertrophy (RVH) measured by cardiac magnetic resonance imaging (cMRI) in adults without clinical cardiovascular disease. Background: Current ECG criteria for RVH were based on cadaveric dissection in small studies. Methods: MESA (Multi-Ethnic Study of Atherosclerosis) performed cMRIs with complete right ventricle (RV) interpretation on 4,062 participants without clinical cardiovascular disease. Endocardial margins of the RV were manually contoured on diastolic and systolic images. The ECG screening criteria for RVH from the 2009 American Heart Association Recommendations for Standardization and Interpretation of the ECG were examined in participants with and without left ventricular (LV) hypertrophy or reduced ejection fraction. RVH was defined using sex-specific normative equations based on age, height, and weight. Results: The study sample with normal LV morphology and function (n = 3,719) was age 61.3 ± 10.0 years, 53.5% female, 39.6% Caucasian, 25.5% African American, 21.9% Hispanic, and 13.0% Asian. The mean body mass index was 27.9 ± 5.0 kg/m2. A total of 6% had RVH, which was generally mild. Traditional ECG criteria were specific (many >95%) but had low sensitivity for RVH by cMRI. The positive predictive values were not sufficiently high as to be clinically useful (maximum 12%). The results did not differ based on age, sex, race, or smoking status, or with the inclusion of participants with abnormal LV mass or function. Classification and regression tree analysis revealed that no combination of ECG variables was better than the criteria used singly. Conclusions: The recommended ECG screening criteria for RVH are not sufficiently sensitive or specific for screening for mild RVH in adults without clinical cardiovascular disease. [Copyright &y& Elsevier]

Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)-related MI (type 4a) and coronary artery bypass grafting (CABG)-related MI (type 5), which are of uncertain prognostic importance. In addition, for both the MI types, cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious consequences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than using an MI definition sensitive for small degrees of myonecrosis (the occurrence of which, based on contemporary large-scale studies, are unlikely to have important clinical consequences), it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a “clinically relevant MI.” The present document introduces a new definition for “clinically relevant MI” after coronary revascularization (PCI or CABG), which is applicable for use in clinical trials, patient care, and quality outcomes assessment. [Copyright &y& Elsevier]

Abstract: Segmentation of cardiac magnetic resonance imaging is considered an important application in clinical practice. An automatic algorithm is proposed for segmentation of both endocardial and epicardial boundaries, in long-axis views. The data consisted of 126 patients, yielding 1008 traces. Estimated clinical parameters were highly correlated to gold standard measurements. The error between the automatic tracing and the gold standard was not significantly different than the error between two manual observers. In conclusion, a tool for segmenting the myocardial boundaries in the long-axis views is proposed, which works well, as demonstrated by the validation performed using a clinical dataset. [Copyright &y& Elsevier]

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Background: Heart failure after myocardial infarction (MI) is a result of increased myocardial workload, adverse left ventricular (LV) geometric remodeling, and less efficient LV fluid movement. In this study we utilize cardiac magnetic resonance imaging to evaluate ventricular function and flow after placement of a novel directed epicardial assist device. Methods: Five swine underwent posterolateral MI and were allowed to remodel for 12 weeks. An inflatable bladder was positioned centrally within the infarct and secured with mesh. The device was connected to an external gas exchange pump, which inflated and deflated in synchrony with the cardiac cycle. Animals then underwent cardiac magnetic resonance imaging during active epicardial assistance and with no assistance. Results: Active epicardial assistance of the infarct showed immediate improvement in LV function and intraventricular flow. Ejection fraction significantly improved from 26.0% ± 4.9% to 37.3% ± 4.5% (p < 0.01). End-systolic volume (85.5 ± 12.7 mL versus 70.1 ± 11.9 mL, p < 0.01) and stroke volume (28.5 ± 4.4 mL versus 39.9 ± 3.1 mL, p = 0.03) were also improved with assistance. End-diastolic volume and regurgitant fraction did not change with treatment. Regional LV flow improved both qualitatively and quantitatively during assistance. Unassisted infarct regional flow showed highly discoordinate blood movement with very slow egress from the posterolateral wall. Large areas of stagnant flow were also identified. With assistance, posterolateral wall blood velocities improved significantly during both systole (26.4% ± 3.2% versus 12.6% ± 1.2% maximum velocity; p < 0.001) and diastole (54.3% ± 9.3% versus 24.2% ± 2.5% maximum velocity; p < 0.01). Conclusions: Directed epicardial assistance can improve LV function and flow in ischemic cardiomyopathy. This novel device may provide a valuable alternative to currently available heart failure therapies. [Copyright &y& Elsevier]

Myocarditis is being increasingly reported as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccines. We herein report a case of myocarditis following COVID-19 mRNA vaccination in a man. Cardiac magnetic resonance imaging (CMRI) revealed an area of high signal intensity on short T1 inversion recovery (STIR) and late gadolinium enhancement (LGE), which are characteristic of myocarditis. Follow-up CMRI performed six months later revealed improvement in the myocardial edema and LGE findings. CMRI is a useful non-invasive imaging modality for making an initial diagnosis as well as for follow-up in cases of myocarditis after COVID-19 mRNA vaccination.

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Purpose: Segmenting the cardiac ventricles in magnetic resonance (MR) images is required for cardiac function assessment. Numerous segmentation methods have been developed and applied to MR ventriculography. Quantitative validation of these segmentation methods with ground truth is needed prior to clinical use, but requires manual delineation of hundreds of images. We applied a well-established method to this problem and rigorously validated the results. Methods: An automatic method based on active contours without edges was used for left and the right ventricle cavity segmentation. A large database of 1,920 MR images obtained from 59 patients who gave informed consent was evaluated. Two standard metrics were used for quantitative error measurement. Results: Segmentation results are comparable to previously reported values in the literature. Since different points in the cardiac cycle and different slice levels were used in this study, a detailed error analysis is possible. Better performance was obtained at end diastole than at end systole, and on mid-ventricular slices than apical slices. Localization of segmentation errors were highlighted through a study of their spatial distribution. Conclusions: Ventricular segmentation based on region-driven active contours provided satisfactory results in MRI, without the use of a priori knowledge. The study of error distribution allows identification of potential improvements in algorithm performance. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Derivation of diagnostically relevant parameters from first-pass myocardial perfusion magnetic resonance images involves the tedious and time-consuming manual segmentation of the myocardium in a large number of images. To reduce the manual interaction and expedite the perfusion analysis, we propose an automatic registration and segmentation method for the derivation of perfusion linked parameters. Materials and Methods: A complete automation was accomplished by first registering misaligned images using a method based on independent component analysis, and then using the registered data to automatically segment the myocardium with active appearance models. We used 18 perfusion studies (100 images per study) for validation in which the automatically obtained (AO) contours were compared with expert drawn contours on the basis of point-to-curve error, Dice index, and relative perfusion upslope in the myocardium. Results: Visual inspection revealed successful segmentation in 15 out of 18 studies. Comparison of the AO contours with expert drawn contours yielded 2.23 ± 0.53 mm and 0.91 ± 0.02 as point-to-curve error and Dice index, respectively. The average difference between manually and automatically obtained relative upslope parameters was found to be statistically insignificant (P = .37). Moreover, the analysis time per slice was reduced from 20 minutes (manual) to 1.5 minutes (automatic). Conclusion: We proposed an automatic method that significantly reduced the time required for analysis of first-pass cardiac magnetic resonance perfusion images. The robustness and accuracy of the proposed method were demonstrated by the high spatial correspondence and statistically insignificant difference in perfusion parameters, when AO contours were compared with expert drawn contours. [ABSTRACT FROM AUTHOR]

Background: The impact of genetic syndromes on cardiac magnetic resonance imaging (cMRI) parameters, particularly on right and/or left ventricular dysfunction, associated with clinical parameters following the repair of Tetralogy of Fallot (rToF) is not well known. Therefore, this study aimed to assess the differences in clinical, surgical, and cMRI data in syndromic and non-syndromic rToF patients. Methods: All syndromic rToF patients undergoing a cMRI without general anesthesia between 2010 and 2020 who were able to match with non-syndromic ones for birth date, sex, type of surgery, timing of cMRI, and BSA were selected. Demographic, clinical, surgical, MRI, ECG, and Holter ECG data were collected. Results: A total of one hundred and eight rToF patients equally subdivided into syndromic and non-syndromic, aged 18.7 ± 7.3 years, were studied. Del22q11.2 and Down syndrome (DS) were the most frequent syndromes (42.6% and 31.5%, respectively). Regarding the cMRI parameters considered, left ventricular (LV) dysfunction (LVEF < 50%) was more frequently found in syndromic patients (p = 0.040). In addition, they were older at repair (p = 0.002) but underwent earlier pulmonary valve replacement (PVR) (15.9 ± 5.6 vs. 19.5 ± 6.0 years, p = 0.049). On multivariate Cox regression analysis, adjusted for age at first repair, LV dysfunction remained significantly more associated with DS than del22q11.2 and non-syndromic patients (HR of 5.245; 95% CI 1.709–16.100, p = 0.004). There were only four episodes of non-sustained ventricular tachycardia in our cohort. Conclusions: Among the cMRI parameters commonly taken into consideration in rToF patients, LV dysfunction seemed to be the only one affected by the presence of a genetic syndrome. The percentage of patients performing PVR appears to be similar in both populations, although syndromic patients were older at repair and younger at PVR. Finally, the number of arrhythmic events in rToF patients seems to be low and unaffected by chromosomal abnormalities. [ABSTRACT FROM AUTHOR]

Objectives: We sought to validate high-resolution transthoracic real-time (RT) three-dimensional echocardiography (3DE), in combination with a novel semi-automatic contour detection algorithm, for the assessment of left ventricular (LV) volumes and function in patients. Background: Quantitative RT-3DE has been limited by impaired image quality and time-consuming manual data analysis. Methods: Twenty-four subjects with abnormal (n = 14) or normal (n = 10) LVs were investigated. The results for end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) obtained by manual tracing were compared with the results determined by the semi-automatic border detection algorithm. Moreover, the results of the semi-automatic method were compared with volumes and EF obtained by cardiac magnetic resonance imaging (CMRI). Results: Excellent correlation coefficients (r = 0.98 to 0.99) and low variability (EDV -1.3 +/- 8.6 ml; ESV -0.2 +/- 5.4 ml; EF -0.1 +/- 2.7%; p = NS) were observed between the semi-automatically and manually assessed data. The RT-3DE data correlated highly with CMRI (r = 0.98). However, LV volumes were underestimated by RT-3DE compared with CMRI (EDV -13.6 +/- 18.9 ml, p = 0.002; ESV -12.8 +/- 20.5 ml, p = 0.005). The difference for EF was not significant between the two methods (EF 0.9 +/- 4.4%, p = NS). Observer variability was acceptable, and repeatability of the method was excellent. Conclusions: The RT-3DE, in combination with a semi-automatic contour tracing algorithm, allows accurate determination of cardiac volumes and function compared with both manual tracing and CMRI. High repeatability suggests applicability of the method for the serial follow-up of patients with cardiac disease. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients., Methods: Fifty patients aged ≥18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E', left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI., Results: ST2 levels showed statistically significant and positive correlation with E/E' (r = 0.837), peak TR velocity (r = 0.373), LAVI (r = 0.74), E/A (r = 0.420), and T1 values in milliseconds (r = 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r = 0.145). The median ST2 levels in patients with E/E' > 14 and E/E' ≤ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3)., Conclusions: Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF., Competing Interests: Declaration of competing interest Dr. Vivek Agrawal, Dr. Suhas Hardas, Dr. Hasmukh Gujar and Dr. Deepak Phalgune declare that they have no conflict of interest. The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work., (Copyright © 2022 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Background: Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality)., Methods: Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan-Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed., Results: In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age ( p < 0.01) and RVEF ( p < 0.01) but not RA area were independent predictors of 1-year mortality., Conclusion: This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Alandejani, Hameed, Tubman, Alabed, Shahin, Lewis, Dwivedi, Mahmood, Middleton, Watson, Alkhanfar, Johns, Rajaram, Garg, Condliffe, Elliot, Thompson, Rothman, Charalampopoulos, Lawrie, Wild, Swift and Kiely.)

Purpose: Cardiac magnetic resonance imaging (CMRI) is a novel non-invasive modality with many potential indications, and was recently introduced in Lebanon. We sought to assess the appropriateness and diagnostic yield of CMR studies performed at a tertiary referral center from the Middle East since the inception of the program., Methods: All patients who underwent CMR studies between January 1(st) 2013 and June 18(th) 2014 were enrolled in this study. CMR reports were retrospectively reviewed. The study indication, clinical history, and findings were extracted and analyzed. The appropriateness of the study was judged according to the 2010 updated Asian Society of Cardiac Imaging guidelines., Results: There were a total of 142 patients [mean age 42.1 (SD: 18) years, 24.6% females] that underwent CMR study. Two-thirds of studies were performed on an outpatient basis, and outside referrals constituted 16.2% of the entire cohort. The cardiologists referred 122 cases (86%) with main contribution from electrophysiology and imaging specialists. Of the 142 cases, 12 (8.4%) were not indicated and added little value. Of the remaining 130 appropriate studies (appropriateness level A8-A9), one-third had an incorrect diagnosis prior to CMR, and 8% had relevant findings that were missed on other studies but captured by CMR. Furthermore, CMR confirmed the diagnosis in 28% of the cases, provided relevant information on scar burden, shunt quantification, and ruled out infiltrative disease in the remaining patients. Also, CMR demonstrated the presence of scar in 45 of patients, among whom 20 (44%) had significant scar volume quantification (>5% of left ventricular myocardium). Finally, 9% of patients had a relevant extra-cardiac finding that needed further investigation., Conclusions: Despite the recent launch of the CMR program at our institution, the majority of studies were appropriately indicated, provided relevant data and were clinically useful. Inappropriate or uncertain studies did not provide relevant data, and should be further minimized to avoid unnecessary costs and downstream testing. Large prospective CMR database with clinical follow-up is needed to provide more insight about cardiovascular disease and outcomes in our population.