BACKGROUND:Heart failure with preserved ejection fraction (HFpEF) is characterised by systemic congestion and elevated left ventricular filling pressures. Pulmonary transit time (PTT) measured by cardiovascular magnetic resonance (CMR) provides a non-invasive, integrated assessment of cardiopulmonary haemodynamics, but its prognostic value in patients with HFpEF remains uncertain. We aimed to determine whether prolonged PTT independently predicts adverse clinical outcomes in HFpEF. METHODS:Adult patients with HFpEF were prospectively recruited and underwent comprehensive phenotyping including blood sampling, 12-lead electrocardiography, 6-min walk testing, echocardiography and multiparametric CMR (NCT03050593). PTT was derived from rest first-pass perfusion imaging and normalised to cardiac cycle length. An abnormal PTT threshold was defined as >95th percentile of asymptomatic controls. The primary endpoint was a composite of heart failure hospitalisation or all-cause mortality. Multivariable Cox proportional hazard regression (HR) models were used to investigate associations with clinical outcome. RESULTS:One-hundred and eighteen HFpEF patients were studied (median follow-up 7.7 years). Eighty-one composite events occurred (50 heart failure hospitalisations and 31 deaths). Prolonged PTT independently predicted the composite outcome across four separate models: clinical (HR 2.222 (1.222, 4.041), p=0.009), blood biomarker (HR 1.776 (1.022, 3.087), p=0.042), imaging (HR 2.108 (1.115, 3.983), p=0.020) and a combined model incorporating the strongest markers (HR 2.989 (1.612, 5.543), p<0.001). CONCLUSION:Prolonged PTT is an independent predictor of death or heart failure hospitalisation in HFpEF. As an easily obtainable and integrative CMR biomarker of cardiopulmonary haemodynamics, PTT may improve risk stratification in HFpEF, although its clinical application requires further investigation.

BACKGROUND:Previous studies have suggested an adverse role of epicardial adipose tissue (EAT) in aortic stenosis (AS), potentially mediated by direct effects on the myocardium. This study aimed to assess whether EAT volume and density are associated with cardiac remodelling and clinical outcomes in a well-phenotyped cohort of patients with initially asymptomatic AS. METHODS:In this post hoc exploratory analysis of a multicentre, prospective longitudinal study, asymptomatic patients with moderate-to-severe AS (n=136; age 68.6 (60.1, 75.3) years, 27% female) and control participants (n=39; age 59.0 (54.0, 67.0) years, 38% female) underwent echocardiography, cardiac CT and MRI. EAT volume and mean CT attenuation were measured from non-contrast cardiac CT using an automated deep learning software. The primary outcome was symptoms necessitating valve replacement, cardiovascular death or major adverse cardiac event. RESULTS:Participants with AS had significantly higher indexed EAT volumes (56.5 vs 38.8 cm3/m2, p<0.001) and lower EAT attenuation (-76.3 vs -69.9 Hounsfield units, p<0.001). Both measures were correlated with markers of AS severity. Indexed EAT volume was not associated with cardiac remodelling in AS after correcting for confounding variables; however, a higher mean EAT CT attenuation was associated with higher indexed left ventricular mass. There were 42 (31%) primary outcome events over a median of 370 days. Lower indexed EAT volume and higher mean CT attenuation were associated with the outcome, independent of age and sex. Indexed EAT volume remained negatively associated after further adjustment for AS severity. CONCLUSION:Indexed EAT volume was higher in patients with AS, but not associated with MRI markers of cardiac remodelling. A higher indexed EAT volume was independently associated with a lower occurrence of symptoms and cardiovascular events. Further studies are needed to corroborate these findings and whether EAT has a potentially protective role in symptom progression in AS. TRIAL REGISTRATION NUMBERS:NCT03518645, NCT03132129.

Background: Stage B heart failure (SBHF) increases the risk of symptomatic HF. Current guideline criteria for SBHF lack sex and ethnic thresholding and cardiac magnetic resonance (CMR) imaging cut-offs. We aimed to assess the prevalence of SBHF in a large cohort of people with type 2 diabetes (T2D) and healthy controls and propose a refined CMR definition for SBHF. Methods: Sex- and ethnic-specific thresholds for imaging criteria were derived from 373 healthy controls, who underwent CMR cine imaging. The current definition for SBHF and refined criteria was applied to our prospectively recruited and intensively phenotyped cohort of asymptomatic people with T2D and no evidence of cardiovascular disease. The prevalence of SBHF by different definitions was calculated and patient characteristics, including exercise capacity, were compared between those classified as Stage A vs. B HF. Finally, the refined criteria were also applied to the following two historical cohorts with symptomatic cardiovascular disease: severe aortic stenosis (AS n = 70) and HF with preserved ejection fraction (HFpEF n = 136). Results: A total of 423 people with T2D and a subset of 102 healthy controls who underwent echocardiography were prospectively recruited. Current guideline criteria classified 91% of those with T2D and 69% of the healthy controls as SBHF, suggesting a lack of specificity. Applying derived sex- and ethnicity-specific thresholds, combining echo and CMR measures, the prevalence of SBHF was reduced to 30% in those with T2D. Using the refined definition, those with Stage B HF had lower exercise capacity than those with Stage A HF (percentage predicted maximal oxygen consumption 81 ± 16% vs. 91 ± 20%, p < 0.001). Applying the refined definition to symptomatic AS and HFpEF participants classified 89% and 85% with abnormal cardiac remodelling. Conclusion: Current guideline criteria for SBHF are non-specific and likely of limited value in clinical practice. Refining these criteria with sex- and ethnic-specific thresholds may improve identification of those at risk of developing symptomatic disease. Further research is required to validate these criteria.

Purpose To compare left ventricular (LV) peak early diastolic strain rate (PEDSR) and peak late diastolic strain rate (PLDSR) using cardiac MRI feature tracking (FT) across a spectrum of diastolic dysfunction and determine the association between diastolic strain rates and cardiac remodeling. Materials and Methods Between October 2008 and December 2022, cardiac MRI and echocardiography were performed in prospectively recruited cohorts with type 2 diabetes mellitus, heart failure with preserved ejection fraction, and severe aortic stenosis, as well as asymptomatic participants without diabetes. Diastolic dysfunction was classified using established echocardiography guidelines. Global circumferential and longitudinal PEDSR and PLDSR were measured at cardiac MRI. Linear regression was performed to identify independent associations between LV diastolic strain rates and remodeling. Results A total of 600 participants (mean age, 65.2 years ± 8.4 [SD]; 361 of 600 male participants [60%]) were included. Proportions of participants with normal diastolic function and those with grade 1, indeterminate, and grade 2 or 3 diastolic dysfunction were 92 of 600 (15%), 401 of 600 (67%), 85 of 600 (14%), and 22 of 600 (4%), respectively. Compared with participants who had normal function, PEDSR decreased in those with grade 1 dysfunction (circumferential PEDSR, 0.99 sec-1 ± 0.22 vs 0.81 sec-1 ± 0.24 [P < .001]; longitudinal PEDSR, 0.79 sec-1 ± 0.19 vs 0.60 sec-1 ± 0.19 [P < .001]) and remained low throughout worsening stages of diastolic dysfunction. In contrast, compared with participants who had normal diastolic function, PLDSR increased in those with grade 1 dysfunction (circumferential PLDSR, 0.70 sec-1 ± 0.17 vs 0.82 sec-1 ± 0.23 [P < .001]; longitudinal PLDSR, 0.73 sec-1 ± 0.18 vs 0.80 sec-1 ± 0.27 [P < .001]) and declined progressively with worsening diastolic dysfunction. After multivariable adjustment for risk factors, inverse associations persisted between PEDSR and PLDSR with cardiac remodeling. Conclusion A distinctive pattern of cardiac MRI FT early and late diastolic strain rates was observed across the range of diastolic dysfunction. Keywords: Diastolic Dysfunction, Peak Early Diastolic Strain Rate, Peak Late Diastolic Strain Rate, Feature Tracking Supplemental material is available for this article. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license.

Myocardial strain measurements are increasingly used in research and clinical practice. However, there are limited data on inter-modality agreement and reproducibility. We aimed to investigate the inter-technique agreement of transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging derived left atrial (LA) and left ventricular (LV) deformation parameters. Subjects with or without cardiovascular disease were prospectively recruited and had TTE and CMR on the same day. Ten subjects with type 2 diabetes (T2D) had both scans repeated within two weeks for test-retest reproducibility assessment. Myocardial deformation analyses were undertaken including LA strain (LAS) corresponding to LA reservoir, conduit and booster pump phases, LV global longitudinal strain (GLS) and peak early/late diastolic strain rate (PE/PLDSR) and LV mid-circumferential strain (Mid-CS) and strain rates. 222 participants (T2D (n = 87); severe aortic stenosis (n = 78) and healthy volunteers (n = 57)) were included. There were no significant differences between TTE and CMR measured LAS parameters, with moderate agreement between imaging modalities (ICC = 0.55–0.69). LV parameters were significantly higher on CMR except for Mid-CS which was higher on TTE (-19.3 ± 3.19 vs. -23.0 ± 4.37; p < 0.001). Inter-technique agreement was poor for all LV deformation parameters, except PLDSR with modest agreement (ICC = 0.52–0.66). CMR test-retest reproducibility was good to excellent for LAS and LV strain rate parameters (ICC = 0.73–0.90). TTE test-retest reproducibility was good for conduit LAS and LV_PEDSR (ICC = 0.80). There is modest agreement between TTE and CMR for LAS and poor agreement for LV strain assessment, suggesting that these techniques cannot be used inter-changeably. In a small subset of participants CMR test-retest reproducibility was overall better than TTE.

Objectives(1) Explore the effects of a 12-week home-based rehabilitation programme on cardiorespiratory fitness in kidney transplant recipients; (2) Compare cardiorespiratory fitness parameters in kidney transplant recipients and age-sex matched healthy volunteers to aid the justification for routine rehabilitation programmes.DesignPilot randomised controlled trial with nested case-control.SettingHome-based rehabilitation; hospital-based outcome assessments.ParticipantsPilot randomised controlled trial: 50 stable kidney transplant recipients (>1 year post-transplant) (randomised 1:1; n = 25 control and n = 25 intervention). Nested case-control: 30 kidney transplant recipients and 30 healthy volunteers.InterventionA 12-week home-based aerobic and resistance rehabilitation programme or guideline-directed care control.Main measuresCardiorespiratory fitness measured by cardiopulmonary exercise testing.ResultsPilot randomised controlled trial: After adjusting for baseline, follow-up values were significantly greater in intervention compared to control for peak oxygen uptake (V̇O2peak) mL/kg/min, (+1.50, p = .03) and maximum workload (+8 W, p = .04) but not V̇O2peak L/min or variables at the gas exchange threshold. Higher frequency of aerobic exercise sessions was associated with greater improvements in cardiorespiratory fitness (R2 = .252, p = .040).Nested case-control: V̇O2peak was reduced in kidney transplant recipients compared to healthy volunteers (18.81 ± 4.61 vs 24.06 ± 5.72 mL/kg/min; p < .01), as was V̇O2 at the gas exchange threshold (11.70 ± 2.67 vs 14.47 ± 3.39 mL/kg/min; p < .01).ConclusionsA 12-week home-based rehabilitation programme induced a significant improvement in some cardiorespiratory fitness variables and higher frequency of aerobic exercise associated with greater improvements. Cardiorespiratory fitness is significantly impaired in kidney transplant recipients compared to age-sex-matched healthy volunteers. Together, these findings highlight the clinical importance of promoting aerobic exercise and the integration of rehabilitation programmes into routine care for this population.Trial registrationClinicalTrials.gov, NCT04123951 (https://clinicaltrials.gov/study/NCT04123951).

Individuals with Type 2 Diabetes (T2D) are at high risk of subclinical cardiovascular disease (CVD), potentially detectable through retinal alterations. In this single-centre, prospective cohort study, 255 asymptomatic adults with T2D and no prior history of CVD underwent echocardiography, non-contrast coronary computed tomography and cardiovascular magnetic resonance. Retinal photographs were evaluated for diabetic retinopathy grade and microvascular geometric characteristics using deep learning (DL) tools. Associations with cardiac imaging markers of subclinical CVD were explored. Of the participants (aged 64 ± 7 years, 62% males); 200 (78%) had no diabetic retinopathy and 55 (22%) had mild background retinopathy. Groups were well-matched for age, sex, ethnicity, CV risk factors, urine microalbuminuria, and serum natriuretic peptide and high-sensitivity troponin levels. Presence of retinopathy was associated with a greater burden of coronary atherosclerosis (coronary artery calcium score ≥ 100; OR 2.63; 95% CI 1.29–5.36; P = 0.008), more concentric left ventricular remodelling (OR 3.11; 95% CI 1.50–6.45; P = 0.002), and worse global longitudinal strain (OR 2.32; 95% CI 1.18–4.59; P = 0.015), independent of key co-variables. Early diabetic retinopathy is associated with a high burden of coronary atherosclerosis and markers of early heart failure. Routine diabetic eye screening may serve as an effective alternative to currently advocated screening tests for detecting subclinical CVD in T2D, presenting opportunities for earlier detection and intervention.

Background: Coronary microvascular dysfunction (CMD) is a significant complication in type 2 diabetes (T2D) and may be more common in women. We aimed to evaluate the sex differences and sex-specific clinical determinants of CMD in adults with T2D without prevalent cardiovascular disease. Methods: Single center pooled analysis of four prospective studies comparing asymptomatic people with T2D and controls. All subjects underwent comprehensive cardiovascular phenotyping with myocardial perfusion reserve (MPR) quantified with perfusion cardiovascular magnetic resonance (CMR). Participants with silent coronary disease were excluded. Multivariable linear regression was performed to identify determinants of MPR with an interaction term for sex. Results: Four hundred and seventy-nine T2D (age 57 +/- 11 years, 42% [202/479] women) were compared with 116 controls (age 53 +/- 11 years, 41% [48/116] women). Men with T2D, but not women, demonstrated worse systolic function and higher extracellular volume fraction than controls. MPR was significantly lower in T2D than controls (women, 2.6 +/- 0.9 vs 3.3 +/- 1.0, p < 0.001; men, 3.1 +/- 0.9 vs 3.5 +/- 1.0, p = 0.004), and lower in women than men with T2D (p < 0.001). More women than men with T2D had MPR < 2.5 (46% [79/202] vs 26% [64/277], p < 0.001). There was a significant interaction between sex and body mass index (BMI) for MPR (p interaction < 0.001). Following adjustment for clinical risk factors, inverse association with MPR were BMI in women (j3 = -0.17, p = 0.045) and systolic blood pressure in men (j3 = -0.14, p = 0.049). Conclusion: Among asymptomatic adults with T2D, women had a greater prevalence of CMD than men. Risk factors modestly but significantly associated with CMD in asymptomatic people with T2D were BMI among women and systolic blood pressure among men.

Background: Dysregulated epicardial adipose tissue (EAT) may contribute to the development of heart failure in Type 2 diabetes (T2D). This study aimed to evaluate the associations between EAT volume and composition with imaging markers of subclinical cardiac dysfunction in people with T2D and no prevalent cardiovascular disease. Methods: Prospective case-control study enrolling participants with and without T2D and no known cardiovascular disease. Two hundred and fifteen people with T2D (median age 63 years, 60 % male) and thirty-nine non-diabetics (median age 59 years, 62 % male) were included. Using computed tomography (CT), total EAT volume and mean CT attenuation, as well as, low attenuation (Hounsfield unit range -190 to -90) EAT volume were quantified by a deep learning method and volumes indexed to body surface area. Associations with cardiac magnetic resonance-derived left ventricular (LV) volumes and strain indices were assessed using linear regression. Results: T2D participants had higher LV mass/volume ratio (median 0.89 g/mL [0.82-0.99] vs 0.79 g/mL [0.75-0.89]) and lower global longitudinal strain (GLS; 16.1 +/- 2.3 % vs 17.2 +/- 2.2 %). Total indexed EAT volume correlated inversely with mean CT attenuation. Low attenuation indexed EAT volume was 2-fold higher (18.8 cm(3)/m(2) vs. 9.4 cm(3)/m(2), p < 0.001) in T2D and independently associated with LV mass/volume ratio (ss = 0.002, p = 0.01) and GLS (ss = -0.03, p = 0.03). Conclusions: Higher EAT volumes seen in T2D are associated with a lower mean CT attenuation. Low attenuation indexed EAT volume is independently, but only weakly, associated with markers of subclinical cardiac dysfunction in T2D.

Background Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently co-exist. There is a limited understanding on whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics. We aimed to determine if patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) represent a distinct phenotype. Methods In this secondary analysis of adults with HFpEF (NCT03050593), participants were comprehensively phenotyped with stress cardiac MRI, echocardiography and plasma fibroinflammatory biomarkers, and were followed for the composite endpoint (HF hospitalisation or death) at a median of 8.5 years. Those with AF were compared to sinus rhythm (SR) and unsupervised cluster analysis was performed to explore possible phenotypes. Results 136 subjects were included (SR = 75, AF = 61). The AF group was older (76 ± 8 vs. 70 ± 10 years) with less diabetes (36% vs. 61%) compared to the SR group and had higher left atrial (LA) volumes (61 ± 30 vs. 39 ± 15 mL/m 2 , p < 0.001), lower LA ejection fraction (EF) (31 ± 15 vs. 51 ± 12%, p < 0.001), worse left ventricular (LV) systolic function (LVEF 63 ± 8 vs. 68 ± 8%, p = 0.002; global longitudinal strain 13.6 ± 2.9 vs. 14.7 ± 2.4%, p = 0.003) but higher LV peak early diastolic strain rates (0.73 ± 0.28 vs. 0.53 ± 0.17 1/s, p < 0.001). The AF group had higher levels of syndecan-1, matrix metalloproteinase-2, proBNP, angiopoietin-2 and pentraxin-3, but lower level of interleukin-8. No difference in clinical outcomes was observed between the groups. Three distinct clusters were identified with the poorest outcomes (Log-rank p = 0.029) in cluster 2 (hypertensive and fibroinflammatory) which had equal representation of SR and AF. Conclusions Presence of AF in HFpEF is associated with cardiac structural and functional changes together with altered expression of several fibro-inflammatory biomarkers. Distinct phenotypes exist in HFpEF which may have differing clinical outcomes.

Introduction Limited data exist on the optimum dose of contrast needed for tissue characterisation using CMR at 3T. We assessed whether reduced contrast dose could provide similar quality of late gadolinium enhanced (LGE) images in standard clinical CMR. Materials and Methods This analysis included patients undergoing clinical CMR scans at Glenfield hospital, Leicester for various indications between November 2022-June 2023. All participants had LGE imaging performed as per clinical practice (either segmented, single-shot or free-breathing motion-corrected) using a 3T scanner (either Siemens Skyra or Vida). Patients underwent CMR scans with a lower dose of contrast (Clariscan, GE HealthCare) at 0.1mmol/kg and were compared with patients receiving the standard dose of 0.15mmol/kg in the previous three months. Scan quality and LGE images were evaluated retrospectively with blinding to dose of contrast given using a grading of non-diagnostic, diagnostic, good or optimum. LGE-to-blood pool ratio was calculated for all participants who had LGE present. Cost-benefit analysis was assessed using standard contrast tariffs and number of vials used per patient. Results 101 participants with standard-dose and 100 participants with low-dose were compared. There was no significant difference in the type of LGE sequence used in the two groups. There was no significant difference in overall scan quality in the standard dose group (non-diagnostic 6%, diagnostic 20%, good 47%, optimum 28%) compared to low dose (non-diagnostic 3%, diagnostic 18%, good 44% and optimum 34%). Likewise, there was no difference in the LGE image quality in the standard dose group (non-diagnostic 3%, diagnostic 17%, good 42%, optimum 39%) compared to low dose (non-diagnostic 2%, diagnostic 7%, good 41%, optimum 50%). Proportion of patients with LGE present was similar between the two groups (Standard 44% vs. Low dose 39%). LGE-to-blood pool ratio was higher in the low-dose compared to the standard-dose group (1.12 [0.71–1.30] vs. 0.76 [0.55–1.05]; P=0.010). Amongst the low-dose group, there was a cost-saving of 29%. Discussion Conclusion The use of standard-dose contrast is not superior to using lower dose contrast when assessing LGE images. Low-dose contrast provides higher LGE-blood pool ratio and is associated with reduced service costs. Acknowledgements

Introduction Dysregulated epicardial adipose tissue (EAT) may play an important role in the development of heart failure in Type 2 Diabetes (T2D). EAT can be measured using computed tomography (CT) but there are limited data directly comparing this with CMR-measured EAT, which offers unique advantages. This study aimed to assess CT- and CMR-measured EAT in people with T2D. Materials and Methods In this single-centre, prospective study of people with and without T2D, participants underwent phenotyping including an ECG-gated non-contrast CT and a multiparametric stress CMR at 3T. CT total EAT volume was determined using a fully automated deep learning algorithm incorporating the whole heart. CMR EAT area was quantified using a 4-chamber long axis cine image at end-systole obtained using a steady-state free precession technique. Contouring was performed by a single observer using two methods to measure EAT area: 1) Contour around the right ventricle starting from the atrioventricular groove up to the left ventricular apex (RV-EAT), and 2) contour around both ventricles (BV-EAT). Values were indexed to height. Twenty scans underwent repeat assessment by a second observer for inter-observer variability. Results 93 people with T2D (age 64.0±6.5, males 60.2%, HbA1c 7.0 [6.5–7.9]%) and 32 controls (age 59.0±7.5, males 65.6%, HbA1c 5.5 [5.3–5.7]%) were included in this analysis. The T2D group had significantly higher body mass index compared to controls and greater proportion of people with hypertension and hypercholesterolaemia. T2D participants had greater indexed EAT compared to controls as measured by CT (81.3±32.7 vs. 48.4±27.4 mL/m, P<0.001) and CMR (RV-EAT: 3.28±1.52 vs. 2.65±1.44 cm2/m, P=0.042; BV-EAT: 4.97±1.99 vs. 4.07±1.92 cm2/m, P=0.027). CT-EAT positively correlated with CMR measured RV-EAT (Whole cohort: r=0.599, P<0.001; T2D: r=0.552, P<0.001; Controls: r=0.712, P<0.001) and BV-EAT (Whole cohort: r=0.688, P<0.001; T2D: r=0.649 P<0.001; Controls r=0.769, P<0.001). Inter-observer variability analysis demonstrated moderate reliability for RV-EAT (ICC: 0.636, Bias: 1.153, LLOA: -4.197, ULOA: 6.503) and BV-EAT (ICC: 0.567, Bias: 1.522, LLOA: -4.292, ULOA: 7.336). Discussion Conclusion CMR-measured RV-EAT and BV-EAT have moderate correlation with CT-measured EAT and have moderate inter-observer reliability. Further work needs to assess association between CMR-measured EAT with cardiac structure, function and outcomes. Acknowledgements

Background: Dysregulated myocardial calcium handling has been demonstrated in ischemic, non-ischemic and diabetic cardiomyopathy. Manganese-enhanced MRI (MEMRI) provides a unique method to quantify in-vivo myocardial calcium uptake but no studies have so far utilized MEMRI in patients with aortic stenosis (AS). We sought to: 1) determine whether myocardial calcium uptake is perturbed in people with severe AS, and 2) assess change in calcium uptake following aortic valve replacement (AVR). Methods: In this prospective, pilot, case-control study, adults with severe AS underwent MEMRI before and after AVR. A group of healthy controls were also recruited. The primary outcome was the rate of manganese uptake (Ki) as assessed by Patlak modeling to act as a surrogate of myocardial calcium uptake. Comparison of Ki between groups was adjusted for age, body mass index (BMI) and systolic blood pressure. Results: Twenty-eight controls and ten subjects with severe AS (age 72 [61-75] years, 8 male, 7 symptomatic, valve area 0.81 [0.74-1.0] cm2) were recruited, with seven returning for repeat scans post-AVR. AS patients had higher BMI and blood pressure, and a greater incidence of hyperlipidemia compared to controls. Baseline left ventricular (LV) volumes were similar between the groups, but the AS patients had higher indexed left ventricular mass. Global longitudinal strain and peak early diastolic strain rate were lower in the AS group. There was no significant difference in Ki between patients with severe AS and controls (7.09 [6.33-8.99] vs. 8.15 [7.54-8.78] mL/100g of tissue/min, P=0.815). Following AVR, there was regression in indexed LV mass (68 [51-79] to 49 [47-65] g/m2, P=0.018) and mass-volume ratio (0.94 [0.80-1.13] to 0.74 [0.71-0.82] g/mL, P=0.028) but no change in Ki was seen (7.35 [6.81-8.96] to 7.11 [6.16-8.01] mL/100 g of tissue/min, P=0.499). Conclusions: Despite clear features of adverse LV remodeling and systolic dysfunction, patients with severe AS demonstrated no alteration in calcium uptake at baseline compared to controls. Moreover, AVR led to reverse LV remodeling but no notable change in calcium uptake was seen. This may suggest that altered myocardial calcium handling does not play a significant pathophysiological role in AS.