Purpose To examine the impact of formalin fixation on biventricular cardiac diffusion tensor imaging (cDTI) parameters in a miniature swine model, using histological findings as the reference standard. Methods High-resolution ex-vivo cDTI data of one healthy miniature swine were acquired at baseline and on days 5 and 9 after formalin fixation. Histology with hematoxylin and eosin staining was employed to assess helix angle (HA) and HA transmurality on day 10 following fixation. In total, 64 myocardial segments, including 48 left ventricular (LV) and 16 right ventricular (RV) segments, were analyzed in head-to-head comparison. Results For this heart, subepicardial HA became more negative after formalin fixation on cDTI, and subendocardial HA showed a positive increase, which led to a significant elevation in HA transmurality (all P < .05). Mean diffusivity decreased in LV and RV walls during the first 5 days of fixation (P < .05 and P < .01, respectively), with a further marked decrease in the LV wall over the next 4 days (P < .001) but no significant change in the RV wall. HAs derived from cDTI at baseline and on days 5 and 9 following fixation exhibited excellent consistencies in the LV wall and poor-to-good consistencies in the RV wall with those assessed with histology, among which baseline HA yielded the highest interclass correlation coefficient of 0.968 in the LV wall and 0.812 in the RV wall. Conclusion In this pilot study, formalin fixation had an impact on both cardiomyocyte orientations and diffusion properties derived from cDTI.

BACKGROUND:Automation in cardiovascular magnetic resonance (CMR) scans holds the potential to improve examination efficiency and workflow consistency. Prospective clinical evidence validating automated scan workflows in routine CMR practice remains limited. METHODS:In this prospective randomized study, consecutive patients referred for non-stress CMR were assigned to either an automated or a manual free-breathing scanning workflow. The fully automated workflow integrated automated plane prescription of multiple steps required for successful image acquisition. The primary endpoint was total examination time; secondary endpoints included plane prescription accuracy, image quality scores, scanner idle time, and technologist workload. RESULTS:Of 255 screened patients, 221 were included (automated, n = 109; manual, n = 112). All examinations were diagnostically adequate. The automated and manual workflows showed a similarly low incidence of plane prescription misalignment, corresponding to 19.3% (21/109) and 17.9% (20/112) misalignment events per examination, respectively, with no significant difference between groups (0.19 vs. 0.18 events per examination, P = 0.780). No significant differences were observed across imaging planes or technologist experience levels, and image quality scores were comparable between workflows (2.74 ± 0.67 vs. 2.69 ± 0.70, P = 0.547). However, the automated scanning workflow significantly reduced total examination time (19.16 ± 2.32 vs. 21.25 ± 2.25 min, P < 0.001) and scanner idle time (7.80 ± 1.80 vs. 10.12 ± 2.03 min, P < 0.001), with consistent savings across all experience levels. Operator workload was also substantially lower with automated scanning, evidenced by fewer mouse clicks and keystrokes (both P < 0.01). CONCLUSIONS:An automated CMR scanning workflow improves examination efficiency and reduces operator workload without compromising image quality or plane prescription accuracy, supporting its integration in routine clinical CMR practice.

BACKGROUND:The prognostic value of serial myocardial fibrosis assessments in hypertrophic cardiomyopathy (HCM) remains to be elucidated. OBJECTIVES:The study aims to investigate late gadolinium enhancement (LGE) progression via follow-up cardiac magnetic resonance (CMR) in HCM patients and its prognostic value. METHODS:Retrospective analysis included 313 HCM patients with 2 CMR studies (between 2010 and 2019). LGE mass progression (ΔLGE mass/y) was defined as the increase in grams of enhanced myocardium divided by interval scan years. The primary endpoint included all-cause mortality, heart transplantation, aborted sudden cardiac death, unscheduled hospitalization for heart failure, and stroke. The secondary endpoint included all-cause mortality, aborted sudden cardiac death, and heart transplantation. Maximally selected rank statistical analysis was conducted to identify the optimal cutoff for ΔLGE mass/y. RESULTS:LGE mass progressed from a median of 2.9 g at the first CMR study to 8.3 g at the second CMR study (median scan interval 4.2 years). During a median follow-up period of 3.4 years after the second CMR study, 69 patients reached the primary endpoint, 17 of whom reached the secondary endpoint. For the primary and secondary endpoints, the optimal cutoffs for ΔLGE mass/y were >1.50 and 3.75 g/y, respectively. Multivariable Cox regression analysis showed that ΔLGE mass/y >1.50 g/year was an independent predictor of the primary endpoint (HR: 2.22 [95% CI: 1.13-4.34]; P = 0.02). The addition of ΔLGE mass/y to the baseline model improved the discrimination (C-statistic = 0.81 vs 0.84) and risk reclassification (net reclassification improvement = 0.27, integrated discrimination improvement = 0.02; P < 0.001 for both). External validation in 6 multicenter data sets confirmed the prognostic value of ΔLGE mass/y. CONCLUSIONS:In HCM patients, myocardial fibrosis increased over time. Serial assessments of myocardial fibrosis on CMR may improve risk stratification and clinical decision-making.

Purpose To histologically validate T1 mapping for quantitative assessment of mild-to-severe myocardial fibrosis in a swine model of chronic myocardial infarction (MI). Materials and Methods In this animal study conducted from June 2021 to July 2022, 18 male miniature swine (16 MI animals; two healthy control animals) underwent cardiac MRI, including cine imaging, late gadolinium enhancement (LGE) imaging, T1 mapping, and extracellular volume fraction (ECV) mapping. Two T1 mapping techniques, modified Look-Locker inversion recovery (MOLLI) and shortened MOLLI (ShMOLLI), were evaluated. Pathologic myocardial slices were categorized as infarcted, peri-infarct, remote, and healthy based on triphenyl tetrazolium chloride staining. Fibrosis was quantified using collagen volume fraction (CVF) and classified as severe (CVF, ≥30%), moderate (CVF, >15%-30%), or mild (CVF, 3%-15%). Associations between cardiac MRI parameters and CVF were assessed, and diagnostic performance in detecting myocardial fibrosis was evaluated using the area under the receiver operating characteristic curve (AUC). Results For detection of severe fibrosis, LGE, T1 mapping, and ECV all demonstrated excellent diagnostic performance (AUC range, 0.88-0.96). ECV using ShMOLLI showed significantly higher performance than ECV using MOLLI for detecting severe fibrosis (AUC, 0.96 vs 0.88; P = .03) and MI (AUC, 0.93 vs 0.87; P = .045), as well as the strongest correlation with histologic CVF (r = 0.90 for ECV with ShMOLLI, 0.84 for ECV with MOLLI, 0.74 for T1 with ShMOLLI, 0.77 for T1 with MOLLI, and 0.74 for LGE extent). In remote myocardium with mild fibrosis (CVF, 8.81%) compared with healthy myocardium (CVF, 2.21%), only T1 with ShMOLLI and ECV with ShMOLLI demonstrated significant differences (P < .05), whereas LGE and MOLLI-based parameters did not. Conclusion Cardiac MRI helped detect mild-to-severe myocardial fibrosis in close agreement with histologic findings. While all techniques helped accurately identify severe fibrosis, T1 mapping-particularly ECV using the ShMOLLI sequence-provided unique sensitivity for detecting low-grade fibrosis, underscoring the importance of sequence selection for precise myocardial tissue characterization and clinical trial design. Keywords: Myocardial Fibrosis, Heart, Histological Techniques, Magnetic Resonance Imaging, Swine Supplemental material is available for this article. © RSNA, 2026.

To validate the use of full free-breathing (FB) motion-corrected (MoCo) cardiac MRI examinations in assessing biventricular systolic function and tissue characterization compared with the reference standard breath-hold (BH) examination. In this prospective study, 216 patients underwent 3-T cardiac MRI. Of these patients, 113 underwent FB motion-corrected cardiac cine imaging in addition to standard BH cine imaging; the remaining 103 patients underwent FB motion-corrected late gadolinium enhancement (LGE) imaging in addition to standard BH LGE imaging. Image quality was assessed with a five-point scale (1 = nondiagnostic, 5 = very good). Left ventricular (LV) and right ventricular (RV) functional parameters and LGE mass in BH and FB examinations were analyzed using Wilcoxon signed-rank test, Bland-Altman plots, and linear regression. Subjective image quality between the FB and BH groups was comparable for cine imaging (4.02 ± 0.81 vs. 4.14 ± 0.79, P = 0.220) but was significantly better in the FB group for LGE (4.79 ± 0.46 vs. 4.16 ± 0.79, P < 0.001). Scan times for both cine (149.46 ± 32.29 s vs. 392.61 ± 47.02 s, P < 0.001) and LGE (198.12 ± 41.90 s vs. 361.69 ± 46.17 s, P < 0.001) were consistently shorter in the FB group than in the BH group. No significant differences were found in biventricular volumetric parameters or LGE mass measurements between FB and BH groups. Bland-Altman plots and linear regression analysis showed good agreement for LV and RV functional parameters and LGE mass in BH and FB sequences. Full FB cardiac MRI produces high-quality images and could be a suitable alternative for patients who cannot tolerate multiple BHs or long examination times.

Background: Myocardial fibrosis predicts adverse outcomes in myocardial infarction (MI) and other cardiovascular conditions. Cardiovascular magnetic resonance (CMR) can non-invasively detect focal and diffuse myocardial fibrosis, but comprehensive validation against histology remains scarce. Aims: To assess the comparative diagnostic performance of CMR methods in detecting myocardial fibrosis, using a mini-swine model and histology as gold standard. Methods: Eighteen mini-swine (16 MI; 2 healthy) underwent CMR cine, LGE, T1- and ECV-mapping. Two commonly-used T1-mapping methods - MOLLI 5(3)3 and ShMOLLI 5(1)1(1)1 - were included. Pathological sections were categorized as infarcted, peri-infarct, remote and healthy myocardium based on triphenyl tetrazolium chloride staining. Fibrotic burden was quantified by collagen volume fraction (CVF) into severe (CVF?30%), moderate (CVF=10-25%), and mild (CVF=3-14%). The relationships between LGE, T1, ECV and CVF, and diagnostic performance using area-under-the-curve (AUC), were analyzed. Results: For detecting severe fibrosis, LGE, T1 and ECV all had excellent diagnostic performance (AUC: LGE=0.93, ECVShMOLLI=0.96, T1ShMOLLI=0.91, T1MOLLI=0.93, ECVMOLLI=0.88). ECVShMOLLI showed significantly better discriminatory accuracy than ECVMOLLI in detecting severe fibrosis and MI (both p<0.05), with the highest correlation to CVF (ECVShMOLLI r=0.86, ECVMOLLI r=0.82, T1ShMOLLI r=0.77, T1MOLLI r=0.77, semi-quantitative LGE r=0.75). Only T1ShMOLLI and ECVShMOLLI, but not LGE or T1MOLLI/ECVMOLLI, differentiated remote myocardium with mild fibrosis (CVF=8.23%) from healthy myocardium (CVF=2.01%). Conclusions: CMR can detect severe to mild myocardial fibrosis as validated against histology. For low-grade fibrosis, T1-mapping significantly outperformed LGE. Choice of CMR methodologies matters for myocardial fibrosis detection, which has importance for clinical trial design. ### Competing Interest Statement The authors have declared no competing interest.

Myocardial fibrosis significantly impacts prognosis in various cardiovascular diseases, yet its role in alcoholic cardiomyopathy (ACM) remains poorly understood. This study evaluates the prognostic value of myocardial fibrosis, as detected by cardiac magnetic resonance (CMR), in ACM patients. We conducted a retrospective analysis of consecutive ACM patients who underwent enhanced CMR from August 2015 to October 2023. Assessment of myocardial fibrosis was performed using late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) fraction. The primary outcome was a composite of cardiac-related mortality, heart transplantation, hospitalization for heart failure, life-threatening arrhythmias, and the need for implantable cardioverter-defibrillator or cardiac resynchronization therapy. A total of 141 male patients were finally enrolled with 27.7

BACKGROUND:Conventional cardiovascular magnetic resonance (CMR) examinations require patients to repeatedly hold their breath, which can reduce examination efficiency and pose challenges for patients unable to do so. This study aimed to demonstrate the feasibility and effectiveness of a full free-breathing CMR protocol in clinical practice. METHODS:Patients prospectively enrolled in this study underwent a full free-breathing CMR exam on a 3T scanner between June 1 and June 30, 2024. Acquisition time and image quality were assessed. Cine and flow imaging were compared with those acquired with the conventional breath-holding CMR protocol. Other sequences, including T1/T2 mapping and late gadolinium enhancement (LGE), were evaluated quantitatively and qualitatively, respectively. Group comparisons were performed using the Wilcoxon signed-rank test or paired t-test. Consistency was assessed using Kappa statistics, Bland-Altman statistics, intraclass correlation coefficient (ICC), and linear regression. RESULTS:A total of 211 patients were evaluated (median age: 53 years [IQR: 38-63]; range: 10-82 years; 145 men). The mean acquisition time for full free-breathing CMR was 22.6±3.7 min. The median image quality scores for cine and LGE images acquired with free-breathing CMR were 4 (IQR: 4-4) and 5 (IQR: 4-5), respectively. Compared with conventional breath-holding CMR, the end-diastolic volume (EDV), end-systolic volume (ESV), EDV index, and ESV index measured by free-breathing CMR were slightly higher (all P＜0.05), whereas the left ventricular ejection fraction and left ventricular mass were slightly lower (both P＜0.05). Nonetheless, the two methods demonstrated good agreement and correlation (r values: 0.85-0.99). Native T1 and T2 values in healthy subjects from free-breathing CMR were 1214.9±16.7ms and 38.4±3.2ms, respectively. Among the 211 patients, 147 were LGE positive. Except for five patients with image quality scores below 3, all others had scores of 3 or higher. CONCLUSION:Full free-breathing CMR examinations are feasible and effective in clinical practice, significantly reduce scan time while maintaining high image quality.

Background:Recently, late gadolinium enhancement (LGE) has been identified as an important risk factor in pediatric hypertrophic cardiomyopathy (HCM). However, its prognostic significance in pediatric HCM remains to be fully validated, particularly in Asian population. This study aims to assess the prognostic value of LGE and explore its incremental utility in predicting sudden cardiac death (SCD) in pediatric HCM using data from a Chinese cohort. Methods:231 primary HCM patients ≤18 years of age with cardiac magnetic resonance (CMR) were retrospectively and consecutively enrolled in a single center. The composite outcomes included SCD or equivalent events and heart failure-related events. Findings:Of 231 patients (median age 15, IQR: 12-16), LGE was present in 195 (84.4%) with a median LGE extent of 4.7% (IQR: 2.0%-9.2%). During a median follow-up of 62 months (IQR: 39-85), 26 (11.3%) patients reached composite outcomes, and 13 (5.6%) patients experienced SCD events. Kaplan-Meier analysis showed a significantly increased risk of composite outcomes (log-rank P < 0.001) and SCD (log-rank P < 0.001) in the group with LGE extent ≥5%. In multivariable Cox analysis adjusted by clinical and imaging factors, LGE extent was independently associated with composite outcomes (adjusted HR: 1.15; P < 0.001) and SCD (adjusted HR: 1.11; P = 0.009). For SCD events, the addition of LGE extent could improve the model performance of HCM Risk-Kids model (C-statistics: 0.65 versus 0.79, P = 0.015) and PRIMaCY model (C-statistics: 0.62 versus 0.82, P = 0.002), respectively. Interpretation:In Chinese pediatric HCM, LGE serves as a risk factor in predicting adverse outcomes and may enhance SCD risk stratification strategies. Funding:This study was funded by the National Key Research and Development Program of China (2021YFF0501400 and 2021YFF0501404), the Key Project of the National Natural Science Foundation of China (82430066), and the Yunnan Province Science and Technology Platform and Talent Project (202305AF150033).

BACKGROUND The cumulative burden of hypertrophic cardiomyopathy (HCM) is significant, with a noteworthy percentage (10%-15%) of patients with HCM per year experiencing major adverse cardiovascular events (MACEs). A current risk stratification scheme for HCM had only limited accuracy in predicting sudden cardiac death (SCD) and failed to account for a broader spectrum of adverse cardiovascular events and cardiac magnetic resonance (CMR) parameters. OBJECTIVES This study sought to develop and evaluate a machine learning (ML) framework that integrates CMR imaging and clinical characteristics to predict MACEs in patients with HCM. METHODS A total of 758 patients with HCM (67% male; age 49 +/- 14 years) who were admitted between 2010 and 2017 from 4 medical centers were included. The ML model was built on the internal discovery cohort (533 patients with HCM, admitted to Fuwai Hospital, Beijing, China) by using the light gradient-boosting machine and internally evaluated using cross-validation. The external test cohort consisted of 225 patients with HCM from 3 medical centers. A total of 14 CMR imaging features (strain and late gadolinium enhancement [LGE]) and 23 clinical variables were evaluated and used to inform the ML model. MACEs included a composite of arrhythmic events, SCD, heart failure, and atrial fibrillation-related stroke. RESULTS MACEs occurred in 191 (25%) patients over a median follow-up period of 109.0 months (Q1-Q3: 73.0-118.8 months). Our ML model achieved areas under the curve (AUCs) of 0.830 and 0.812 (internally and externally, respectively). The model outperformed the classic HCM Risk-SCD model, with significant improvement (P < 0.001) of 22.7% in the AUC. Using the cubic spline analysis, the study showed that the extent of LGE and the impairment of global radial strain (GRS) and global circumferential strain (GCS) were nonlinearly correlated with MACEs: an elevated risk of adverse cardiovascular events was observed when these parameters reached the high enough second tertiles (11.6% for LGE, 25.8% for GRS,-17.3% for GCS). CONCLUSIONS ML-empowered risk stratification using CMR and clinical features enabled accurate MACE prediction beyond the classic HCM Risk-SCD model. In addition, the nonlinear correlation between CMR features (LGE and left ventricular pressure gradient) and MACEs uncovered in this study provides valuable insights for the clinical assessment and management of HCM. (c) 2024 Published by Elsevier on behalf of the American College of Cardiology Foundation.

This study aimed to evaluate the prognostic value of left atrial (LA) strain in patients with apical hypertrophic cardiomyopathy (ApHCM), as assessed by cardiac magnetic resonance (CMR) imaging. Four hundred and five consecutive patients with ApHCM who underwent CMR examination were retrospectively included. The study endpoint included all-cause death, heart transplant, aborted sudden cardiac death, hospitalization for heart failure, stroke, and new-onset atrial fibrillation (AF). After a median follow-up of 97 months, 75 patients (18.5

The cumulative burden of hypertrophic cardiomyopathy (HCM) is significant, with a noteworthy percentage (10%-15%) of patients with HCM per year experiencing major adverse cardiovascular events (MACEs). A current risk stratification scheme for HCM had only limited accuracy in predicting sudden cardiac death (SCD) and failed to account for a broader spectrum of adverse cardiovascular events and cardiac magnetic resonance (CMR) parameters.

Rationale and Objectives: It is still challenging for cardiac magnetic resonance (CMR) to detect ischemic heart disease (IHD) without the use of gadolinium contrast. We aimed to evaluate the potential value of adenosine triphosphate (ATP) stress myocardial strain derived from feature tracking (FT) as a novel method for detecting IHD in a swine model. Materials and Methods: CMR cines, myocardial perfusion imaging at rest and during ATP stress, and late gadolinium enhancement were obtained in both control and IHD swine. Normal, remote, ischemic, and infarcted myocardium were analyzed. The diagnostic accuracy of myocardial strain for infarction and ischemia was assessed using coronary angiography and pathology as reference. Results: Eleven IHD swine and five healthy control swine were enrolled in this study. Strain parameters, even at rest, were associated with myocardial ischemia and infarction(all p < 0.05). The area under receiver operating characteristic curve (AUC) values of all strain parameters for detecting infarcted myocardium exceeded 0.900 (all p < 0.05). The AUC values for detecting ischemic myocardium were as follows: 0.906 and 0.847 for stress and rest radial strain, 0.763 and 0.716 for stress and rest circumferential strain, 0.758 and 0.663 for stress and rest longitudinal strain (all p < 0.001). Heat maps demonstrated that all strain parameters showed mild to moderate cor-relations with the stress myocardial blood flow and myocardial perfusion reserve (all p < 0.05). Conclusion: CMR-FT-derived ATP stress myocardial strain shows promise as a noninvasive method for detecting myocardial ischemia and infarction in an IHD swine model, with rest strain parameters offering potential as a needle-free diagnostic option.

This preclinical study has established that chronic coronary artery stenosis can induce significant myocyte loss with modest global replacement fibrosis that leads to global LV dysfunction and varying degrees of congestive heart failure.

Background and Aims Identifying patients with hypertrophic cardiomyopathy (HCM) who are candidates for implantable cardioverter defibrillator (ICD) implantation in primary prevention for sudden cardiac death (SCD) is crucial. The aim of this study was to externally validate the 2022 European Society of Cardiology (ESC) model and other guideline-based ICD class of recommendation (ICD-COR) models and explore the utility of late gadolinium enhancement (LGE) in further risk stratification. Methods Seven hundred and seventy-four consecutive patients who underwent cardiac magnetic resonance imaging were retrospectively enrolled. Results Forty-six (5.9%) patients reached the SCD-related endpoint during 7.4 ± 2.5 years of follow-up. Patients suffering from SCD had higher ESC Risk-SCD score (4.3 ± 2.4% vs. 2.8 ± 2.1%, P < .001) and LGE extent (13.7 ± 9.4% vs. 4.9 ± 6.6%, P < .001). Compared with the 2014 ESC model, the 2022 ESC model showed increased area under the curve (.76 vs. .63), sensitivity (76.1% vs. 43.5%), positive predictive value (16.8% vs. 13.6%), and negative predictive value (98.1% vs. 95.9%). The C-statistics for SCD prediction of 2011 American College of Cardiology (ACC)/American Heart Association (AHA), 2014 ESC, 2020 AHA/ACC, and 2022 ESC models were .68, .64, .76 and .78, respectively. Furthermore, in patients without extensive LGE, LGE ≥5% was responsible for seven-fold SCD risk after multivariable adjustment. Whether in ICD-COR II or ICD-COR III, patients with LGE ≥5% and <15% showed significantly worse prognosis than those with LGE <5% (all P < .001). Conclusions The 2022 ESC model performed better than the 2014 ESC model with especially improved sensitivity. LGE enabled further risk stratification based on current guidelines.

Purpose:To assess the efficacy of cardiac MRI stress T1 mapping in detecting ischemic and infarcted myocardium in a miniature-swine model, using pathologic findings as the reference standard.Materials and Methods:Ten adult male Chinese miniature swine, with coronary artery stenosis induced by an ameroid constrictor, and two healthy control swine were studied. Cardiac 3-T MRI rest and adenosine triphosphate stress T1 mapping and perfusion images, along with resting and late gadolinium enhancement images, were acquired at baseline and weekly up to 4 weeks after surgery or until humanely killed. A receiver operating characteristic analysis was used to analyze the performance of T1 mapping in the detection of myocardial ischemia.Results:In the experimental group, both the infarcted myocardium (ΔT1 = 10 msec ± 2 [SD]; ΔT1 percentage = 0.7% ± 0.1) and ischemic myocardium (ΔT1 = 10 msec ± 2; ΔT1 percentage = 0.9% ± 0.2) exhibited reduced T1 reactivity compared with the remote myocardium (ΔT1 = 53 msec ± 7; ΔT1 percentage = 4.7% ± 0.6) and normal myocardium (ΔT1 = 56 msec ± 11; ΔT1 percentage = 4.9% ± 1.1). Receiver operating characteristic analysis demonstrated high diagnostic performance of ΔT1 in detecting ischemic myocardium, with an area under the curve (AUC) of 0.84 (P < .001). Rest T1 displayed high diagnostic performance in detecting infarcted myocardium (AUC = 0.95; P < .001). When rest T1 and ΔT1 were combined, the diagnostic performance for both ischemic and infarcted myocardium were improved (AUCs, 0.89 and 0.97, respectively; all P < .001). The collagen volume fraction correlated with ΔT1, ΔT1 percentage, and Δ extracellular volume percentage (r = -0.70, -0.70, and -0.50, respectively; P = .001, .001, and .03, respectively).Conclusion:Using histopathologic validation in a swine model, noninvasive cardiac MRI stress T1 mapping demonstrated high performance in detecting ischemic and infarcted myocardium without the need for contrast agents.Keywords: Coronary Artery Disease, MRI, Myocardial Ischemia, Rest T1 Mapping, Stress T1 Mapping, Swine Model Supplemental material is available for this article. © RSNA, 2023See also commentary by Burrage and Ferreira in this issue.

Purpose:To determine the association of myocardial fibrosis and left ventricular (LV) dyssynchrony measured using cardiac MRI with late gadolinium enhancement (LGE) and feature tracking (FT), respectively, with response to cardiac resynchronization therapy (CRT) for nonischemic dilated cardiomyopathy (DCM).Materials and Methods:This retrospective study included 98 patients (mean age, 59 years ± 10 [SD]; 54 men) who had nonischemic DCM, as assessed with LGE cardiac MRI before CRT. Cardiac MRI FT-derived dyssynchrony was defined as the SD of the time-to-peak strain (TTP-SD) of the LV segments in three directions (longitudinal, radial, and circumferential). CRT response was defined as a 15% increase in LV ejection fraction (LVEF) at echocardiography at 6-month follow-up, and then, long-term cardiovascular events were assessed. The likelihood ratio test was used to evaluate the incremental prognostic value of LGE and dyssynchrony parameters.Results:Seventy-one (72%) patients showed a favorable LVEF response following CRT. LGE presence (odds ratio: 0.14 [95% CI: 0.04, 0.47], P = .002; and hazard ratio: 3.52 [95% CI: 1.37, 9.07], P = .01) and lower circumferential TTP-SD (odds ratio: 1.04 [95% CI: 1.02, 1.07], P = .002; and hazard ratio: 0.98 [95% CI: 0.96, 1.00], P = .03) were independently associated with LVEF nonresponse and long-term outcomes. Combined LGE and circumferential TTP-SD provided the highest discrimination for LVEF nonresponse (area under the receiver operating characteristic curve [AUC]: 0.89 [95% CI: 0.81, 0.94], sensitivity: 84.5% [95% CI: 74.0%, 92.0%], specificity: 85.2% [95% CI: 66.3%, 95.8%]) and long-term outcomes (AUC: 0.84 [95% CI: 0.75, 0.91], sensitivity: 76.9% [95% CI: 56.4%, 91.0%], specificity: 87.0% [95% CI: 76.7%, 93.9%]).Conclusion:Myocardial fibrosis and lower circumferential dyssynchrony assessed with pretherapy cardiac MRI were independently associated with unfavorable LVEF response and long-term events following CRT in patients with nonischemic DCM and may provide incremental value in predicting prognosis.Keywords: MR Imaging, Cardiac, Outcomes Analysis Supplemental material is available for this article. © RSNA, 2023.

The prevalence of hypertension (HTN) continues to increase in developing countries.The control rate of HTN is relatively low.The management of resistant HTN remains problematic.Recently, a promising new non-pharmacological technology using endovascular ultrasound renal denervation (uRDN) had shown its remarkable effect in resistant HTN patients.In this article, we pooled the currently available data concerning uRDN and conducted a meta-analysis to evaluate the efficacy of this technique systematically in patient with resistant HTN.Finally, a total of 3 studies out of 636 identified articles were retained.Compared to the blood pressure (BP) at randomization, the ambulatory systolic BP in daytime and nighttime reduced significantly after the procedure of uRDN.The reduction from baseline in 24-hour ambulatory systolic BP was 9.07 mm Hg.In conclusion, that uRDN was effective in reducing daytime and nighttime ambulatory systolic BP in resistant HTN populations.More randomized controlled trials with large scales and long-term follow-up are deserved in the future.