Applications Of Cardiovascular Magnetic Resonance Research Articles

Early diagnosis and prognosis of MINOCA by CMR

Cardiovascular disease is a prevalent health concern in contemporary society. Numerous studies have indicated that certain individuals with myocardial infarction may not obtain symptoms of coronary obstruction in coronary angiography. As a result, there is a growing interest in exploring the evaluation of myocardial infarction with non-obstructive coronary arteries (MINOCA). This article focuses on the application of cardiovascular magnetic resonance (CMR) in the diagnosis and prognosis of MINOCA. In conjunction with the pathological characteristics of MINOCA and the imaging principles underlying CMR technology, this article investigates the role of CMR in the clinical practice of MINOCA. CMR is a valuable technique employed for studying multiple aspects of the heart, including morphology, function, organization and perfusion. By applying diverse parameters and sequences, this non-invasive imaging method emerges as an essential tool for clinical diagnosis and prognosis of various cardiovascular diseases. MINOCA is characterized by insufficient blood supply to the coronary arteries or direct myocardium dysfunction with non-ST-segment elevation and normal or less than 50% stenosis in angiography. The aetiology of MINOCA encompasses a wide range of factors, while the application of CMR shows ability to enhance the diagnostic sensitivity of MINOCA, enabling better identification of the underlying cause of the symptoms and facilitating a personalized prognosis for patients.

Current use of cardiac MRI in animals

Cardiovascular magnetic resonance (CMR) imaging has evolved to become an indispensable tool in human cardiology. It is a non-invasive technique that enables objective assessment of myocardial function, size, and tissue composition. Recent innovations in magnetic resonance imaging scanner technology and parallel imaging techniques have facilitated the generation of parametric mapping to explore tissue characteristics, and the emergence of strain imaging has enabled cardiologists to evaluate cardiac function beyond conventional metrics. As veterinary cardiology continues to utilize CMR beyond the reference standard, clinical application of CMR will further expand our capabilities. This article describes the current use of CMR and adoption of more recent advances such as T1/T2 mapping in veterinary cardiology.

Cardiovascular magnetic resonance imaging for sequential assessment of cardiac fibrosis in mice: technical advancements and reverse translation.

Cardiovascular magnetic resonance (CMR) imaging has become an essential technique for the assessment of cardiac function and morphology, and is now routinely used to monitor disease progression and intervention efficacy in the clinic. Cardiac fibrosis is a common characteristic of numerous cardiovascular diseases and often precedes cardiac dysfunction and heart failure. Hence, the detection of cardiac fibrosis is important for both early diagnosis and the provision of guidance for interventions/therapies. Experimental mouse models with genetically and/or surgically induced disease have been widely used to understand mechanisms underlying cardiac fibrosis and to assess new treatment strategies. Improving the appropriate applications of CMR to mouse studies of cardiac fibrosis has the potential to generate new knowledge, and more accurately examine the safety and efficacy of antifibrotic therapies. In this review, we provide 1) a brief overview of different types of cardiac fibrosis, 2) general background on magnetic resonance imaging (MRI), 3) a summary of different CMR techniques used in mice for the assessment of cardiac fibrosis including experimental and technical considerations (contrast agents and pulse sequences), and 4) provide an overview of mouse studies that have serially monitored cardiac fibrosis during disease progression and/or therapeutic interventions. Clinically established CMR protocols have advanced mouse CMR for the detection of cardiac fibrosis, and there is hope that discovery studies in mice will identify new antifibrotic therapies for patients, highlighting the value of both reverse translation and bench-to-bedside research.

Qualitative and Quantitative Stress Perfusion Cardiac Magnetic Resonance in Clinical Practice: A Comprehensive Review.

Stress cardiovascular magnetic resonance (CMR) imaging is a well-validated non-invasive stress test to diagnose significant coronary artery disease (CAD), with higher diagnostic accuracy than other common functional imaging modalities. One-stop assessment of myocardial ischemia, cardiac function, and myocardial viability qualitatively and quantitatively has been proven to be a cost-effective method in clinical practice for CAD evaluation. Beyond diagnosis, stress CMR also provides prognostic information and guides coronary revascularisation. In addition to CAD, there is a large body of literature demonstrating CMR's diagnostic performance and prognostic value in other common cardiovascular diseases (CVDs), especially coronary microvascular dysfunction (CMD). This review focuses on the clinical applications of stress CMR, including stress CMR scanning methods, practical interpretation of stress CMR images, and clinical utility of stress CMR in a setting of CVDs with possible myocardial ischemia.

Cardiovascular magnetic resonance in clinical practice: who, when and why?

Cardiovascular magnetic resonance (CMR) is an imaging modality with growing indications in cardiology. The purpose of this article is to illustrate the current clinical applications of CMR across the spectrum of ischemic heart disease, non-ischemic cardiomyopathies, cardiac arrhythmias and valvular or vascular heart disease. The strengths of CMR lie in its ability to comprehensively image, without the need for ionizing radiation, cardiac and vascular anatomy, function, perfusion, viability and physiology, providing a powerful non-invasive tool for patient diagnosis and prognostication.

Role of Cardiovascular Magnetic Resonance in the Management of Atrial Fibrillation: A Review.

Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is growing with time. Since the introduction of catheter ablation procedures for the treatment of AF, cardiovascular magnetic resonance (CMR) has had an increasingly important role for the treatment of this pathology both in clinical practice and as a research tool to provide insight into the arrhythmic substrate. The most common applications of CMR for AF catheter ablation are the angiographic study of the pulmonary veins, the sizing of the left atrium (LA), and the evaluation of the left atrial appendage (LAA) for stroke risk assessment. Moreover, CMR may provide useful information about esophageal anatomical relationship to LA to prevent thermal injuries during ablation procedures. The use of late gadolinium enhancement (LGE) imaging allows to evaluate the burden of atrial fibrosis before the ablation procedure and to assess procedural induced scarring. Recently, the possibility to assess atrial function, strain, and the burden of cardiac adipose tissue with CMR has provided more elements for risk stratification and clinical decision making in the setting of catheter ablation planning of AF. The purpose of this review is to provide a comprehensive overview of the potential applications of CMR in the workup of ablation procedures for atrial fibrillation.

A deep learning approach to real-time volumetric measurements without image reconstruction for cardiovascular magnetic resonance

Objective. Cardiovascular magnetic resonance (CMR) can measure ventricular volumes for the quantitative assessment of cardiac function in clinical cardiology. Conventionally, CMR volumetric measurements require image reconstruction and segmentation. There are limited clinical applications of real-time CMR for volumetric measurements because real-time images cannot provide sufficient quality for accurate segmentation. The presented work aims to develop a new deep learning approach to measuring ventricular volumes without image reconstruction and demonstrate that this ‘imageless’ approach would improve volumetric measurements with real-time CMR. Approach. We have developed a deep learning model for measuring ventricular volumes directly from real-time CMR raw data without image reconstruction. This novel ‘imageless’ deep learning model, not being as sensitive to image quality, provided reliable volumetric measurements for real-time CMR. To demonstrate ‘imageless’ volumetric measurements, we conducted a real-time CMR study with healthy volunteers. Several performance metrics, including mean absolute error (MAE), the Pearson correlation coefficient, and Bland–Altman analysis, were used to evaluate the proposed ‘imageless’ deep learning model in reference to U-net and fully convolutional neural network (FCNN) models based on conventional image reconstruction and segmentation. Main results. With the same raw data, the ‘imageless’ deep learning model gave a lower MAE (‘imageless’ ≤9.6 ml; ‘image-based’ ≥12.1 ml), a higher correlation coefficient (‘imageless’ ≥0.75; ‘image-based’ ≤0.51) and smaller measurement difference ranges in Bland–Altman analysis (‘imageless’ ≤23.1 ml; ‘image-based’ ≥33.8 ml). To achieve comparable performance, the ‘imageless’ deep learning model needed 2/3 of the raw data used in image reconstruction for U-net and FCNN models, indicating there was a gain in imaging acceleration for real-time CMR. Significance. We have demonstrated a novel deep learning framework that can provide reliable volumetric measurements from real-time CMR raw data without image reconstruction. This ‘imageless’ approach to real-time volumetric measurements will improve the quantitative assessment of cardiac function in clinical cardiology.

Detection of myocardial fibrosis: Where we stand.

Myocardial fibrosis, resulting from the disturbance of extracellular matrix homeostasis in response to different insults, is a common and important pathological remodeling process that is associated with adverse clinical outcomes, including arrhythmia, heart failure, or even sudden cardiac death. Over the past decades, multiple non-invasive detection methods have been developed. Laboratory biomarkers can aid in both detection and risk stratification by reflecting cellular and even molecular changes in fibrotic processes, yet more evidence that validates their detection accuracy is still warranted. Different non-invasive imaging techniques have been demonstrated to not only detect myocardial fibrosis but also provide information on prognosis and management. Cardiovascular magnetic resonance (CMR) is considered as the gold standard imaging technique to non-invasively identify and quantify myocardial fibrosis with its natural ability for tissue characterization. This review summarizes the current understanding of the non-invasive detection methods of myocardial fibrosis, with the focus on different techniques and clinical applications of CMR.

Myocardial extracellular volume assessed by cardiovascular magnetic resonance may predict adverse left ventricular remodeling in rheumatic heart disease after valvular surgery.

Only a few studies to date have focused on the application of cardiovascular magnetic resonance (CMR) in rheumatic heart disease (RHD); in particular, research on the application of T1-mapping CMR sequences is limited. This study aimed to investigate whether diffuse myocardial fibrosis evaluated using preoperative T1 mapping and extracellular volume (ECV) fraction measurement could predict the progression of adverse left ventricular remodeling (LVR) after surgery. A total of 32 adult patients with RHD and 30 healthy controls were recruited. Baseline clinical characteristics, CMR findings, and T1 mapping measurements were compared between the two groups. Transthoracic echocardiography measurements were collected before and after surgery. Patients with an increase in left ventricular end-diastolic volume of >15% or a decrease in left ventricular ejection fraction of >10% were classified into the adverse remodeling group; otherwise, patients were categorized into the non-adverse remodeling group. Compared with the healthy controls, patients with RHD had impaired biventricular function, enlarged ventricular volume, and increased native T1 and ECV values. Patients in the adverse remodeling group had higher ECV values than those in the non-adverse remodeling group (33.25%±3.67% vs. 28.45%±4.46%, P=0.002). Binary logistic regression analysis showed that the ECV value was associated with adverse LVR (odds ratio: 1.273, P=0.045). ECV was found to be a sensitive biomarker for predicting adverse LVR (area under the curve: 0.78; sensitivity: 75.0%; specificity: 77.3%). ECV has potential value for predicting the progression of adverse LVR and for identifying non-responders among patients with RHD undergoing surgery.

Cardiovascular Magnetic Resonance in Cardiomyopathy

Cardiomyopathies are defined as “myocardial disorders in which the heart muscle is structurally and functionally abnormal, in the absence of attributable coronary artery disease, hypertension, heart valve or congenital heart disease”. This is an aetiologically and clinically diverse group of conditions, sharing important characteristics such as risk of sudden cardiac death (SCD) and possible heritable nature. Accurate phenotyping is key to the diagnosis and management for both probands and their relatives. Cardiovascular magnetic resonance (CMR) is central in this process, offering comprehensive multi-parametric assessment, enabling not only accurate phenotyping, but also identifying prognostic risk markers. We review the key aspects of CMR technique and the diagnostic and risk stratification applications of CMR in cardiomyopathy.

Role of cardiovascular magnetic resonance in pediatric pulmonary hypertension-novel concepts and imaging biomarkers.

Pulmonary hypertension (PH) in children is a heterogenous disease of the small pulmonary arteries characterized by a progressive increase in pulmonary vascular resistance. Despite adequate medical therapy, long-term pressure overload is frequently associated with a progressive course leading to right ventricular failure and ultimately death. Invasive hemodynamic assessment by cardiac catheterization is crucial for initial diagnosis, risk stratification and therapeutic strategy. Although echocardiography remains the most important imaging modality for the assessment of right ventricular function and pulmonary hemodynamics, cardiovascular magnetic resonance (CMR) has emerged as a valuable non-invasive imaging technique that enables comprehensive evaluation of biventricular performance, blood flow, morphology and the myocardial tissue. In this review, we summarize the principles and applications of CMR in the evaluation of pediatric PH patients and present an update about novel CMR based concepts and imaging biomarkers that may provide further diagnostic, therapeutic and prognostic information.

Appropriate use criteria for cardiovascular MRI: SIC - SIRM position paper Part 2 (myocarditis, pericardial disease, cardiomyopathies and valvular heart disease).

Cardiovascular magnetic resonance (CMR) has emerged as an accurate diagnostic technique for the evaluation of patients with cardiac disease in the majority of clinical settings, thanks to an established additional diagnostic and prognostic value. This document has been developed by a joined group of experts of the Italian Society of Cardiology (SIC) and Italian Society of Radiology (SIRM) to provide a summary about the current state of technology and clinical applications of CMR, to improve the clinical diagnostic pathways and to promote its inclusion in clinical practice. The writing committee consisted of members and experts of both societies in order to develop a more integrated approach in the field of cardiac imaging. This section 2 will cover myocarditis, pericardial disease, cardiomyopathies and valvular heart disease.

Role of cardiovascular magnetic resonance imaging in cardio-oncology.

Advances in cancer therapy have led to significantly longer cancer-free survival times over the last 40 years. Improved survivorship coupled with increasing recognition of an expanding range of adverse cardiovascular effects of many established and novel cancer therapies has highlighted the impact of cardiovascular disease in this population. This has led to the emergence of dedicated cardio-oncology services that can provide pre-treatment risk stratification, surveillance, diagnosis, and monitoring of cardiotoxicity during cancer therapies, and late effects screening following completion of treatment. Cardiovascular imaging and the development of imaging biomarkers that can accurately and reliably detect pre-clinical disease and enhance our understanding of the underlying pathophysiology of cancer treatment-related cardiotoxicity are becoming increasingly important. Multi-parametric cardiovascular magnetic resonance (CMR) is able to assess cardiac structure, function, and provide myocardial tissue characterization, and hence can be used to address a variety of important clinical questions in the emerging field of cardio-oncology. In this review, we discuss the current and potential future applications of CMR in the investigation and management of cancer patients.

The role of cardiac magnetic resonance imaging in the detection and monitoring of cardiotoxicity in patients with breast cancer after treatment: a comprehensive review.

The use of chemotherapy medicines for breast cancer (BC) has been associated with an increased risk of cardiotoxicity. In recent years, there have been growing interests regarding the application of cardiovascular magnetic resonance (CMR) imaging, a safe and noninvasive modality, with the potential to identify subtle morphological and functional changes in the myocardium. In this investigation, we aimed to review the performance of various CMR methods in diagnosing cardiotoxicity in BC, induced by chemotherapy or radiotherapy. For this purpose, we reviewed the literature available in PubMed, MEDLINE, Cochrane, Google Scholar, and Scopus databases. Our literature review showed that CMR is a valuable modality for identifying and predicting subclinical cardiotoxicity induced by chemotherapy. The novel T1, T2, and extracellular volume mapping techniques may provide critical information about cardiotoxicity, in addition to other CMR features such as functional and structural changes. However, further research is needed to verify the exact role of these methods in identifying cardiotoxicity and patient management. Since multiple studies have reported the improvement of left ventricular performance following the termination of chemotherapy regimens, CMR remains an essential imaging tool for the prediction of cardiotoxicity and, consequently, decreases the mortality rate of BC due to heart failure.

Myocardial Involvement in Rheumatic Disorders.

Autoimmune rheumatic diseases (ARDs) affect 8% of the population and approximately 78% of patients are women. Myocardial disease in ARDs is the endpoint of various pathophysiologic mechanisms including atherosclerosis, valvular disease, systemic, myocardial, and/or vascular inflammation, as well as myocardial ischemia and replacement/diffuse fibrosis. The increased risk of CVD in ARDs leads to excess comorbidity not fully explained by traditional cardiovascular risk factors. It seems that the chronic inflammatory status typically seen in ARDs, promotes both the development of myocardial inflammation/fibrosis and the acceleration of atherosclerosis. CMR (cardio-vascular magnetic resonance) is the ideal imaging modality for the evaluation of cardiac involvement in patients with ARDs, as it can simultaneously assess cardiac function and characterize myocardial tissues with regard to oedema and fibrosis. Due to its high spatial resolution, CMR is capable of identifying various disease entities such as myocardial oedema /inflammation, subendocardial vasculitis and myocardial fibrosis, that are often missed by other imaging modalities, notably at an early stage of development. Although generally accepted guidelines about the application of CMR in ARDs have not yet been formulated, according to our experience and the available published literature, we recommend CMR in ARD patientS with new-onset heart failure (HF), arrhythmia, for treatment evaluation/change or if there is any mismatch between patient symptoms and routine non-invasive evaluation.

Cardiac Magnetic Resonance in Nonischemic Cardiomyopathies

Cardiovascular magnetic resonance (CMR) has emerged as a key modality to assess nonischemic cardiomyopathies. Its ability to detect cardiac morphology and function with fast cine imaging, myocardial edema with T2-based techniques, and fibrosis with late gadolinium enhancement techniques has enabled noninvasive characterization of cardiac tissue, thus helping clinicians assess cardiovascular risk and determine the most effective management strategy. Active investigations into parametric imaging techniques will further expand the potential clinical applications of CMR for cardiac tissue characterization. This review discusses the use of CMR techniques in characterizing the major morphofunctional phenotypes of nonischemic cardiomyopathies.

Cardiovascular magnetic resonance imaging for structural heart disease.

Cardiovascular magnetic resonance (CMR) has increasingly become a powerful imaging technique over the past few decades due to increasing knowledge about clinical applications, operator experience and technological advances, including the introduction of high field strength magnets, leading to improved signal-to-noise ratio. Its success is attributed to the free choice of imaging planes, the wide variety of imaging techniques, and the lack of harmful radiation. Developments in CMR have led to the accurate evaluation of cardiac structure, function and tissues characterisation, so this non-invasive technique has become a powerful tool for a broad range of cardiac pathologies. This review will provide an introduction of magnetic resonance imaging (MRI) physics, an overview of the current techniques and clinical application of CMR in structural heart disease, and illustrated examples of its use in clinical practice.

Myocardial fibrosis: why image, how to image and clinical implications

### Learning objectives The current era has seen major advances in myocardial imaging. We are now able to assess cardiac anatomy, function, tissue composition and disease activity across a wide...

Update on the application of cardiovascular magnetic resonance in the diagnosis of hypertrophic cardiomyopathy

肥厚型心肌病是常见的遗传性心脏病之一，15年来肥厚型心肌病的影像学特征、遗传因素、临床病程和治疗都取得了长足的进步。其中心血管磁共振多参数多序列成像可为临床提供丰富的诊疗信息，成为了肥厚型心肌病患者基线及随访的重要辅助检查，本文就此做一论述。.

Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices.

Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for imaging myocardial viability. An important application of LGE CMR is the assessment of the location and extent of the myocardial scar in patients with ventricular tachycardia (VT), which allows for more accurate identification of the ablation targets. However, a large percentage of patients with VT have cardiac implantable electronic devices (CIEDs), which is a relative contraindication for cardiac magnetic resonance imaging due to safety and image artifact concerns. Previous studies showed that these patients can be safely scanned on 1.5 T scanners provided that an adequate imaging protocol is adopted. Nevertheless, imaging patients with a CIED result in metal artifacts due to the strong frequency off-resonance effects near the device; therefore, the spins in the surrounding myocardium are not completely inverted, and thus give rise to hyperintensity artifacts. These artifacts obscure the myocardial scar tissue and limit the ability to study the correlation between the myocardial scar structure and the electro-anatomical map during catheter ablation. In this study, we developed a modified inversion recovery technique to alleviate the CIED-induced metal artifacts and improve the diagnostic image quality of LGE images in patients with CIEDs without increasing scan time or requiring additional hardware. The developed technique was tested in phantom experiments and in vivo scans, which showed its capability for suppressing the hyperintensity artifacts without compromising myocardium nulling in the resulting LGE images.