BACKGROUND:Heart failure (HF) is a significant public health concern. Early detection, particularly during the asymptomatic stage, is essential for prompt intervention and preventing progression. Conventional measures, such as left ventricular ejection fraction (LVEF) have limited sensitivity. However, left ventricular global longitudinal strain (GLS) can detect subclinical myocardial dysfunction. Preliminary data from the previous HERZCHECK study showed that 23% (1023/4509) of participants in rural Germany had GLS-defined subclinical pre-HF (stage B HF) when examined with mobile cardiac MRI units. Yet, the prevalence of asymptomatic HF in urban populations remains unclear. The WE-CARE-HF-CMR trial aims to address this issue. STUDY DESIGN AND METHODOLOGY:The WE-CARE-HF-CMR trial is a single-center prospective observational study with a cross-sectional baseline assessment and an exploratory longitudinal follow-up conducted in five urban German cities (Berlin, Cologne, Frankfurt, Hamburg, Munich; NCT07185100). Asymptomatic patients between the ages of 40 and 69 with cardiovascular risk factors but without a history of symptomatic HF are enrolled via outpatient physician referral or self-referral. Participants undergo a standardized diagnostic evaluation including a medical history review, laboratory testing, cardiovascular magnetic resonance (CMR) imaging with GLS analysis, and quality-of-life questionnaires. CMR examinations are performed using both stationary and mobile magnetic resonance imaging (MRI) units. Subclinical pre-HF (stage B HF) is defined as GLS ≥ -15%. The primary endpoint is the prevalence of subclinical pre-HF (stage B HF) in the urban population. Secondary endpoints assess therapy adherence, quality of life, and the prevalence of chronic kidney disease. CMR images are analyzed centrally following standardized protocols to ensure comparability with HERZCHECK rural data. CONCLUSION:The WE-CARE-HF-CMR trial will provide critical data on the prevalence of subclinical pre-HF (stage B HF) in urban populations. Using CMR-based GLS analysis with stationary and mobile units, and building on the HERZCHECK trial methodology, the study will close the diagnostic gap between rural and urban areas. These findings may ultimately support the implementation of targeted screening programs for subclinical pre-HF (stage B HF) to enable early intervention and prevent the progression to symptomatic HF. CLINICALTRIALS: GOV IDENTIFIER:NCT07185100.

Extracellular volume (ECV) quantification involves time-consuming multi-step post-processing and a blood draw for hematocrit analysis. This study aimed to develop a fully automated blood draw-free, machine learning-based approach for synthetic ECV assessment for non-invasive assessment of diffuse myocardial fibrosis. We retrospectively evaluated a large clinical cohort of 1092 patients who underwent CMR and ECV measurement at 1.5T or 3T. Participants were divided into training (n = 767) and validation (n = 325) cohorts. Manual contouring of T1 maps was used to iteratively develop a neural network segmentation model, which was then applied for automated analysis. Fully-automated synthetic ECV was calculated using validated sex- and field strength-specific models. Agreement was assessed using Student's t-test, Pearson correlation, Bland-Altman analysis, and classification analysis. Fully-automated synthetic ECV showed strong correlation with conventional ECV (r = 0.79, p < 0.001), with no significant differences (26.9% ± 4.9% vs. 27.3% ± 6.4%, p = 0.056). Bland-Altman analysis indicated minimal mean difference of 0.4% with moderate limits of agreement (LoA) spanning - 7.24% to + 8.07%, with good agreement for values of up to 35% (mean difference 0.1%, LoA: - 5.38% to + 5.23%). Fully automated synthetic ECV offers a blood-free proof-of-concept for large-scale post-processing, supporting consistent and efficient assessment of myocardial fibrosis in research settings, pending further validation for clinical use at higher ECV ranges.

BACKGROUND:There is a growing consensus that screening for subclinical preheart failure (HF) may reduce the burden of symptomatic HF by allowing for timely preventive interventions. However, validated screening algorithms are currently lacking. The aim of this study was to evaluate a fully mobile telemedically supervised cardiac magnetic resonance, as a simple standardized, and ubiquitously applicable screening algorithm for subclinical pre-HF in rural and underresourced regions. METHODS:HERZCHECK was a cross-sectional cohort study conducted at 12 sites across rural and underresourced regions of Germany. Asymptomatic participants (40-69 years) with ≥1 cardiovascular risk factor-obesity, smoking, arterial hypertension, diabetes, hypercholesterolemia, or chronic kidney disease-were enrolled and underwent telemedically supervised contrast-free short cardiac magnetic resonance in mobile screening units. Subclinical pre-HF was diagnosed using a predefined cutoff of global longitudinal strain ≥-15%. A matched and entropy-balanced control cohort constructed from claims data was used to determine the time difference between detection of subclinical pre-HF in HERZCHECK and the first symptom-based diagnosis of HF within the standard of care. RESULTS:Between June 2021 and April 2023, 4666 participants were enrolled in the study, of which 4509 participants were included in the final analysis. The prevalence of subclinical pre-HF in the studied at-risk population was 22.7% (95% CI, 21.5%-23.9%). Global longitudinal strain-based screening identified subclinical pre-HF 6.7 years before the average onset of symptomatic HF within the standard of care (n=8420). CONCLUSIONS:Subclinical pre-HF affects approximately one-fourth of the at-risk population in rural and underresourced regions. The HERZCHECK approach identifies patients suitable for targeted preventive interventions ≈7 years earlier than the standard of care. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT05122793.

Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor that may extend into the right atrium and mimic a primary cardiac neoplasm. Because clinical presentation is often non-specific and depends on tumor location and extent, diagnosis may be delayed, particularly in acute settings with suboptimal imaging conditions. We report the case of a 33-year-old woman presenting with progressive dyspnea, ascites and peripheral edema consistent with right-sided heart failure. Initial contrast-enhanced computed tomography, performed to exclude pulmonary embolism, suggested a right atrial myxoma. However, stepwise multimodality imaging including transthoracic and transesophageal echocardiography, multiphasic computed tomography (CT), and cardiac magnetic resonance imaging (CMR) revealed a large intravascular mass originating from the IVC with contiguous extension in the right atrium, causing near-complete luminal obstruction of atrium and IVC. CMR was essential in establishing the diagnosis by demonstrating tumor continuity, tissue heterogeneity, and malignant enhancement patterns. Histopathological analysis confirmed a low-grade spindle cell leiomyosarcoma (G2, Ki-67 approximately 40%). Staging with multiphasic CT and magnetic resonance imaging of the brain excluded distant metastases. The patient was initiated on neoadjuvant chemotherapy with doxorubicin and ifosfamide with planned surgical resection. This case illustrates the importance of multimodality imaging, with CMR playing a central role, in distinguishing malignant intravascular tumors from benign intracardiac masses. Early diagnosis and a multidisciplinary approach are essential for optimal management.

Background: Magnetic resonance imaging (MRI) allows for the assessment of myocardial strain and identification of heart failure (HF) patients with reduced (HFrEF), mildly reduced (HFmrEF), or preserved (HFpEF) left ventricular ejection fraction (LVEF). The cardiovascular angiographic analysis system magnetic resonance (Caas MR) strain (Pie Medical Imaging) has recently been implemented in the IntelliSpace Portal Suite (Philips Healthcare) to assess the global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS). However, standard values for this software across different HF entities, as well as normal values, have yet to be established. Thus, this study aimed to establish reference values for the GLS, GCS, and GRS using the Caas MR strain in healthy individuals and HF patients, to assess the ability of these parameters to differentiate between HF subtypes, and to compare CAAS-derived strain values with those obtained using CVI42 software. Methods: Using a 1.5 T Philips Achieva scanner, we analyzed 19 healthy volunteers and 56 HF patients (HFpEF, n = 19; HFmrEF, n = 20; and HFrEF, n = 17) using the feature tracking post-processing software Caas MR Strain. GLS, GCS, and GRS were quantified using 4-chamber-view, 2-chamber-view, and short-axis (SAX) cine images. All volunteers and patients were evaluated by CVI42 to analyze inter-vendor reliability with a validated software. Results: Mean GLS, GCS, and GRS by Caas MR Strain were significantly different for healthy volunteers compared to HF patients (GLS –15.8 ± 1.9% vs. –11.7 ± 3.0%, p < 0.001; GCS –17.0 ± 2.6% vs. –11.4 ± 3.3%, p < 0.001; GRS 27.3 ± 6.2% vs. 14.5 ± 5.5%, p < 0.001). The upper limit of the 99% confidence interval for healthy volunteers was –14.6% for GLS, –15.3% for GCS and the lower limit of the 99% CI for GRS was 23.1%. GLS, GRS, and GCS by Caas MR Strain were significantly different among HF entities (p < 0.001). Intervendor comparison showed very good agreement for GLS and GRS between Caas MR Strain and CVI42 (GLS r = 0.86, p < 0.001; GCS r = 0.83, p < 0.001; GRS r = 0.76, p < 0.001). Conclusion: Magnetic resonance imaging assessment of left ventricular myocardial strain using Caas MR Strain software reliably identifies HF patients. Discrimination between the different HF entities is potentially feasible by GLS, GCS, and GRS. Intervendor agreement was most robust for GLS and GCS, but less robust for GRS. For practical clinical use, we propose cut-off values for GLS above –15%, GCS above –15%, and GRS below 23% to define pathological findings.

AimsHeart failure (HF) is a complex clinical syndrome with high morbidity and mortality, influenced significantly by sodium balance. Recently, magnetic resonance imaging (MRI) has emerged as a non-invasive method to evaluate tissue sodium load in HF patients. This proof-of-principle study investigates the association between tissue sodium content, assessed by MRI, and HF-related baseline parameters in an outpatient cohort of patients with chronic heart failure, including those with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF).Methods and resultsThis prospective study included 29 HF patients (10 HFpEF, 12 HFmrEF, and 7 HFrEF) recruited from two centers in Berlin, Germany. Patients underwent MRI to assess tissue sodium content in the lower extremity. Tissue sodium content was analyzed in relation to baseline HF parameters, including renal function, natriuretic peptide levels, clinical signs of congestion, diuretic use, and New York Heart Association (NYHA) functional class. No significant differences in tissue sodium content were observed between the three HF entities. Sodium values did not differ significantly with clinical signs of congestion or diuretic use. No significant correlations were found between tissue sodium content and renal function (eGFR) or natriuretic peptide levels (NT-proBNP) in any HF group overall. However, explorative analyses showed a positive correlation between free (r = 0.79, p = 0.036) and total (r = 0.79, p = 0.036) tissue sodium content in the skin and NT-proBNP levels in HFrEF patients, but not in HFmrEF and HFpEF. Similarly, there was a correlation between kidney function and both free (r = −0.64, p = 0.025) and total (r = −0.61, p = 0.035) skin sodium in patients with edema and no prior use of loop diuretics, but no correlation for kidney function and both free and total skin sodium in symptomatic patients with established diuretic therapy or asymptomatic patients with no diuretic therapy.ConclusionOur findings provide exploratory insights into the potential diagnostic value of tissue sodium content in HF, particularly in HFrEF patients. With findings showing an association of tissue sodium content with NT-proBNP levels in HFrEF patients and with kidney function in edema patients without prior loop diuretic use, further research is needed to understand the role of tissue sodium content in HF pathophysiology and its potential diagnostic and prognostic implications. Trial registrationGerman Clinical Trials Register (DRKS), registration number (DRKS00015615).

The number of patients with cardiac implantable electronic devices (CIEDs) is increasing. However, there is limited experience regarding vasodilator-stress cardiovascular magnetic resonance (CMR) and resulting device artifacts on perfusion images. The aim of this study was to determine CMR image quality in patients with different CIED types for CMR-based perfusion stress testing. A total of 156 patients with active CIEDs underwent CMR on a 1.5-Tesla scanner. Both conventional steady-state-free-precession (SSFP) and modified spoiled gradient-echo (sGE) protocols under stress and resting conditions were used to evaluate image artifacts in a 16-segment segment model of the heart. The study group comprised 39

Strain quantifies myocardial deformation. Despite its high diagnostic value, strain analyses using cardiovascular magnetic resonance (CMR) feature tracking (FT) have not been fully implemented into clinical routine due to lack of information on reproducibility. The purpose of this study was to assess the comparability of cardiovascular magnetic resonance CMR FT strain and ejection fraction (EF) measurements, obtained from different MR scanners and analyzed using different software platforms. CMR examinations were performed in 15 healthy volunteers using three different scanners (German Heart Center of the Charité, Charité Campus Berlin Buch, and Theresien-Hospital Mannheim). FT was performed using Medis Suite and Circle CVI. Inter-software/scanner agreement was determined using Bland–Altman plots, Wilcoxon test, and paired Student’s t test. Intra-/inter-observer reproducibility was evaluated using intraclass correlation coefficients. Left ventricular (LV) global longitudinal (GLS) and circumferential (GCS) strain did not differ between the three centers (small bias of − 1.27 to 1.32

Aims:Fast Strain-encoding (fSENC) is a pulse sequence that enables the acquisition of cardiovascular magnetic resonance images within a few heartbeats and at free breathing to quantify myocardial strain, a deformation parameter of the heart muscle. Strain is gaining importance in heart failure diagnostics, but implementing fast strain-encoding into a routine magnetic resonance protocol has not been thoroughly explored from a practical viewpoint. This video manuscript aims to provide a simple guide for the acquisition of cardiovascular magnetic resonance exams in cardiac patients and to determine the scan-rescan reproducibility of segmental strain analyses. Methods and results:A volunteer was scanned for demonstration purposes on a 1.5T MRI Scanner ('Ingenia, Philips Healthcare, Best, The Netherlands'). The acquisition of cine steady-state free precession (SSFP) and fSENC sequences is demonstrated in a step-by-step fashion, accompanied by a multilingual video tutorial and an image guide. Scan-rescan reproducibility of acquisition-based strain values was excellent between subsequent scans for segmental longitudinal (SLS) [0.93 (0.91-0.95) and circumferential strain (SCS) [0.78 (0.73-0.82) to 0.84 (0.80-0.87)], and good to excellent between scans that were interrupted by a break for SLS [0.80 (0.74-0.85) to 0.84 (0.79-0.87)] and SCS [0.57 (0.46-0.66) to 0.65 (0.56-0.77)]. Conclusion:This multilingual video manuscript provides a practical guide to conducting cardiovascular magnetic resonance exams including SSFP and fSENC, useful for further quantitative analysis to grasp heart function on a global and regional basis.

Myocarditis, characterized by inflammatory cell infiltration, can have multiple etiologies, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or, rarely, mRNA-based coronavirus disease 2019 (COVID-19) vaccination. The underlying cellular and molecular mechanisms remain poorly understood. In this study, we performed single-nucleus RNA sequencing on left ventricular endomyocardial biopsies from patients with myocarditis unrelated to COVID-19 (Non-COVID-19), after SARS-CoV-2 infection (Post-COVID-19) and after COVID-19 vaccination (Post-Vaccination). We identified distinct cytokine expression patterns, with interferon-γ playing a key role in Post-COVID-19, and upregulated IL16 and IL18 expression serving as a hallmark of Post-Vaccination myocarditis. Although myeloid responses were similar across all groups, the Post-Vaccination group showed a higher proportion of CD4+ T cells, and the Post-COVID-19 group exhibited an expansion of cytotoxic CD8+ T and natural killer cells. Endothelial cells showed gene expression changes indicative of vascular barrier dysfunction in the Post-COVID-19 group and ongoing angiogenesis across all groups. These findings highlight shared and distinct mechanisms driving myocarditis in patients with and without a history of SARS-CoV-2 infection or vaccination. Maatz, Lindberg et al. identify molecular alterations and immune response changes in endomyocardial biopsies from patients with myocarditis after COVID-19 infection, after anti-COVID-19 vaccination or from non-COVID-related causes.

ABSTRACTBackgroundDespite a phenylalanine (Phe) restrictive diet, most adult patients with ‘classical’ phenylketonuria (PKU) maintain life‐long Phe concentrations above the normal range and receive tyrosine (Tyr) and protein‐enriched diets to maintain acceptable concentrations and ensure normal development. While these interventions are highly successful in preventing adverse neuropsychiatric complications, their long‐ term consequences are incompletely explored. We observed early cardiomyopathic characteristics and associated hemodynamic changes in adult PKU patients and present here the results of a longitudinal evaluation of cardiac phenotype.MethodsFifteen adult patients with PKU (age: 39.8 ± 8.1 years, 9 males and 6 females) underwent a comprehensive follow‐up cardiac magnetic resonance (CMR) imaging assessment after a mean follow‐up interval of 8.3 ± 0.3 years from the initial baseline visit. The CMR protocol included left (LV) and right (RV) ventricular and left atrial (LA) volumetric assessment, LV parametric mapping (precontrast and postcontrast T1 and T2 maps, extracellular volume [ECV]), multilayer LV myocardial strain, systolic and diastolic hemodynamic forces and RV and LA strain and aortic distensibility evaluation. Plasma concentrations of Phe, tyrosine (Tyr) and other biochemical markers of disease were retrospectively collected. For comparison, a group of 20 matched control subjects undergoing an identical CMR protocol was included.ResultsOn average, the LV end‐diastolic volume (EDV) (158 ± 29 vs. 143 ± 29 mL, p = 0.013) and end‐systolic volume (ESV) (68 ± 18 vs. 62 ± 18 mL, p = 0.011) were lower at follow‐up. In contrast, LV mass (LVM) (72 ± 25 vs. 82 ± 29 g, p < 0.001) and the ratio LVM/EDV (0.46 ± 0.12 vs. 0.58 ± 0.23 g/mL, p = 0.005) were increased, and T1 times were longer (940 ± 42 vs. 1010 ± 35 ms, p < 0.001). LV EF (57 ± 6 vs. 57 ± 7%, p = 0.90), longitudinal (GLS) and circumferential (GCS) systolic strain remained unchanged, but early diastolic hemodynamic (HD) forces were more markedly negative (−19.4 ± 7.0 vs. −26.5 ± 12.2%, p = 0.012), while LA strain 43.8 ± 11.3 vs. 37.3 ± 9.6%, p = 0.031) and aortic distensibility (6.38 ± 1.75 vs. 5.21 ± 1.17 10−3 mmHg−1, p = 0.008) decreased at follow‐up. Compared with controls, PKU patients maintain reduced systolic function with lower LV EF and impaired GCS and have more markedly negative early diastolic HD pressures. A higher decrease in Phe concentration (ΔPhe) was associated with longer T1 times, ΔT1 (β = −0.78, p < 0.001), increased ECV, ΔECV (β = −0.61, p = 0.016) and a decrease in systolic function, ΔEF (β = 0.61, p = 0.017). In contrast, variations in Tyr concentrations did not affect the cardiac phenotype.ConclusionsAt long‐term follow‐up, a marked drop in Phe plasma concentration was associated with detrimental cardiac remodelling consisting of decreased LV systolic function and increased diffuse fibrosis, in PKU patients. These new data prompt further investigation into the effects of large Phe variability over time and underline the usefulness of periodic cardiovascular assessment in adults with PKU.

The diagnostic criteria for HFpEF remain inconsistently defined, further confounded by comorbidities such as obesity and type 2 diabetes mellitus (T2DM), which are thought to contribute to its pathogenesis via chronic pro-inflammatory mechanisms. This study aimed to evaluate the relationship between advanced cardiac magnetic resonance (CMR) imaging and pro-fibrotic and inflammatory serum biomarkers, assessing their potential to discriminate HFpEF from associated comorbid conditions. This was an exploratory analysis of a prospective cohort study of 35 obese/overweight participants (mean age 64 ± 8 years, 23

Background: While left-bundle-branch-block-related contraction patterns as well as echocardiography-derived strain are variably associated with the volumetric response to cardiac resynchronization therapy (CRT), the role of CMR-derived strain parameters is unexplored. Methods: A total of 50 patients receiving CRT implantation were retrospectively analyzed, all of whom had undergone CMR imaging within one year before, and echocardiography within 6 months before and 6–12 months after CRT implantation. We assessed CMR-derived morphological and functional parameters with regard to the echocardiographic response, defined as a reduction in the left ventricular end-systolic volume of ≥15%. Results: Among the standard CMR parameters, the indexed right ventricular volumes in end-diastole (RVEDVi) (74.5 ± 19.5 vs. 94.8 ± 30.2 mL/m2, p = 0.006) and end-systole (RVESVi) (43.2 ± 13.3 vs. 61.6 ± 28.8 mL/m2, p = 0.003), as well as the left atrial (LA) area (24.8 ± 3.5 vs. 30.4 ± 9.5 cm2, p = 0.020), differed significantly between CRT responders and non-responders. In strain analysis, CRT responders showed a significantly better LA global longitudinal strain (GLS) (25.1 ± 10.4 vs. 15.3 ± 10.5, p = 0.002), LA global circumferential strain (GCS) (27.9 ± 14.7 vs. 17.1 ± 13.1%, p = 0.012), RV GLS (−25.0 ± 6.5 vs. −18.9 ± 7.6%, p = 0.004) and RV free wall strain (−31.1 ± 7.9 vs. −24.9 ± 9.5, p = 0.017). Conclusions: CMR-derived peak septal circumferential strain and RVEDVi correlated with the echocardiographic volumetric response to CRT at 6–12 months.

BACKGROUND:Late gadolinium enhancement imaging is the cornerstone of tissue characterization via cardiac magnetic resonance imaging. The contrast-enhancing effect of gadolinium is caused by a linear increase in tissue longitudinal R1 relaxation rates (R1 = 1/T1). The change in R1 of blood pre- and post-contrast (ΔR1blood) is therefore a surrogate for the blood-pool gadolinium concentration, which in turn correlates linearly to the tissue gadolinium concentration. The total volume of distribution for gadolinium is the extracellular volume of the body, which differs with body composition, potentially leading to variations in blood-pool and tissue gadolinium concentrations. METHODS:This study is a hypothesis-generating secondary analysis of a dataset of 1098 patients who underwent contrast cardiovascular magnetic resonance between August 2014 and November 2020 at a tertiary center. ΔR1blood was calculated from T1 relaxation time maps acquired before and approximately 15 min after application of 0.15 mmol/kg gadobutrol. Explorative data analysis and multiple linear regression were performed to assess the influence of body mass index (BMI), gender, age, cardiac index (CI), hematocrit (Hct), and left ventricular end-diastolic volume index (LVEDVi) on ΔR1blood. RESULTS:In bivariate analysis, ΔR1blood showed moderate correlation to BMI and weak correlation to LVEDVi, Hct, and CI. The correlation to BMI was higher in women (r = 0.52 at 1.5T and r = 0.47 at 3T) than in men (r = 0.27 at 1.5T and r = 0.37 at 3T). Multiple linear regression showed independent predictive value of BMI, BMI:gender, gender, CI, field strength (FS), and LVEDVi (R² = 0.268, P < 0.001), with BMI remaining the strongest individual predictor (b = 0.032 [0.025; 0.040], η² = 0.13, P < 0.001). CONCLUSION:ΔR1blood, a measurement of gadolinium contrast enhancement in the blood-pool and a surrogate of plasma CGd at the time of late enhancement imaging, showed moderate association with BMI, FS, and gender and weak association with LVEDVi and CI. Further research is necessary to assess the need for individualized gadolinium dosing.

4D-flow MRI is a promising technique for assessing vessel hemodynamics. However, its utilization is currently limited by the lack of reference values, particularly for pulmonary vessels. In this work, we have analysed flow and velocity in the pulmonary trunk (PT), left and right pulmonary arteries (LPA and RPA, respectively) in Landrace pigs at both rest and stress through the software MEVISFlow. Nine healthy Landrace pigs were acutely instrumented closed-chest and transported to the CMR facility for evaluation. After rest measurements, dobutamine was administered to achieve a 25% increase in heart rate compared to rest. 4D-flow MRI images have been analysed through MEVISFlow by two independent observers. Inter- and intra-observer reproducibility was quantified using intraclass correlation coefficient. A significant difference between rest and stress regarding flow and velocity in all the pulmonary vessels was observed. Mean flow increased 55% in PT, 75% in LPA and 40% in RPA. Mean peak velocity increased 55% in PT, 75% in LPA and 66% in RPA. A good-to-excellent reproducibility was observed in rest and stress for flow measurements in all three arteries. An excellent reproducibility for velocity was found in PT at rest and stress, a good one for LPA and RPA at rest, while poor reproducibility was found at stress. The current study showed that pulmonary flow and velocity assessed through 4D-flow MRI follow the physiological alterations during cardiac cycle and after stress induced by dobutamine. A clinical translation to assess pulmonary diseases with 4D-flow MRI under stress conditions needs investigation.

Aims:Left ventricular global longitudinal strain (LV-GLS) shows promise as a marker to detect early heart failure (HF). This study sought to (i) establish cardiac magnetic resonance imaging (CMR)-derived LV-GLS cut-offs to differentiate healthy from HF for both acquisition-based and post-processing techniques, (ii) assess agreement, and (iii) provide a method to convert LV-GLS between both techniques. Methods and results:A secondary analysis of a prospective study enrolling healthy subjects (n = 19) and HF patients (n = 56) was conducted. LV-GLS was measured using fast strain-encoded imaging (fSENC) and feature tracking (FT). Receiver operating characteristic (ROC) analyses were performed to derive and evaluate LV-GLS cut-offs discriminating between healthy, HF with mild deformation impairment (DI), and HF with severe DI. Linear regression and Bland-Altman analyses assessed agreement. Cut-offs discriminating between healthy and HF were identified at -19.3% and -15.1% for fSENC and FT, respectively. Cut-offs of -15.8% (fSENC) and -10.8% (FT) further distinguished mild from severe DI. No significant differences in area under ROC curve were identified between fSENC and FT. Bland-Altman analysis revealed a bias of -4.01%, 95% CI -4.42, -3.50 for FT, considering fSENC as reference. Linear regression suggested a factor of 0.76 to rescale fSENC-derived LV-GLS to FT. Using this factor on fSENC-derived cut-offs yielded rescaled FT LV-GLS cut-offs of -14.7% (healthy vs. HF) and -12% (mild vs. severe DI). Conclusion:LV-GLS distinguishes healthy from HF with high accuracy. Each measurement technique requires distinct cut-offs, but rescaling factors facilitate conversion. An FT-based LV-GLS ≥ -15% simplifies HF detection in clinical routine.