Native T1, extracellular volume fraction (ECV), and late gadolinium enhancement (LGE) characterize myocardial tissue and relate to patient prognosis in a variety of diseases, including pulmonary hypertension. The purpose of this study was to evaluate if left ventricle (LV) fibrosis measurements have prognostic value for cardiac outcomes in pulmonary hypertension subgroups. 54 patients with suspected pulmonary hypertension underwent right-heart catheterization and were classified into pulmonary hypertension subgroups: pre-capillary component (PreCompPH) and isolated post-capillary (IpcPH). Cardiac magnetic resonance imaging (MRI) scans were performed with the acquisition of balanced cine steady-state free precession, native T1, and LGE pulse sequences to measure cardiac volumes and myocardial fibrosis. Associations between cardiac events and cardiac MRI measurements were analyzed within PreCompPH and IpcPH patients. IpcPH: LV native T1 was higher in patients who experienced a cardiac event within two years vs. those who did not. In patients with LV native T1 > 1050 ms, the rate of cardiac events was higher. ECV and quantitative LGE did not differ between groups. PreCompPH: native T1, ECV, and quantitative/qualitative LGE did not differ between patients who experienced a cardiac event within two years vs. those who did not. LV native T1 may have potential value for forecasting cardiac events in IpcPH, but not in PreCompPH, patients.

AIMS A shorter cardiac rest period within a cardiac cycle is usually thought to be a result of a fast heart rate, and its clinical relevance has long been ignored. The aim of the present study was to test the hypothesis that the length of cardiac rest periods is altered in postcapillary pulmonary hypertension (PH). METHODS AND RESULTS Twenty-six patients with postcapillary PH and 20 healthy controls were recruited for cardiac magnetic resonance imaging (MRI) scans. All participants had a heart rate no higher than 80 beats/minute. Cine magnetic resonance imaging (MRI, acquired at a four-chamber view) was analyzed to determine the length of cardiac rest periods at end-systole and mid-to-late diastole. PH patients had a shorter rest period at mid-to-late diastole than controls (17.5 ± 8.7% vs. 24.2 ± 4.2%, P = 0.003). Receiver operating characteristic (ROC) curves showed that the proportion of the rest period in diastole (defined as the length of diastasis/diastole) can discriminate PH patients from controls [area under the curve (AUC) = 0.83, 95% confidence interval (CI): 0.71-0.96]. The existence of postcapillary PH was a significant contributor (β = -5.537, P = 0.023) to shorter cardiac rest periods at mid-to-late diastole after adjusting for potential confounders, including age, sex, heart rate, and blood pressure. CONCLUSIONS Postcapillary PH is independently associated with shorter cardiac rest periods at mid-to-late diastole. The length of cardiac rest periods has the potential to become a novel quantitative imaging biomarker for indicating cardiovascular health.

This study investigated the impact of bicuspid aortic valve (BAV) on valve morphology and motion as well as proximal and aortic hemodynamics using a same-day echocardiography and cardiac MRI. Transthoracic echocardiography, two-dimensional cine MRI of the aortic valve, and aortic 4D flow MRI were performed on the same day in 9 normofunctional BAV patients (age = 41 ± 12, 3 female), 4 BAV with moderate to severe aortic stenosis (AS) (age = 63 ± 5, 1 female), and 36 healthy tricuspid aortic valve controls (age = 52 ± 10, 21 female). Valve opening and closing timings and transvalvular peak velocity were measured using B-mode and Doppler echocardiogram, respectively. Valve orifice morphology at a fully-opened state was characterized using cine MRI. Ascending aortic (AAo) wall shear stress (WSS) was measured using 4D flow MRI data. Valve motion timings were similar between BAV and controls. BAV was associated with an increased orifice aspect ratio (1.44 ± 0.11 vs. 1.10 ± 0.13, P < 0.001), transvalvular peak velocity (1.5 ± 0.3 vs. 1.2 ± 0.2 m/s, P < 0.001) and maximum AAo WSS (1.62 ± 0.31 vs. 0.91 ± 0.24 Pa, P < 0.001). The increased orifice aspect ratio was associated with the increase in transvalvular peak velocity (r = 0.80, P < 0.0001) and maximum AAo WSS (r = 0.83, P < 0.0001). Transvalvular peak velocity was also positively correlated with maximum AAo WSS (r = 0.83, P < 0.0001). A same-day echo and MRI imaging allows for a comprehensive assessment of the impact of aortic valve disease on valve function and hemodynamics. In this pilot application to BAV, we found increased orifice aspect ratio may be responsible for increased transvalvular peak velocity and maximum AAo WSS.

Cardiac magnetic resonance imaging (MRI) is emerging as an alternative to right heart catheterization for the evaluation of pulmonary hypertension (PH) patients. The aim of this study was to compare cardiac MRI-derived left ventricle fibrosis indices between pre-capillary PH (PrePH) and isolated post-capillary PH (IpcPH) patients and assess their associations with measures of ventricle function. Global and segmental late gadolinium enhancement (LGE), longitudinal relaxation time (native T1) maps, and extracellular volume fraction (ECV) were compared among healthy controls (N = 25; 37% female; 52 ± 13 years), PH patients (N = 48; 60% female; 60 ± 14 years), and PH subgroups (PrePH: N = 29; 65% female; 55 ± 12 years, IpcPH: N = 19; 53% female; 66 ± 13 years). Cardiac cine measured ejection fraction, end diastolic, and end systolic volumes and were assessed for correlations with fibrosis. LGE mural location was qualitatively assessed on a segmental basis for all subjects. PrePH patients had elevated (apical-, mid-antero-, and mid-infero) septal left ventricle native T1 values (1080 ± 74 ms, 1077 ± 39 ms, and 1082 ± 47 ms) compared to IpcPH patients (1028 ± 53 ms, 1046 ± 36 ms, 1051 ± 44 ms) (p < 0.05). PrePH had a higher amount of insertional point LGE (69%) and LGE patterns characteristic of non-vascular fibrosis (77%) compared to IpcPH (37% and 46%, respectively) (p < 0.05; p < 0.05). Assessment of global LGE, native T1, and ECV burdens did not show a statistically significant difference between PrePH (1.9 ± 2.7%, 1056.2 ± 36.3 ms, 31.2 ± 3.7%) and IpcPH (2.7 ± 2.7%, 1042.4 ± 28.1 ms, 30.7 ± 4.7%) (p = 0.102; p = 0.229 p = 0.756). Global native T1 and ECV were higher in patients (1050.9 ± 33.8 and 31.0 ± 4.1%) than controls (28.2 ± 3.7% and 1012.9 ± 29.4 ms) (p < 0.05). Cardiac MRI-based tissue characterization may augment understanding of cardiac involvement and become a tool to facilitate PH patient classification.

BackgroundPulmonary hypertension (PH) contributes to restricted flow through the pulmonary circulation characterized by elevated mean pulmonary artery pressure acquired from invasive right heart catheterization (RHC). MRI may provide a noninvasive alternative for diagnosis and characterization of PH.PurposeTo characterize PH via quantification of regional pulmonary transit times (rPTT).Study TypeRetrospective.PopulationA total of 43 patients (58% female); 24 controls (33% female). RHC‐confirmed patients classified as World Health Organization (WHO) subgroups 1–4.Field Strength/SequenceA 1.5 T/time‐resolved contrast‐enhanced MR Angiography (CE‐MRA).AssessmentCE‐MRA data volumes were combined into a 4D matrix (3D resolution + time). Contrast agent arrival time was defined as the peak in the signal‐intensity curve generated for each voxel. Average arrival times within a vessel region of interest (ROI) were normalized to the main pulmonary artery ROI (t0) for eight regions to define rPTT for all subjects. Subgroup analysis included grouping the four arterial and four venous regions. Intraclass correlation analysis completed for reproducibility.Statistical TestsAnalysis of covariance with age as covariate. A priori Student's t‐tests or Wilcoxon rank‐sum test; α = 0.05. Results compared to controls unless noted. Significant without listing P value. ICC ran as two‐way absolute agreement model with two observers.ResultsPH patients demonstrated elevated rPTT in all vascular regions; average rPTT increase in arterial and venous branches was 0.85 ± 0.15 seconds (47.7%) and 1.0 ± 0.18 seconds (16.9%), respectively. Arterial rPTT was increased for all WHO subgroups; venous regions were elevated for subgroups 2 and 4 (group 1, P = 0.86; group 3, P = 0.32). No significant rPTT differences were found between subgroups (P = 0.094–0.94). Individual vessel ICC values ranged from 0.58 to 0.97.Data ConclusionNoninvasive assessment of PH using standard‐of‐care time‐resolved CE‐MRA can detect increased rPTT in PH patients of varying phenotypes compared to controls.Level of Evidence1Technical EfficacyStage 3.

Abstract PURPOSE The purpose of this study was to systematically compare the intra-individual image quality, signal parameters, and aortic dimensions between equal doses of gadobutrol (GB) and gadoterate meglumine (GM) in patients undergoing contrast-enhanced MRA of the thoracic aorta. METHODS 33 patients (50 ± 12 years, 30M) with aortic disease who underwent GB-enhanced thoracic aortic MRA were prospectively recruited to undergo a GM-enhanced MRA within 8 weeks. MRAs were obtained after administration of 0.2mL/kg of 1.0M GB and 0.4mL/kg of 0.5M GM at flow rate of 2mL/s. Aortic luminal signal intensities (SI) and contrast ratios (CR) with respect to trapezius were measured at three regions. Aortic orthogonal diameters were measured at six regions. Overall image quality, vessel wall conspicuity, and artifacts were scored by two radiologists. RESULTS GB demonstrated significantly higher SI at all regions when compared to GM (AAo: 234 ± 97 vs. 116 ± 29, p < 0.001; Arch: 206 ± 92 vs. 99 ± 24, p < 0.001; DAo: 265 ± 132 vs. 102 ± 28, p < 0.001). CR at all regions (AAo: 3.0 ± 1.1 vs. 2.7 ± 1.0, p = 0.503; Arch: 2.7 ± 1.0 vs. 2.8 ± 1.1, p = 0.599; DAo: 3.3 ± 1.5 vs. 3.0 ± 1.1, p = 0.099) and aortic diameters at all regions did not show any significant difference between GB and GM. Overall image quality, vessel wall conspicuity, and artifact scores did not significantly differ between GB and GM. CONCLUSION This intra-individual study found that for contrast-enhanced MRA of the thoracic aorta, CR, aortic diameter measurements, overall image quality, vessel wall conspicuity, and artifact scores were comparable between equal doses of GB and GM. However, GB showed significantly higher aortic luminal SI when compared to GM.

PURPOSE:The purpose of this study was to investigate the relationships between hemodynamic parameters and longitudinal changes in aortic dimensions on four-dimensional (4D) flow magnetic resonance imaging (MRI) in patients with bicuspid aortic valve (BAV) and repaired coarctation. MATERIALS AND METHODS:The study retrospectively included patients with BAV and childhood coarctation repair who had at least two cardiothoracic MRI examinations including 4D flow MRI at baseline and follow-up. Analysis included the calculation of aortic peak velocities, wall shear stress (WSS), pulse wave velocity (PWV), aortic dimensions and annual growth rates. Differences between examinations were assessed using paired t-test or Wilcoxon signed rank test. Relationships between growth rate and 4D flow metrics were assessed using Pearson or Spearman correlation tests. RESULTS:The cohort included 15 patients (mean age 35 ± 8 [SD] years, 9 men) with a median follow-up time of 3.98 years (Q1: 2.10; Q3: 4.96). There were no significant differences in aortic mean WSS, peak velocities, and PWV between baseline and follow-up values. Greater baseline peak velocities at the site of the coarctation were strongly associated with aortic narrowing (follow-up vs. baseline diameter) at coarctation zone (r = -0.64; P = 0.010) and moderately in descending aorta (r = -0.53; P = 0.042). In addition, increased baseline WSS in the aortic arch was strongly related with narrowing of the coarctation zone at follow-up (r = -0.64, P = 0.011). CONCLUSION:Measures of aortic hemodynamics and aortic WSS are stable over time in patients with BAV with coarctation repair. Increased peak velocity was associated with a progressive narrowing at the site of the coarctation repair.

Combined modality PET/MR may be a sensitive modality to detect severe large vessel vasculitis. To distinguish severe large vessel vasculitis, a qualitative review of PET imaging findings appears more useful than standardized uptake values of a patient’s highest-uptake vessel. Inflammatory marker levels and trends, as well as single-modality scan findings, were not significantly different between severe and non-severe large vessel vasculitis patients.

Background Gadobutrol (GB) and gadoterate meglumine (GM) are contrast agents used for contrast‐enhanced magnetic resonance angiography (CEMRA). Supraaortic vasculature (SAV) CEMRAs are used to evaluate stroke risk and neurologic symptoms. There is a need to compare the SAV CEMRA image quality obtained with GB and GM. Purpose To intra‐individually compare MRA images obtained with equimolar GB and GM at 1.5 T in the SAV. Study Type Prospective, crossover. Population Twenty‐eight subjects (54 ± 13 years; 17 female). Field Strength/Sequence 1.5 T ; three‐dimensional ( 3D) gradient recalled echo. Assessment Quantitative image quality was measured by normalized signal intensity (SI n ) [SI n = SI blood/SD blood] and contrast ratio (CR) [CR = SI blood/SI muscle], determined by an observer (JWC) with 1 year of vascular imaging experience. Three radiologists (AS, PA, and MU) with (5, 5, and 6 years of) vascular imaging experience evaluated image quality by Likert‐scale ratings (of image impression, wall conspicuity, and artifact absence). Statistical Tests SI n and CR were compared with paired t ‐tests or Wilcoxon signed‐rank tests and Bland–Altman plots. Qualitative ratings were compared with Wilcoxon signed‐rank test. Results No significant difference in SI n was found between GB and GM. CRs with GB were significantly higher than GM at the right common carotid (6.9 ± 2.5 vs. 4.8 ± 1), left internal carotid (7.3 ± 2 vs. 4.4 ± 1.2), right internal carotid (7.7 ± 2.2 vs. 5 ± 1.1), and left vertebral (6.6 ± 2.2 vs. 4.5 ± 1.1) arteries. Bland–Altman plots showed relatively greater differences between GB and GM at higher CRs and SI n s. GM showed significantly higher artifact than GB (3.56 ± 0.52 vs. 3.36 ± 0.46) and significantly lower overall image quality (10.73 ± 1.45 vs. 11.26 ± 1.58) at the left vertebral artery. Data Conclusion At 1.5 T and equimolar demonstration, GB (0.1 mL/kg, i.e., 0.1 mmol/kg) showed higher CRs in the SAV compared to GM (0.2 mL/kg, i.e., 0.1 mmol/kg) at most vessels. Subjective image quality was not significantly different between the two agents for most vessels. Level of Evidence 2 Technical Efficacy Stage 2

Cardiac magnetic resonance imaging (MRI) is becoming an alternative to right heart catheterization (RHC) for evaluating pulmonary hypertension (PH). A need exists to further evaluate cardiac MRI's ability to characterize PH.

PURPOSE:To test the hypothesis that cine MRI can be used to characterize features of left and right ventricles in post-capillary pulmonary hypertension (PH) caused by heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).METHODS:With the approval of institution review board (IRB), 28 consecutive post-capillary PH patients (11 males, 62.1 ± 13.4 years old, range 39-89 years old) underwent cine MRI scans. Cine MRI-derived left ventricular (LV) ejection fraction (LVEF) and other function, motion, and deformation indices (acquired with heart deformation analysis [HDA]) were compared between PH-HFpEF (defined as LVEF ≥ 50 %]) and PH-HFrEF (LVEF < 50 %) patients and were related with right ventricular (RV) indices and right heart catheterization (RHC)-derived pulmonary artery measurements.RESULTS:Totally 19 patients (68 %, 95 % confident interval [CI] 49 %-86 %) were assigned to PH-HFpEF group while 9 (32 %) was assigned to the PH-HFrEF group. There were differences of LV and right ventricular (RV) global functional indices, LV mass, LV displacement, velocity, strain and strain rate between the two patient groups. Cine MRI-derived LV indices had broad associations with RV indices and RHC measurements. LVEF was negatively correlated with pulmonary capillary wedge pressure (PCWP) (r = -0.5, p = 0.007). LV cardiac index (LVCI) was associated with systolic pulmonary artery pressure (sPAP) (r = 0.443, p = 0.018).CONCLUSIONS:PH-HFpEF and PH-HFrEF patients present dissimilar function, motion and deformation features in LV and RV. Cine MRI-derived LV measures are correlated with hemodynamic abnormalities of PH.

Introduction: Right heart catheterization (RHC) is used to diagnose and classify pulmonary hypertension (PH). Because RHC is invasive, there is growing interest in non-invasive PH evaluation techniques, such as cardiac magnetic resonance (CMR). Hypothesis: CMR-derived fibrosis indices [native T1 (NT1) and extracellular volume (ECV)] differ between pre-capillary PH (PRE-PH), post-capillary PH (POST-PH) and controls. Methods: RHC-defined PH patients and healthy controls (N=25, age=52+/-13 years) underwent CMR. A cardiologist classified patients into PRE-PH (N=29, age=55+/-8 years) and POST-PH (N=19, age=66+/-13 years) based on RHC measurements and clinical history. T1 maps of the left ventricle were acquired using a Modified Look-Locker Inversion Recovery sequence before and after administration of gadolinium contrast. T1 maps were manually segmented using the AHA 16 segment model to obtain segmental native and post-contrast T1. Segmental ECV was calculated using NT1, post-contrast T1, and hematocrit. Global ECV and NT1 were calculated by averaging all segments. Results: PRE-PH had higher NT1 than POST-PH in segments 8 (1077+/-39 vs 1046+/-36 ms, p=.01), 9 (1082+/-47 vs 1051+/-44 ms, p=.03), and 14 (1080+/-74 vs 1028+/-53 ms, p=.01). Global ECV and NT1 were higher in PRE-PH (31+/-4% and 1056+/-36 ms) than controls (28+/-4% and 1013+/-29 ms) (p=.017 and p=.000, respectively). Conclusions: NT1 was different between PRE-PH and POST-PH in mid- and apical-septal segments, however segmental ECV and global measures were not. NT1 may reflect more than just ECV expansion, providing additional insight into the myocardium. Regional NT1 may complement RHC for classifying PH.

Cine magnetic resonance imaging (MRI) is an emerging modality for evaluating left ventricular (LV) motion/deformation patterns, which may have potential to identify LV dysfunctions underlying postcapillary pulmonary hypertension (PH). The aim of this study was to test the hypothesis that cine MRI-derived LV motion/deformation indices can be used to identify an elevated left heart pressure in PH. This was a retrospective study, which included 26 precapillary and 28 postcapillary PH patients (23 males, 58.9 ± 13.5 years old). All patients underwent right heart catheterization (the "reference standard") and cardiac MRI. Balanced steady-state free precession cine sequence acquired at 1.5 T was used. Cine MRI datasets were analyzed by using heart deformation analysis. LV motion/deformation indices were measured through 25 phases within a cardiac cycle. Peak LV displacement, velocity, strain, and strain rates at systole, early and late diastole were compared between the two patient groups using t-tests. The Pearson correlation coefficient (r) was used to investigate the association between cine MRI-derived indices and pulmonary capillary wedge pressure (PCWP). Multivariable linear and logistic regression models were applied to assess the ability of MRI-derived parameters to predict PCWP and postcapillary PH. Compared to 26 precapillary PH patients, the 28 postcapillary PH patients had lower peak late radial diastolic displacement (0.43 ± 0.19 cm vs. 0.64 ± 0.18 cm) and velocity (12.2 ± 5.8 mm/s vs. 18.9 ± 5.6 mm/s) and peak late radial (52.1 ± 32.7%/s vs. 97.1 ± 38%/s) and circumferential (38 ± 19.8%/s vs. 63.1 ± 22.9%/s) strain rates. PCWP was correlated with peak late radial diastolic displacement (r = -0.54) and velocity (r = -0.57) and peak late radial (r = -0.63) and circumferential diastolic (r = -0.63) strain rates. Peak late radial strain rate could predict PCWP (β = -0.09) and postcapillary PH (β = -0.036). All p < 0.05. Cine MRI-derived LV late diastolic motion/deformation properties can be used to estimate elevated left heart pressure in PH. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 1.

Tissue phase mapping (TPM) is an MRI technique for quantification of regional biventricular myocardial velocities. Despite its potential, clinical use is limited due to the requisite labor‐intensive manual segmentation of cardiac contours for all time frames. The purpose of this study was to develop a deep learning (DL) network for automated segmentation of TPM images, without significant loss in segmentation and myocardial velocity quantification accuracy compared with manual segmentation. We implemented a multi‐channel 3D (three dimensional; 2D + time) dense U‐Net that trained on magnitude and phase images and combined cross‐entropy, Dice, and Hausdorff distance loss terms to improve the segmentation accuracy and suppress unnatural boundaries. The dense U‐Net was trained and tested with 150 multi‐slice, multi‐phase TPM scans (114 scans for training, 36 for testing) from 99 heart transplant patients (44 females, 1‐4 scans/patient), where the magnitude and velocity‐encoded (Vx, Vy, Vz) images were used as input and the corresponding manual segmentation masks were used as reference. The accuracy of DL segmentation was evaluated using quantitative metrics (Dice scores, Hausdorff distance) and linear regression and Bland‐Altman analyses on the resulting peak radial and longitudinal velocities (Vr and Vz). The mean segmentation time was about 2 h per patient for manual and 1.9 ± 0.3 s for DL. Our network produced good accuracy (median Dice = 0.85 for left ventricle (LV), 0.64 for right ventricle (RV), Hausdorff distance = 3.17 pixels) compared with manual segmentation. Peak Vr and Vz measured from manual and DL segmentations were strongly correlated (R ≥ 0.88) and in good agreement with manual analysis (mean difference and limits of agreement for Vz and Vr were −0.05 ± 0.98 cm/s and −0.06 ± 1.18 cm/s for LV, and −0.21 ± 2.33 cm/s and 0.46 ± 4.00 cm/s for RV, respectively). The proposed multi‐channel 3D dense U‐Net was capable of reducing the segmentation time by 3,600‐fold, without significant loss in accuracy in tissue velocity measurements.

BACKGROUND AND OBJECTIVES:Renal transplant patients often require periodic imaging to evaluate the transplant vessel anastomosis for potential vascular complications. The use of non-contrast enhanced magnetic resonance angiography (NCE-MRA) techniques is encouraged in these patients because they are at increased risk of nephrogenic systemic fibrosis (NSF) due to their renal insufficiency. This study aimed to evaluate the performance of two NCE-MRA techniques (three-dimensional [3D] balanced steady-state free precession [bSSFP] with inversion recovery and quiescent-interval slice-selective [QISS]) for the evaluation of renal allograft vasculature in patients with clinical suspicion, or Doppler ultrasound, or both of arterial anastomotic stenosis.METHODS:A total of 43 patients were included in this retrospective study. Two radiologists independently scored the images from 3D bSSFP and QISS MRA sequences for image quality and confidence in anastomosis interpretation, and the degree of stenosis at the arterial anastomosis. Correlations with digital subtraction angiography (DSA) were carried out when available. In addition, inter-rater agreement was calculated.RESULTS:In total, 43 patients underwent QISS and 3D bSSFP MRA. For QISS, all cases were adequate for evaluation. For 3D SSFP, 86% of cases were adequate for evaluation. There was a good-to-excellent inter-rater agreement for all scores and an excellent correlation between NCE-MRA and DSA results when available (12 patients).CONCLUSIONS:QISS and 3D SSFP showed good inter-rater agreement for image quality and stenosis grade, with more cases being of adequate image quality that used QISS. Further study is required; however, NCE-MRA shows potential as a risk-free alternative to CTA and contrast-enhanced MRA (CE-MRA) for the evaluation of arterial anastomoses in renal transplant patients.

RATIONALE AND OBJECTIVES:To develop a 16-fold accelerated real-time, free-breathing cine cardiovascular magnetic resonance (CMR) pulse sequence with compressed sensing reconstruction and test whether it is capable of producing clinically acceptable summed visual scores (SVS) and accurate left ventricular ejection fraction (LVEF) in patients with a cardiac implantable electronic device (CIED).MATERIALS AND METHODS:A 16-fold accelerated real-time cine CMR pulse sequence was developed using gradient echo readout, Cartesian k-space sampling, and compressed sensing. We scanned 13 CIED patients (mean age = 59 years; 9/4 males/females) using clinical standard, breath-hold cine and real-time, free-breathing cine. Two clinical readers performed a visual assessment of image quality in four categories (conspicuity of endocardial wall at end diastole, temporal fidelity of wall motion, any artifact level on the heart, noise) using a five-point Likert scale (1: worst; 3: clinically acceptable; 5: best). SVS was calculated as the sum of 4 individual scores, where 12 was defined as clinical acceptable. The Wilcoxon signed-rank test was performed to compare SVS, and the Bland-Altman analysis was conducted to evaluate the agreement of LVEF.RESULTS:Median scan time was 3.7 times shorter for real-time (3.5 heartbeats per slice) than clinical standard (13 heartbeats per slice, excluding nonscanning time between successive breath-hold acquisitions). Median SVS was not significantly different between clinical standard (15.0) and real-time (14.5). The mean difference in LVEF was -2% (4.7% of mean), and the limits of agreement was 5.8% (13.5% of mean).CONCLUSION:This study demonstrates that the proposed real-time cine method produces clinically acceptable SVS and relatively accurate LVEF in CIED patients.

Intracardiac and pulmonary artery (PA) pressures are currently assessed by cardiac catheterization (CC). Tissue phase mapping (TPM) is a cardiac magnetic resonance (CMR) 2D phase contrast technique for 3-directional myocardial velocity calculation. This study aims to verify correlations between LV/

Highly accelerated real‐time cine MRI using compressed sensing (CS) is a promising approach to achieve high spatio‐temporal resolution and clinically acceptable image quality in patients with arrhythmia and/or dyspnea. However, its lengthy image reconstruction time may hinder its clinical translation. The purpose of this study was to develop a neural network for reconstruction of non‐Cartesian real‐time cine MRIk‐space data faster (<1 min per slice with 80 frames) than graphics processing unit (GPU)‐accelerated CS reconstruction, without significant loss in image quality or accuracy in left ventricular (LV) functional parameters. We introduce a perceptual complex neural network (PCNN) that trains on complex‐valued MRI signal and incorporates a perceptual loss term to suppress incoherent image details. This PCNN was trained and tested with multi‐slice, multi‐phase, cine images from 40 patients (20 for training, 20 for testing), where the zero‐filled images were used as input and the corresponding CS reconstructed images were used as practical ground truth. The resulting images were compared using quantitative metrics (structural similarity index (SSIM) and normalized root mean square error (NRMSE)) and visual scores (conspicuity, temporal fidelity, artifacts, and noise scores), individually graded on a five‐point scale (1, worst; 3, acceptable; 5, best), and LV ejection fraction (LVEF). The mean processing time per slice with 80 frames for PCNN was 23.7 ± 1.9 s for pre‐processing (Step 1, same as CS) and 0.822 ± 0.004 s for dealiasing (Step 2, 166 times faster than CS). Our PCNN produced higher data fidelity metrics (SSIM = 0.88 ± 0.02, NRMSE = 0.014 ± 0.004) compared with CS. While all the visual scores were significantly different (P< 0.05), the median scores were all 4.0 or higher for both CS and PCNN. LVEFs measured from CS and PCNN were strongly correlated (R2= 0.92) and in good agreement (mean difference = −1.4% [2.3% of mean]; limit of agreement = 10.6% [17.6% of mean]). The proposed PCNN is capable of rapid reconstruction (25 s per slice with 80 frames) of non‐Cartesian real‐time cine MRIk‐space data, without significant loss in image quality or accuracy in LV functional parameters.