Untwisting contributes to left ventricular filling through suction generation. We sought to investigate diastolic function and untwisting dynamics in different forms of left ventricular hypertrophy: in athlete?s heart and hypertrophic cardiomyopathy. Elite athletes in kayaking, canoeing and rowing (n=28), patients with hypertrophic cardiomyopathy (HCM, n=15) and healthy sedentary volunteers (n=13) were compared. Left ventricular volumes, wall thickness-to-volume ratio were assessed by cardiac MRI. Following conventional and tissue Doppler measurements, untwist and untwist rate were determined by speckle tracking echocardiography. Wall thickness-to-volume ratio describing remodelling was significantly higher in HCM, but similar in athletes and controls (athlete vs. HCM vs. control: 0.107?0.019 vs. 0.271?0.091 vs. 0.104?0.012?mm?m?/ml, mean?SD, p<0.001). Mitral lateral annulus e? velocity referred to diastolic dysfunction in HCM (15.3?3.6 vs. 7.9?3.3 vs. 15.0?3.0?cm/s, p<0.01). At time point of mitral valve opening, untwist and untwist rate were significantly different: the highest values were measured in athletes, while the lowest were found in HCM (untwist: 51.3?19.1 vs. 11.6?10.4 vs. 35.9?16.3%; untwist rate: ?32.5?13.0 vs. ?10.6?10.8 vs. ?23.0?7.7?/s, p<0.05). Untwisting correlated with E/A, e? and E/e?. Athlete?s heart is characterized by increased untwist and untwist rate, which can aid diastolic function. Evaluation of untwisting dynamics may help to distinguish pathological hypertrophy.

In the Advisa MRI study, high-quality CMR images for the assessment of cardiac anatomy and function were obtained in most patients with an implantable pacing system. In addition, this study demonstrated the feasibility of acquiring tagging data to study the LV function during pacing.

ObjectiveWe assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries.MethodsIn total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out.ResultsCMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality.ConclusionsCMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.

While cardiac magnetic resonance (CMR) is the reference method to evaluate left and right ventricular functions, volumes and masses, there is no widely accepted method for the quantitative analysis of trabeculae and papillary muscles (TPM). The aim of this study was to investigate the effect of TPM quantification on left and right ventricular CMR values in a normal cohort and to investigate interobserver variability of threshold-based (TB) analysis by three independent observers with variant experience in CMR. At our clinic, 60 healthy volunteers (30 males, mean age 25.6 ± 4.7 years) underwent CMR scan performed on a 1.5T Philips Achieva MR machine. On short-axis cine images, endo-and epicardial contours were detected by three independent observers with variable experience in CMR (low-ca. 120, mid-> 800, high-experienced > 5000 original CMR cases). Using Conv and TB methods (Medis 7.6 QMass software Leiden, The Netherland), we measured LV and RV ejection fractions, end-diastolic, end-systolic, stroke volumes and masses. We used TB method for quantifying TPM in ventricles using epicardial contour layers. Interobserver variability was evaluated, and the observer's experience as an impact on variability of each investigated parameters was assessed. Comparing Conv and TB quantification methods' significant difference were detected for all LV and RV parameters in case of all observers (H, M and L p < 0.0001). The global intraclass correlation coefficient (G-ICC) representing interobserver agreement for all investigated parameters was lower with Conv method (G-ICC Conv vs. G-ICC TB 0.86 vs. 0.92 p < 0.0001). The ICC of LV parameters was higher using TB quantification (LV-ICC Conv vs. LV-ICC TB 0.92 vs. 0.96 p < 0.0001), and for the evaluation of RV values, the TB method also had significantly higher interobserver agreement (RV-ICC Conv vs. RV-ICC TB 0.80 vs. 0.89 p < 0.0001). The TB algorithm could be a consistent method to assess LV and RV CMR values, and to measure trabeculae and papillary muscles quantitatively in various level of experience in CMR.

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