X-ray Coronary Angiography Research Articles

Mono-Energy Coronary Angiography with a Compact Synchrotron Source

X-ray coronary angiography is an invaluable tool for the diagnosis of coronary artery disease. However, the use of iodine-based contrast media can be contraindicated for patients who present with chronic renal insufficiency or with severe iodine allergy. These patients could benefit from a reduced contrast agent concentration, possibly achieved through application of a mono-energetic x-ray beam. While large-scale synchrotrons are impractical for daily clinical use, the technology of compact synchrotron sources strongly advanced during the last decade. Here we present a quantitative analysis of the benefits a compact synchrotron source can offer in coronary angiography. Simulated projection data from quasi-mono-energetic and conventional x-ray tube spectra is used for a CNR comparison. Results show that compact synchrotron spectra would allow for a significant reduction of contrast media. Experimentally, we demonstrate the feasibility of coronary angiography at the Munich Compact Light Source, the first commercial installation of a compact synchrotron source.

Diagnostic performance of image navigated coronary CMR angiography in patients with coronary artery disease

BackgroundThe use of coronary MR angiography (CMRA) in patients with coronary artery disease (CAD) remains limited due to the long scan times, unpredictable and often non-diagnostic image quality secondary to respiratory motion artifacts. The purpose of this study was to evaluate CMRA with image-based respiratory navigation (iNAV CMRA) and compare it to gold standard invasive x-ray coronary angiography in patients with CAD.MethodsConsecutive patients referred for CMR assessment were included to undergo iNAV CMRA on a 1.5 T scanner. Coronary vessel sharpness and a visual score were assigned to the coronary arteries. A diagnostic reading was performed on the iNAV CMRA data, where a lumen narrowing >50% was considered diseased. This was compared to invasive x-ray findings.ResultsImage-navigated CMRA was performed in 31 patients (77% male, 56 ± 14 years). The iNAV CMRA scan time was 7 min:21 s ± 0 min:28 s. Out of a possible 279 coronary segments, 26 segments were excluded from analysis due to stents or diameter less than 1.5 mm, resulting in a total of 253 coronary segments. Diagnostic image quality was obtained for 98% of proximal coronary segments, 94% of middle segments, and 91% of distal coronary segments. The sensitivity and specificity was 86% and 83% per patient, 80% and 92% per vessel and 73% and 95% per segment.ConclusionIn this study, iNAV CMRA offered a very good diagnostic performance when compared against invasive x-ray angiography. Due to the short and predictable scan time it can add clinical value as a part of a comprehensive CAD assessment protocol.

TCT-11 Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve from Diagnostic Coronary X-ray Angiography in the International Multicenter FAVOR (Functional Assessment by Various FlOw Reconstructions) Pilot Study

TCT-11 Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve from Diagnostic Coronary X-ray Angiography in the International Multicenter FAVOR (Functional Assessment by Various FlOw Reconstructions) Pilot Study

Extracting contrast-filled vessels in X-ray angiography by graduated RPCA with motion coherency constraint

X-ray coronary angiography can provide rich dynamic information of cardiac and vascular function. Extracting contrast-filled vessel from the complex dynamic background (caused by the movement of diaphragm, lung, bones, etc.) in X-ray coronary angiograms has great clinical significance in assisting myocardial perfusion evaluation, reconstructing vessel structures for diagnosis and treatment of heart disease. Considering the angiography image sequence is a sum of a low-rank background matrix and a sparse flowing contrast agent matrix, we propose a novel graduated robust principal component analysis (RPCA) with spatio-temporal motion coherency constraint to accurately extract contrast-filled vessel from the X-ray coronary angiograms: (1) We first use a statistically structured RPCA with complex noise model exploiting the complex structural connectivity of vessel regions to identify all candidate foreground contrast-filled vessels; (2) To eliminate the background remained in the candidates, we further introduce trajectory decomposition on the candidate foregrounds to accurately extract contrast-filled vessels using motion coherency regularized RPCA, which imposes total variation minimization on the foreground trajectories to model the spatio-temporal contiguity and smoothness of the foreground trajectories. The graduated RPCA with motion coherency constraint shows to consistently outperform other state-of-the-art methods, in particular on real-world X-ray coronary angiograms that contain a significant amount of complex dynamic background motion. Experimental results on twelve sequences of real X-ray coronary angiograms are evaluated using both qualitative and quantitative methods to demonstrate the obvious advantages of our method over the state-of-the-art alternatives.

A Case of Cardiac Amyloidosis With Dilated Left Ventricular Chamber and Improvement of Electrocardiogram After Standard Heart Failure Treatment

A 40-years-old man presented with orthopnea, lower limb edema and exertional dyspnea, markedly worsening over last 1 month. He was diagnosed as severe heart failure (NYHA4) and admitted to our hospital in April 2016. An electrocardiogram showed low QRS voltage in the limb leads and poor R progression in the precordial leads (V1-4). Prominent left ventricular (LV) dilation with diffuse LV hypokinesis (LVDd/Ds 68.5/64.2 mm), severe impairment of LV systolic function (LVEF 14%) and left atrium dilatation (55.3 mm) were revealed by echocardiography. Thickness of interventricular septum was 12.3 mm in diastole, without “granular sparkling sign”. Immediately after the admission, medical therapies with intravenous dobutamine, carperitide, furosemide were initiated. His body weight was decreased to 61 kg (−20.4 kg), serum BNP concentration was improved from 1970 pg/dl to 26 pg/dl. On X-ray coronary angiography, there was no significant coronary arterial stenosis. Both myocardial biopsy and subcutaneous fat biopsy demonstrated amyloid deposition, diagnosing him as having AL cardiac amyloidosis. Interestingly, after medical treatment, low QRS voltage were disappeared in limb leads, and the range of QS pattern in the precordial leads became small (only in V1-2). We've reported a case of cardiac amyloidosis with dilated LV chamber and significant improvement of low QRS voltage in limb lead after standard medical therapy.

Higher CHADS2 score is associated with impaired coronary flow reserve: A study using phase contrast cine magnetic resonance imaging

BackgroundThe presence of coronary microvascular dysfunction (CMD) is an important prognostic marker for coronary artery disease (CAD) patients. The purpose of this study was to investigate whether the CHADS2 score is associated with CMD evaluated by magnetic resonance imaging (MRI). Materials and methodsOne hundred forty three patients with known or suspected CAD (mean age 70.3±9.5years) were enrolled. All patients did not have any significant coronary stenosis on X-ray coronary angiography (CAG) at the time of MRI acquisition. By using a 1.5T MRI scanner, breath-hold phase contrast cine MRI images of coronary sinus (CS) were obtained to assess the blood flow of CS both at rest and during adenosine triphosphate (ATP) infusion. Coronary flow reserve (CFR) was calculated as CS blood flow during ATP infusion divided by CS blood flow at rest. CMD was defined as CFR<2.5 according to a previous study. Patients were allocated to four groups based on the CHADS2 score (group1: CHADS2 score=0, group2: CHADS2 score=1; group3: CHADS2 score=2, and group4: CHADS2 score≥3). ResultsMean CFR was 2.81±0.95 (77.6±32.7mL/min at rest; 208.2±86.5mL/min during ATP infusion, p<0.001). Patients with higher CHAD2 score had lower CFR. In the multiple logistic regression analysis, CHADS2 score was independently associated with CFR (odds ratio=0.61, 95% confidence interval: 0.37–0.99, p=0.049). ConclusionsHigher CHADS2 score was significantly associated with lower CFR evaluated by phase contrast cine MRI.

Fractional flow reserve based on computed tomography: an overview.

Computed tomography coronary angiography (CTCA) is a technique proved to provide high sensitivity and negative predictive value for the identification of anatomically significant coronary artery disease (CAD) when compared with invasive X-ray coronary angiography. While the CTCA limitation of a ionizing radiation dose delivered to patients is substantially overcome by recent technical innovations, a relevant limitation remains the only anatomical assessment of coronary stenoses in the absence of evaluation of their functional haemodynamic significance. This limitation is highly important for those stenosis graded as intermediate at the anatomical assessment. Recently, non-invasive methods based on computational fluid dynamics were developed to calculate vessel-specific fractional flow reserve (FFR) using data routinely acquired by CTCA [computed tomographic fractional flow reserve (CT-FFR)]. Here we summarize methods for CT-FFR and review the evidence available in the literature up to June 26, 2016, including 16 original articles and one meta-analysis. The perspective of CT-FFR may greatly impact on CAD diagnosis, prognostic evaluation, and treatment decision-making. The aim of this review is to describe technical characteristics and clinical applications of CT-FFR, also in comparison with catheter-based invasive FFR, in order to make a cost-benefit balance in terms of clinical management and patient's health.

Reconstruction of coronary arteries from X-ray angiography: A review.

Despite continuous progress in X-ray angiography systems, X-ray coronary angiography is fundamentally limited by its 2D representation of moving coronary arterial trees, which can negatively impact assessment of coronary artery disease and guidance of percutaneous coronary intervention. To provide clinicians with 3D/3D+time information of coronary arteries, methods computing reconstructions of coronary arteries from X-ray angiography are required. Because of several aspects (e.g. cardiac and respiratory motion, type of X-ray system), reconstruction from X-ray coronary angiography has led to vast amount of research and it still remains as a challenging and dynamic research area. In this paper, we review the state-of-the-art approaches on reconstruction of high-contrast coronary arteries from X-ray angiography. We mainly focus on the theoretical features in model-based (modelling) and tomographic reconstruction of coronary arteries, and discuss the evaluation strategies. We also discuss the potential role of reconstructions in clinical decision making and interventional guidance, and highlight areas for future research.

Extraction of the best frames in coronary angiograms for diagnosis and analysis

X-ray coronary angiography has been a gold standard in the clinical diagnosis and interventional treatment of coronary arterial diseases for decades. In angiography, a sequence of images is obtained, a few of which are suitable for physician inspection. This paper proposes an automatic algorithm for the extraction of one or more frames from an angiogram sequence, which is most suitable for diagnosis and analysis by experts or processors. The algorithm consists of two stages: In the first stage, the background and illumination in the angiogram sequence are omitted. By analyzing the histogram of the sequence, a feature is attributed to each frame. These features, determining the visibility of the vessel tree, are clustered by a fuzzy c-means method. In the second stage, the cardiac phase for each frame is specified. Using the results of both stages, the best frames in an angiogram sequence are obtained. To evaluate the proposed method, it has been tested on angiogram sequences from several patients. The results demonstrate the accuracy of the method. The performance and speed of our method indicate its usefulness in clinical applications.

Free-Wall Rupture Post–Reperfused Acute Myocardial Infarction

A 37-year-old man presented with acute inferior ST-segment–elevation myocardial infarction (MI). His only risk factor for coronary artery disease was smoking. He underwent urgent x-ray coronary angiography, which showed a chronically occluded left anterior descending artery and recannulized right coronary artery. A bedside echocardiogram was performed to assess left ventricular function and any postinfarct complications. It demonstrated severely impaired left ventricular systolic function and an aneurysmal apex with a mobile intracavity mass (Figure 1A and 1B, online-only Data Supplement Movies I and II). Further views demonstrated hemopericardium suggesting concealed free-wall rupture (Figure 1B, purple arrow). An intramyocardial tear at the level of the midinferior wall (Figure 1B, red arrow) was suspected. Figure 1. A and B , Echocardiogram demonstrating a hemopericardium located posteriorly to the inferior wall (purple arrow) and intramyocardial dissection …

Abstract 14005: Myocardium at Risk in Revascularized Non-ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance Imaging and Validated by the Invasive Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Score

Background: In the setting of acute myocardial ischemia, the hypoperfused portion of the myocardium is in danger of becoming irreversibly injured. This portion of myocardium is often referred to as area at risk (AAR) and is correlated to adverse events and outcome. Hypothesis: Aim of the trial at hand was to assess the AAR in patients with acute non-ST-elevation myocardial infarction (NSTEMI) by cardiac magnetic resonance imaging (CMR). Results were validated by the well-established Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Score (APPROACH-score) that was assessed by invasive coronary x-ray angiography. Methods: Sixty-four patients presenting with acute NSTEMI who underwent coronary x-ray angiography including subsequent percutaneous coronary intervention within 72 hours of symptom onset were enrolled. Two blinded readers performed offline angiographic AAR assessment using the modified APPROACH-score. For measurement of AAR by CMR, a 1.5 T whole-body scanner with a 32-channel phased-array surface coil was used. Besides functional and volumetric analyses, a 3D T2-weighted black-blood fat-saturated spin-echo sequence was used for visualization of myocardial edema. Area at risk was calculated as edema volume in relation to left ventricular mass. Using this technique, AAR was quantified semi-automatically by two blinded readers in consensus. Results: Mean age of study cohort was 62.9 years. Forty-four subjects were male (73.3%), mean symptom-to-balloon time was 1212 ± 976 min. The resulting mean AAR determined by the modified APPROACH-score was 28.6 ± 10.0%. The mean CMR derived AAR was 27.9 ± 13.7%. CMR assessment tended to slightly underestimate the AAR in comparison to angiographic scoring (difference -0.21 ± 8.1 %, p=NS). A good correlation between the AAR assessed by CMR and by angiography (r=0.84, p&lt;0.0001) was observed. Conclusion: T2-weigthed CMR is able to quantify the AAR with very good correlation to the angiographic APPROACH-score in NSTEMI patients. Therefore, CMR might serve as an excellent surrogate in clinical reperfusion trials.

Non-contrast coronary artery wall and plaque imaging using inversion-recovery prepared steady-state free precession.

BackgroundThe objective of this study was to investigate whether three-dimensional (3D) single inversion-recovery prepared steady-state free precession (IR-SSFP) could characterize the coronary artery wall.MethodsIR-SSFP was scanned on a 1.5-T MR scanner with a five element cardiac coil. One hundred and twenty-one subjects with known or suspected coronary artery disease who had undergone X-ray coronary angiography (XCA) underwent coronary artery wall imaging using IR-SSFP sequences. In each coronary segment, the detection of the coronary wall was categorized, and contrast (signal of plaque minus signal of blood in the aorta divided by the signal of plaque plus signal of blood in the aorta) was calculated.Results422 of 517 segments (82 %) were successfully visualized, and the detection scores tended to be higher at the proximal coronary artery when compared with other segments of the coronary artery. High contrast (contrast ≥ 0.75) areas were observed in 62 of 218 segments with ≥50 % coronary artery stenosis by XCA but also in 25 of 299 segments without ≥50 % coronary stenosis.ConclusionsIR-SSFP provided good visualization of the coronary wall. This approach represents a promising noninvasive strategy for the assessment of the coronary artery wall.

Development of a method for automated and stable myocardial perfusion measurement using coronary X-ray angiography images.

The purpose of this study was to develop a method for automatic and stable determination of the optimal time range for fitting with a Patlak plot model in order to measure myocardial perfusion using coronary X-ray angiography images. A conventional two-compartment model is used to measure perfusion, and the slope of the Patlak plot is calculated to obtain a perfusion image. The model holds for only a few seconds while the contrast agent flows from artery to myocardium. Therefore, a specific time range should be determined for fitting with the model. To determine this time range, automation is needed for routine examinations. The optimal time range was determined to minimize the standard error between data points and their least-squares regression straight line in the Patlak plot. A total of 28 datasets were tested in seven porcine models. The new method successfully detected the time range when contrast agent flowed from artery to myocardium. The mean cross correlation in the linear regression analysis (R(2)) was 0.996 ± 0.004. The mean length of the optimal time range was 3.61 ± 1.29 frames (2.18 ± 1.40 s). This newly developed method can automatically determine the optimal time range for fitting with the model.

A Pig Model of Ischemic Mitral Regurgitation Induced by Mitral Chordae Tendinae Rupture and Implantation of an Ameroid Constrictor

A miniature pig model of ischemic mitral regurgitation (IMR) was developed by posterior mitral chordae tendinae rupture and implantation of an ameroid constrictor. A 2.5-mm ameroid constrictor was placed around the left circumflex coronary artery (LCX) of male Tibetan miniature pigs to induce ischemia, while the posterior mitral chordae tendinae was also ruptured. X-ray coronary angiography, ECG analysis, echocardiography, and magnetic resonance imaging (MRI) were used to evaluate heart structure and function in pigs at baseline and one, two, four and eight weeks after the operation. Blood velocity of the mitral regurgitation was found to be between medium and high levels. Angiographic analyses revealed that the LCX closure was 10–20% at one week, 30–40% at two weeks and 90–100% at four weeks subsequent ameroid constrictor implantation. ECG analysis highlighted an increase in the diameter of the left atria (LA) at two weeks post-operation as well as ischemic changes in the left ventricle (LV) and LA wall at four weeks post-operation. Echocardiography and MRI further detected a gradual increase in LA and LV volumes from two weeks post-operation. LV end diastolic and systolic volumes as well as LA end diastolic and systolic volume were also significantly higher in pig hearts post-operation when compared to baseline. Pathological changes were observed in the heart, which included scar tissue in the ischemic central area of the LV. Transmission electron microscopy highlighted the presence of contraction bands and edema surrounding the ischemia area, including inflammatory cell infiltration within the ischemic area. We have developed a pig model of IMR using the posterior mitral chordae tendineae rupture technique and implantation of an ameroid constrictor. The pathological features of this pig IMR model were found to mimic the natural history and progression of IMR in patients.

Cardiac Radiology: Centenary Review

During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

GW25-e1625 Measurement of myocardial perfusion reserve index at 3.0T MR system compared with X-ray coronary angiography

GW25-e1625 Measurement of myocardial perfusion reserve index at 3.0T MR system compared with X-ray coronary angiography

Value of additional strain analysis with feature tracking in dobutamine stress cardiovascular magnetic resonance for detecting coronary artery disease.

BackgroundDobutamine stress cardiovascular magnetic resonance (DS-CMR) has been established for the detection of coronary artery disease (CAD). The novel technique feature tracking (FT) analyses left ventricular circumferential strain (Ecc) thus offering detailed information about myocardial deformation. The purpose of this study was to evaluate FT based Ecc for the detection of myocardial ischemia during DS-CMR.MethodsA total of 25 patients (18 males; mean age 64 ± 10 years) with suspected or known CAD underwent a standardized high-dose DS-CMR protocol at 1.5 T. For FT analysis cine short axis (SAX) views (apical, medial, basal) at rest and during maximum dobutamine stress were used. None of the patients had wall motion abnormalities (WMAs) or impaired left ventricular function at rest or scar tissue. For analysis of Ecc the three SAX planes were divided into 16 segments (n = 400 segments). During stress 15 patients (34 segments) developed WMAs as assessed by visual analysis. All patients underwent x-ray coronary angiography for clinical reasons which served as the reference standard. Patients without WMAs during DS-CMR and exclusion of stenotic CAD were defined as normal (10 patients, 160 segments). In patients with significant CAD segments that were supplied by a vessel of >70% narrowing were defined as stenotic (n = 64). The remaining segments in patients with significant CAD were considered as remote (n = 176).ResultsAt rest no differences in Ecc were observed between normal, stenotic and remote segments. High-dose dobutamine stress revealed highly significant differences between Ecc of normal and stenotic segments (p < 0.001), as well as between remote and stenotic segments (p < 0.001). The same observation took place for the absolute change of Ecc (p < 0.001 and p = 0.01). ROC analysis of Ecc during maximum DS-CMR differentiated normal from stenotic segments with a sensitivity of 75% and specificity of 67% using a cutoff -33.2% with an area under the curve of 0.78. Additional analysis of intermediate-dose dobutamine also showed a significant difference between normal and stenotic segments (p = 0.001).ConclusionFT based analysis of Ecc during intermediate- and high-dose DS-CMR was feasible and differentiated between stenotic, remote and normal segments. Quantitative assessment of Ecc with FT may improve the diagnostic accuracy of DS-CMR for detection of ischemia.

Cardiovascular magnetic resonance profiling of coronary atherosclerosis: vessel wall remodelling and related myocardial blood flow alterations.

To determine the association between coronary vessel wall morphology and haemodynamic consequences to the myocardium using a combined cardiovascular magnetic resonance (CMR) imaging protocol. Non-invasive CMR profiling of coronary atherosclerotic wall changes and related myocardial blood flow impairment has not been established yet. Sixty-three patients (45 men, 61.5 ± 10.7 years) with suspected or known coronary artery disease underwent 3.0 Tesla CMR imaging. The combined CMR protocol consisted of the following imaging modules at rest: 3D vessel wall imaging and flow measurement of the proximal right coronary artery (RCA), myocardial T2*, and first-pass perfusion imaging. During adenosine stress coronary flow, T2* and first-pass perfusion imaging were repeated. Coronary X-ray angiography classified patient groups: (i) all-smooth (n = 19); (ii) luminal irregular (diameter reduction < 30%; n = 35); and (iii) stenosed RCA (diameter reduction ≥ 50%; n = 9). The ratio of CMR-derived vessel wall area-to-lumen area significantly increased stepwise for the comparison of all-smooth vs. luminal irregular vs. stenosed RCA (1.9 ± 0.6 vs. 2.6 ± 0.6 vs. 3.6 ± 0.9, P < 0.01). Epicardial coronary flow reserve exhibited a stepwise significant decrease (3.4 ± 0.5 vs. 2.9 ± 0.7 vs. 1.7 ± 0.3, P < 0.01). On the myocardial level, stress-induced percentage gain of T2* values (ΔT2*) was significantly decreased between groups (29.2 ± 10.6 vs. 9.0 ± 9.8 vs. 2.2 ± 11.8%, P < 0.01) while perfusion reserve index decreased in the presence of stenosed RCA only (2.2 ± 0.6 vs. 2.0 ± 0.4 vs. 1.3 ± 0.3, P = ns and P < 0.01, respectively). The proposed comprehensive CMR imaging protocol provided a non-invasive approach for direct assessment of coronary vessel wall remodelling and resultant pathophysiological consequences on the level of epicardial coronary and myocardial blood flow in patients.

Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification.

Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.

OP0250 Distinct Imaging Patterns of Heart Failure in Systemic Lupus Erythematosus: Evaluation Using Cardiovascular Magnetic Resonance

BackgroundSystemic lupus erythematosus (SLE) is associated with increased cardiovascular disease either due to disease per se or to non-SLE related causes. We hypothesized that cardiac tissue characterization by cardiovascular magnetic...