In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
The role of cardiovascular magnetic resonance imaging in assessing heart failure with a short, contrast-agent free protocol
INTRODUCTION: Heart Failure (HF) is the leading cause of cardiovascular morbidity, mortality, and health care use. New technological developments, including the use of T1 and T2-imaging to assess tissue characterization, in Cardiovascular Magnetic Resonance Imaging (CMR) has led to reduced scan times. The potential for contrast-agent free protocols have further been made possible through Oxygenation-Sensitive CMR (OS-CMR) in combination with standardized breathing maneuvers, which has been established as a potential marker for microvascular function.
PURPOSE: The aim of this study was to assess the time of a contrast-free protocol for routine clinical heart failure assessment.
METHODS: Twelve heart failure patients (mean age 64±9 years; 36% female) and fourteen age-matched healthy volunteers (mean age 56±5 years; 64% female) underwent a CMR on a clinical 3T scanner (Skyra, Siemens, Erlangen, Germany). The short, contrast-free CMR protocol included standard cine sequences for ventricular function (short axis stack), T1 mapping (MOLLI, short axis view), T2 mapping (FLASH, short axis view), and OS-CMR (in basal and mid-ventricular short axis views). Strain values were obtained using the standard cine short-axis views and the 2- and 4-chamber long-axis images. The global myocardial oxygenation reserve (MORE) was obtained from OS-CMR images at baseline and during a long breath-hold that was preceded by a 60s period of hyperventilation. Time of scan was determined from the first and last sequences performed.
RESULTS: Compared with the control group, patients with HF had, on average, a higher global T1 (p<0.0001), higher global T2 (p=0.0009), larger end-diastolic volume (p=0.0005), larger end-systolic volume (p<0.0001), larger left-ventricular end-diastolic atrial volume (p=0.0016) and lower left-ventricular ejection fraction (p<0.0001), with a reduced global peak systolic circumferential strain (<0.0001), and global peak systolic longitudinal strain (p<0.0001). In patients, the breathing-induced MORE was also significantly lower than in healthy controls (0.3±3.3 vs 4.5±4.2, p=0.013). The study protocol was significantly shorter (p<0.0001) than the current clinical MRI protocol, 49.3±10.7 and 31.4±8.3 minutes, respectively.
CONCLUSION: A significantly shorter, contrast-free CMR protocol of 31- compared to the standard 49-minute protocol was able to determine that heart failure patients were characterized by functional, mapping, and strain CMR parameters as well as impaired coronary microvascular function, that could be detected by OS-CMR.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
Our mission: To reduce the burden of cardiovascular disease