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Dima Bishara^1,2, Kyungpyo Hong¹, Suvai Gunasekaran¹, Daniel C Lee^1,3, Bradley D Allen¹, Michael Markl^1,2, Rod Passman³, and Daniel Kim^1,2
1Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States, ²Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States, ³Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Keywords: Arrhythmia, Image Reconstruction

Signal processing of self-navigation in 3D late gadolinium enhancement (LGE) with XD-GRASP reconstruction often leads to variable results due to a variety of factors including arrhythmia (variations in inversion-recovery of self-navigated signal) and bright signals around the body that are projected onto the edge profile used for tracking respiratory motion. Principal component analysis (PCA) is the conventional approach to process navigation signal. We hypothesize that exploratory factor analysis (EFA) produces better extraction of respiratory motion. Our results show that EFA improves respiratory motion tracking in 3D LA LGE obtained b-SSFP readout, but not in gradient echo [GRE] readout.

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Siva Sreedhar¹, Aakash Gupta², Teodora Chitiboi³, Maurice Pradella⁴, and Mohammed S.M. Elbaz^1
1Northwestern University Feinberg School of Medicine, Chicago, IL, United States, ²Radiology, Stanford University, Stanford, CA, United States, ³Digital Technology and Innovation, Siemens Healthineers, Erlangen, Germany, ⁴Cardiothoracic Radiology, University Hospital of Basel, Basel, Switzerland

Keywords: Myocardium, Valves, strain

Short-axis CMR left atrial (LA) circumferential strain has not yet been investigated as a cardiac biomarker. This study assessed feasibility and reproducibility of LA circumferential strain in a healthy cohort, examined changes in strain within mitral regurgitation (MR) patients, and assessed correlations between reproducible strain measures and MR severity and cardiac function. Reservoir strain globally and at superior and mid LA regions was found to be reproducible, was significantly different between healthy volunteers and MR patients, and was correlated with cardiac function. CMR LA circumferential strain is reproducible with potential utility in evaluating impaired LA mechanics in MR patients.

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Dagmar Bertsche¹, Patrick Metze¹, Erfei Luo¹, Tillman Dahme¹, Birgit Gonzka¹, Wolfgang Rottbauer¹, Ina Vernikouskaya¹, Leonhard Moritz Schneider¹, and Volker Rasche^1
1Internal Medicine II, Ulm University Medical Center, Ulm, Germany

Keywords: Arrhythmia, MR-Guided Interventions, LAA closere, preprocedural planning

An isotropic 2D six-point Dixon method was applied for assessment of the left arterial appendix (LAA) morphology prior to LAA closure intervention. Sufficient image quality was achieved even in highly arrhythmic patients allowing for the preinterventional quantification of the LAA dimensions as required for proper closure device selection. MR derived diameters were compared to periprocedurally TEE and XR derived values, which were in good agreement. Further, optimal XR angulation providing projections perpendicular to the envisaged landing zone could be identified. 

Zhaoxia Yang¹, Dazong Tang¹, Yi Luo², Chunlin Xiang¹, Lu Huang¹, and Liming Xia^1
1Tongji Hospital,Huazhong University of Science and Technology, wuhan, China, ²Tongji Hospital,Huazhong University of Science and Technology, Wuhan, China

Keywords: Heart, Hypertension, epicardial adipose tissue

Cardiac MRI enables quantification of EAT thickness with good to excellent reproducibility for differentiating the hypertensive patients with arrhythmias from those without arrhythmias and normal controls. Additionally, EAT thickness was correlated with native T1 and LVMi, which demonstrated EAT might induce cardiac remodeling and promote myocardial fibrosis. Cardiac MRI-derived EAT thickness metrics has great potential to further explore the mechanism of EAT with arrhythmias and guide an appropriate treatment in patients of hypertension.

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Yunling Li¹, Shengliang Liu¹, Jianxiu Lian², Goukun Wang¹, Xia Gu¹, Yong Sun¹, and Bo Yu^1
1Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China, HarBin, China, ²Phillips Healthcare, Beijing, China

Keywords: Heart, Cardiovascular, Heart failure

Heart failure with preserved ejection fraction (HFpEF) characterized by heart diastolic dysfunction. Epicardial adipose tissue (EAT) has been speculated to play an important role in HFpEF pathophysiological processes. In present study, EAT volume was significantly increased in patients with HFpEF and patients with high risk for developing HFpEF compared with healthy controls, and it was correlated with CMR parameters indicative of diastolic dysfunction, particularly GLS and LA reservoir, conduit, and pump strains. These findings provided compelling evidence for the potential role of EAT in adverse myocardial remodeling and the pathophysiology of HFpEF.

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Tianyu Ke¹, Xiaolin Mu², Jing Chen¹, and Yang Song^2
1Graduate School of Dalian Medical University, Dalian Municipal Central Hospital, Dalian, China, ²The Affiliated Hospital of Dalian University of Technology, Dalian Municipal Central Hospital, Dalian, China

Keywords: Heart, Hypertension, Heart failure LA/LV strain

The application value of left atrial and left ventricular strain parameters to heart failure with preserved left ventricular ejection fraction in hypertensive heart disease was evaluated by cardiac magnetic resonance feature tracking technology. We found that the left atrial function, strain, and left ventricular strain parameters were impaired to varying degrees in the HFpEF-HHD group, and the left atrial ejection fraction was significantly correlated with some feature parameters of left atrial and left ventricular strain. However, NT-proBNP is only significantly correlated with LAεa.In the identification of the HFpEF-HHD population, the LASRe parameter has shown optimal diagnostic value.

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Justin J Baraboo¹, Maurice Pradella¹, Anthony Maroun¹, Elizabeth Weiss¹, Amanda Dicarlo¹, Suvai Gunasekaran¹, Daniel Lee¹, Rod Passman¹, Daniel Kim¹, and Michael Markl^1
1Northwestern, Chicago, IL, United States

Keywords: Arrhythmia, Velocity & Flow

2D real time phase contrast was utilized in atrial fibrillation patients with and without a prior history of stroke. To account for within patient heartbeat variability, heartbeats were aggregated within each patient according to ECG trace. Heartbeat durations (RR-intervals) were sorted from fast to slow for each patient. Three groups were formed from the tertiles of the RR-intervals (faster, regular, and slower heartbeats). Blood stasis and peak velocity were compared between the stoke subgroups for each grouping. Patients with prior stroke had significantly higher stasis which remained significant in multivariable modeling using demographic variables as well.

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Rajesh Dash^1,2, Henry Chubb³, Xianglun Mao⁴, Fara Nikbeh⁴, Pingni Wang⁴, Yuko Tada¹, Gaspar Delso⁵, Martin Janich⁶, Sanjiv Narayan¹, Daniel Ennis¹, and Phillip C Yang^1
1Stanford University, Stanford, CA, United States, ²Cardiovascular Institute, Stanford, CA, United States, ³Stanford Lucille Packard Childrens Hospital, Stanford, CA, United States, ⁴GE Healthcare, Inc., Menlo Park, CA, United States, ⁵GE Healthcare, Inc., Barcelona, Spain, ⁶GE Healthcare, Inc., Munich, Germany

Keywords: Myocardium, Arrhythmia, atrial fibrillation, ablation, atrial wall, scar, delayed gadolinium enhancement

Atrial fibrillation (AF) ablation procedures still face challenges to achieve durable restoration of sinus rhythm. Advanced cardiac MRI delayed enhancement can delineate atrial wall scar to aid in planning AF ablation. However, thin atrial walls demand more advanced sequence development. In this study, we report protocol optimizations for high-resolution, free-breathing, fat-suppressed 3D LGE to detect atrial wall scar. In three AF patients to date, we found progressive improvements in CNR and detailed the sequence modification that led to these improvements. Future iterations will be used to assess atrial scar in patients, pre- and post-AF ablation.

Chengchen Zhao^1,2, Chunna Jin^1,2, Xiaopeng He^1,2, Simin Meng^1,2, Qi Liu³, Zhongqi Zhang³, Jianzhong Sun⁴, and Meixiang Xiang^4
1Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, ²Key Lab of Cardiovascular Disease of Zhejiang Province, Hangzhou, China, ³UIH America, Inc., Houston, TX, United States, ⁴Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Keywords: Arrhythmia, Arrhythmia

CMR multitasking T1 mapping, a recently proposed free-breathing, non-ECG technique, was evaluated in atrial fibrillation patients. It demonstrated good image quality, differentiated patients from healthy participants, and correlated with important cardiac function biomarkers. It is a promising T1 mapping tool in atrial fibrillation patients.

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Rebecca E Thornhill^1,2, Jessie Kang^1,2, Pablo B Nery^3,4, Calum Redpath^3,4, David Birnie^3,4, Sophie Chenier³, and Elena Peña^1,2
1Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada, ²Radiology, Radiation Oncology, and Medical Physics, University of Ottawa, Ottawa, ON, Canada, ³University of Ottawa Heart Institute, Ottawa, ON, Canada, ⁴Medicine, University of Ottawa, Ottawa, ON, Canada

Keywords: Arrhythmia, Heart

Atrial Fibrillation (AF) is a heart rhythm disorder of the left atrium (LA) that is associated with an increased risk of stroke and death. AF has been known to induce morphological changes of the LA that may be detectable with fractal analysis. The purpose of this study was to assess whether there are differences in fractal dimension of the LA based on AF severity or subtype. The paroxysmal AF groups demonstrated increased fractal dimension compared to persistent or permanent groups. LA dilatation associated with persistent or permanent AF may explain this result, but this requires validation in a larger cohort.

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huang wei wei¹, luo song¹, zhang jun¹, zhang ling yan¹, and dou wei qiang^2
1Jinling Hospital, Medical School of Nanjing University, nanjing, China, ²MR Research, GE Healthcare, beijing, China

Keywords: Cardiomyopathy, MR Value

This study aimed to detect left atrial (LA) strain and left ventricular (LV) stain by cardiac magnetic resonance imaging feature tracking (CMR-FT) in patients with systemic lupus erythematosus (SLE). SLE patients showed lower LVEF and multiple LV strain data than control group. Furthermore, significantly different LA reservoir, conduit and bump function were found in SLE patients than healthy controls. With these findings, CMR-FT has proven as an effective method in the diagnosis of cardiac injury in SLE patients.

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Di Tian¹, Ziqi Xiong¹, Yifan He¹, Jingyu Zhang¹, and Zhiyong Li^1
1Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China, Dalian, China

Keywords: Cardiomyopathy, Cardiomyopathy

Myocardial fibrosis causes functional impairment in patients with hypertrophic cardiomyopathy (HCM). The clinical gold standard for imaging myocardial fibrosis is cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE), which is commonly used for the diagnosis and prognostic evaluation of patients with HCM. However, LGE imaging is an invasive test and some patients have adverse reactions to contrast agents. The aim of this study is to predict the presence of fibrosis in the left ventricular myocardium by cardiac magnetic resonance (CMR) non-invasive assessment of left atrial and left ventricular parameters in patients with HCM.

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Wen Li¹, Xianchang Zhang², Xiaoyue Zhou³, Jens Wetzl⁴, Qing Gu⁵, and Jianguo He^6
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ²MR Collaboration, Siemens Healthineers Ltd, Beijing, China, ³MR Collaboration, Siemens Healthineers Ltd, Shanghai, China, ⁴Magnetic Resonance, Siemens Healthcare, Erlangen, Germany, ⁵Emergency Center, State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ⁶Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Keywords: Heart, Heart, Strain, Right ventricle

This is the first study to demonstrate that right ventricle (RV) layer-specific strain rate measured by deformation registration algorithm based cardiovascular magnetic resonance had the long-term and 3-year mortality predictive values in pulmonary arterial hypertension (PAH) patients. Our findings indicated that RV layer-specific strain rate may be sensitive indicators of RV dysfunction in PAH.

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Simon Reiss¹, Enaam Chleilat², Thomas Lottner¹, Peter Kohl², and Michael Bock^1
1Division of Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany, ²Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany

Keywords: Heart, Arrhythmia

RF ablation is an established treatment option for cardiac arrhythmia. After RF ablation the scar can be assessed with LGE MRI. However, imaging of scars in the right atrium (RA) remains difficult due to the small geometry. In this animal study, we assessed the conspicuity of chronic RA scars by comparing scar extent on MRI to ex vivo anatomical dissected preparations. We show, the detection of chronic RF ablation scars in the RA is feasible but with limited precision. The presented comparison to gross histology provides and important evaluation of RF ablation scar conspicuity in LGE MRI.

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Jo-Hua Peng¹, Ming-Ting Wu², Nai-Yu Pan³, Teng-Yi Huang³, Yi-Jui Liu⁴, Ken-Pen Weng^5,6, and Hsu-Hsia Peng^1
1Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan, ²Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ³Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, ⁴Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, ⁵Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ⁶Dpartment of Pediatrics, National Yang Ming Chiao Tung University, Taipei, Taiwan

Keywords: Heart, Radiomics

Radiomics is a novel technique of advanced cardiac magnetic resonance (CMR) phenotyping by analyzing a couple of variables of cardiac shape and tissue texture. This study aimed to develop the radiomics-based classification model to differentiate rTOF patients from normal controls and evaluate the representative features of ventricular and myocardial abnormalities in rTOF patients. In conclusion, the radiomics-based classification model can successfully differentiate rTOF patients from normal controls with routine CMR cine images. The selected features underlined the right ventricular remodeling and left ventricular myocardium fibrosis in rTOF patients.

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Shengliang Liu¹, Yunling Li¹, Jianxiu Lian², Guokun Wang¹, Xueying Wang¹, Ye Li¹, Yanming Zhao¹, and Bo Yu^1
1The Second Affiliated Hospital of Harbin Medical University, Harbin, China, ²Philips Healthcare, Beijing, China

Keywords: Cardiomyopathy, Myocardium, strain, feature tracking, fast long-axis

Dilated cardiomyopathy (DCM) remains to attract worldwide attention for its poor prognosis and high mortality. The interaction of biatrial and biventricular deformation capacity in DCM patients is unclear. In this study, feature tracking and fast long-axis method were used to evaluate myocardial strain. We found that biventricular and biatrial strain were significantly impaired in DCM group than control group. LV GLS was obviously impaired in event group than no event group, and it showed significantly prognostic value in predicting cardiovascular events. Comprehensive CMR analysis should be performed to improve the diagnosis ability for DCM patients.

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Wen Li¹, Xianchang Zhang², Jens Wetzl³, Qing Gu⁴, and Jianguo He^5
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ²MR Collaboration, Siemens Healthineers Ltd, Beijing, China, ³Magnetic Resonance, Siemens Healthcare, Erlangen, Germany, ⁴Emergency Center, State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ⁵Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Keywords: Heart, Data Processing, Strain

Studies have reported left ventricular (LV) dysfunction was associated with more severe disease and poorer prognosis in pulmonary arterial hypertension (PAH). However, there are only few studies that evaluated LV strain abnormalities using cardiovascular magnetic resonance (CMR) in PAH patients. This is the first study to describe the distribution pattern and prognostic values of LV layer-specific strain/strain rate in PAH patients using a deformation registration algorithm (DRA) based on CMR. It’s found that CMR derived LV layer-specific strain could predict long-term prognosis in PAH patients.

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Kai Lin¹, Roberto Sarnari¹, Daniel Z Gordon¹, Michael Markl¹, and James C Carr^1
1Northwestern University, Chicago, IL, United States

Keywords: Heart, Radiomics, blood pool

Radiomics features acquired from the blood pool in different chambers (LV/RV/LA/RA) at various periods within a cardiac cycle present diverse property in characterizing PH-HFpEF. Multiple blood pool radiomics features were significantly related to PCWP and mPAP (r: 0.4 – 0.643). Compared to the LV wall, the blood pools provide more efficient features (individual AUC: 0.7 – 0.821) to discriminate PH-HFpEF from controls (p < 0.05). Cine MRI-derived radiomics features of the blood pool can be used to characterize PH-HFpEF. Radiomics features of the blood pool have the potential to become novel quantitative imaging biomarkers for presenting cardiovascular pathology.

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Jo-Hua Peng¹, Ming-Ting Wu², Nai-Yu Pan³, Teng-Yi Huang³, Yi-Jui Liu⁴, Ken-Pen Weng^5,6, and Hsu-Hsia Peng^1
1Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan, ²Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ³Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, ⁴Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, ⁵Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ⁶Dpartment of Pediatrics, National Yang Ming Chiao Tung University, Taipei, Taiwan

Keywords: Heart, Radiomics

Radiomics analysis of cardiac magnetic resonance (CMR) may provide new insights into the quantitative analysis of cardiac imaging by extracting many computational quantitative metrics. This study aimed to develop a radiomics-based classification model by left ventricular (LV) CMR images to identify repaired tetralogy of Fallot (rTOF) patients with severe right ventricular (RV) dilation. In our results, the AUC were 0.81 and 0.91 for LV radiomics and LV radiomics+LV indices models, respectively. The extracted features underlined the LV intracardiac flow alteration due to RV dilation and the potential LV remodeling in rTOF patients with severe RV dilation.

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Tingting Liu¹, Weibin Dai¹, Yueyou Peng¹, Qianyu Hu¹, Kunkun Liu¹, Ningning Song¹, Tianfeng Shi¹, Donglian Du¹, Xiaoqiong Li¹, Yueluan Jiang², and Yanfeng Meng^1
1Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China, ²Department of MR Scientific Marketing, Siemens Healthineers Ltd., Beijing, China

Keywords: Myocardium, Cardiomyopathy, Hypertrophic cardiomyopathy, Biventricular function

This study evaluated the right ventricular (RV) myocardial strain of Hypertrophic Cardiomyopathy (HCM) patients with preserved ejection fraction (EF) and without myocardial hypertrophy in RV based on Cardiovascular magnetic resonance feature tracking technique (CMR-FT), and further explored the effect of left ventricular (LV) myocardial mechanics on the RV. The results showed that the global longitudinal strain (GLS) of the RV has been impaired, although the structure and EF of the RV were normal, so myocardial strain can be more sensitive and earlier to identify cardiac impairment. The systole  function of the LV has a great influence on the RV function.