Background Cardiac magnetic resonance imaging (CMR) remains underutilized as an exercise imaging modality, mostly because of the limited availability of MR-compatible exercise equipment. This study prospectively evaluates the clinical feasibility of a newly developed MR-conditional pedal ergometer for exercise CMR Methods Ten healthy volunteers (mean age 44 ± 16 years) and 11 patients (mean age 60 ± 9 years) with known or suspected coronary artery disease (CAD) underwent rest and post-exercise cinematic 3T CMR. Visual analysis of wall motion abnormalities (WMA) was rated by 2 experienced radiologists, and volumes and ejection fractions (EF) were determined. Image quality was assessed by a 4-point Likert scale for visibility of endocardial borders. Results Median subjective image quality of real-time cine at rest was 1 (interquartile range [IQR] 1–2) and 2 (IQR 2–2.5) for post-exercise real-time cine (p = 0.001). Exercise induced a significant increase in heart rate (62 [62–73] to 111 [104–143] bpm, p < 0.0001). Stroke volume and cardiac index increased from resting to post-exercise conditions (85 ± 21 to 101 ± 19 mL and 2.9 ± 0.7 to 6.6 ± 1.9 L/min/m2, respectively; both p < 0.0001), driven by a reduction in end-systolic volume (55 ± 20 to 42 ± 21 mL, p < 0.0001). Patients (2/11) with inducible regional WMA at high-resolution post-exercise cine imaging revealed significant coronary artery stenosis in subsequently performed invasive coronary angiography. Conclusions Exercise-CMR using our newly developed 3T MR-conditional pedal ergometer is clinically feasible. Imaging of both cardiac response and myocardial ischemia, triggered by dynamic stress, is rapidly conducted while the patient is near their peak heart rate.

IntroductionQuantitative MR planimetric measurements were reported to discriminate between progressive supranuclear palsy (PSP) and non-PSP parkinsonism, yet few data exist on the usefulness of these markers in early disease stages.MethodsThe pons-to-midbrain area ratio (P/M) and the Magnetic Resonance Parkinsonism Index (MRPI) as well as new indices, termed P/M2.0 and MRPI2.0, multiplying the former by a ratio of the third ventricle (3rdV) width/frontal horns (FH) width, were calculated on T1-weighted images in 84 patients with clinically unclassifiable neurodegenerative parkinsonism (CUP) at the time of imaging. Areas under the curve (AUCs) of these markers for predicting future PSP was determined. The final clinical diagnosis was made after at least 24 months of follow-up.ResultsFinal diagnosis was Parkinson's disease in 55 patients, multiple system atrophy in 12 cases, and PSP in 17. At baseline imaging, patients with a final PSP diagnosis had significantly higher MRPI, P/M, MRPI2.0 and P/M2.0 values compared to the other groups. AUCs in discriminating between future PSP and non-PSP parkinsonism were 0.91 for both the P/M and the MRPI and 0.98 for the P/M2.0 and the MRPI2.0.ConclusionsBrainstem-derived MR planimetric measures yield high diagnostic accuracy for separating PSP from non-PSP parkinsonism in early disease stages when clinical criteria are not yet fully met. Consistent with the underlying pathology in PSP, our study suggests that inclusion of 3rdV width makes P/M2.0 and MRPI2.0 more accurate in diagnosing early stage PSP patients than the P/M and MRPI.

Introduction The hummingbird sign and the morning glory flower sign, reflecting midbrain pathology on MRI, have previously been shown to separate patients with progressive supranuclear palsy (PSP) from those with Parkinson's disease (PD) and multiple system atrophy (MSA). The aim of the present study was to determine the diagnostic accuracy and reproducibility of visual assessment of midbrain atrophy patterns in a large cohort of patients with neurodegenerative parkinsonism. Methods Retrospective analysis of midbrain atrophy patterns on T1-weighted MRI in a large cohort of patients with neurodegenerative parkinsonism and healthy controls who underwent MR imaging during their diagnostic work-up. Results 481 patients with neurodegenerative parkinsonism and 79 healthy controls were included in the present study. The presence of the hummingbird sign had a specificity of 99.5% and a positive predictive value of 96.1% for a diagnosis of PSP while sensitivity was suboptimal with 51.6%. Similarly, the presence of the morning glory flower sign yielded a specificity of 97.7% for a diagnosis of PSP, but sensitivity was only 36.8%. Sensitivity of both signs was 35.3% in early, clinically unclassifiable parkinsonism. Visual assessment of these midbrain alterations showed excellent inter-rater agreement. Conclusion Midbrain atrophy patterns are useful in the differential diagnosis of neurodegenerative parkinsonism but both the hummingbird sign and more so the morning glory flower sign suffer from low sensitivity, especially in early disease stages.

Introduction: Several previous studies examined different brainstem-derived MR planimetric measures with regards to their diagnostic accuracy in separating patients with neurodegenerative parkinsonian disorders and reported conflicting results. The current study aimed to compare their performance in a well-characterized sample of patients with neurodegenerative parkinsonian disorders. Methods: MR planimetric measurements were assessed in a large retrospective cohort of 55 progressive supranuclear palsy (PSP), 194 Parkinson's disease (PD) and 63 multiple system atrophy (MSA) patients. This cohort served as a training set used to build C4.5 decision tree models to discriminate PSP, PD and MSA. The models were validated in two independent test sets. The first test set comprised 84 patients with early, clinically unclassifiable parkinsonism (CUP). A prospective cohort of patients with PSP (n = 23), PD (n = 40) and MSA (n = 22) was exploited as a second test-set. Results: The pons-to-midbrain diameter ratio, the midbrain diameter, the middle cerebellar peduncle width and the pons area were identified as the most predictive parameters to separate PSP, MSA and PD in C4.5 decision tree models derived from the training set. Using these decision models, AUCs in discriminating PSP, MSA and PD were 0.90, 0.57 and 0.73 in the CUP-cohort and 0.95, 0.61 and 0.87 in the prospective cohort, respectively. Conclusion: We were able to demonstrate that brainstem-derived MR planimetric measures yield high diagnostic accuracy for the discrimination of PSP from related disorders when decision tree algorithms are applied, even at early, clinically uncertain stages. However, their diagnostic accuracy in discriminating PD and MSA was suboptimal. (C) 2017 The Authors. Published by Elsevier Ltd.

To quantify myocardial edema by using a T2 relaxometry approach with a dual-contrast turbo spin-echo (dcTSE) sequence in patients with acute myocarditis regarding focal late gadolinium enhancement (LGE) burden. CMR T2 relaxometry was performed in 39 patients (age 41 ± 19 years; 36% women) with LGE in a typical myocarditis pattern and in ten healthy volunteers (age 46 ± 12; 60% woman). dcTSE sequence (echo time 29 and 75 ms, respectively) was used for T2 mapping, analysis were performed on the basis of region of interest (ROI). Myocardial T2 relaxation times (T2 RT) in patients-ROI with focal LGE were significantly (p < 0.001) higher than T2 RT in patients—ROI without apparent LGE pattern (65 ms (IQR 36–95) vs. 60 ms (IQR 26–88), respectively). T2 RT in healthy volunteers [55 ms (IQR 35–71)] were significantly lower than in patients ROI with or without focal LGE-pattern (p < 0.001, respectively). T2 RT assessed by dcTSE are significantly higher in patients segments with and without focal LGE compared to normal controls, supporting a global myocardial inflammatory process in acute myocarditis. Furthermore, this quantitative T2-mapping approach highlights the potential to identify patients with diffuse myocarditis.

OBJECTIVES:Pulse wave velocity (PWV) is the proposed gold-standard for the assessment of aortic elastic properties. The aim of this study was to compare aortic PWV determined by a recently developed oscillometric device with cardiac magnetic resonance imaging (CMR).METHODS:PWV was assessed in 40 volunteers with two different methods. The oscillometric method (PWVOSC) is based on a transfer function from the brachial pressure waves determined by oscillometric blood pressure measurements with a common cuff (Mobil-O-Graph, I.E.M. Stolberg, Germany). CMR was used to determine aortic PWVCMR with the use of the transit time method based on phase-contrast imaging at the level of the ascending and abdominal aorta on a clinical 1.5 Tesla scanner (Siemens, Erlangen, Germany).RESULTS:The median age of the study population was 34 years (IQR: 24-55 years, 11 females). A very strong correlation was found between PWVOSC and PWVCMR (r = 0.859, p < 0.001). Mean PWVOSC was 6.7 ± 1.8 m/s and mean PWVCMR was 6.1 ± 1.8 m/s (p < 0.001). Analysis of agreement between the two measurements using Bland-Altman method showed a bias of 0.57 m/s (upper and lower limit of agreement: 2.49 m/s and -1.34 m/s). The corresponding coefficient of variation between both measurements was 15%.CONCLUSION:Aortic pulse wave velocity assessed by transformation of the brachial pressure waveform showed an acceptable agreement with the CMR-derived transit time method.

The purpose of the present study was to evaluate the potential of multimodal MR imaging including mean diffusivity (MD), fractional anisotropy (FA), relaxation rates R2 and R2* to detect disease specific alterations in Parkinson's Disease (PD). We enrolled 82 PD patients (PD-all) with varying disease durations (≤5 years: PD≤5, n = 43; >5 years: PD>5, n = 39) and 38 matched healthy controls (HC), receiving diffusion tensor imaging as well as R2 and R2* relaxometry calculated from multi-echo T2*-weighted and dual-echo TSE imaging, respectively. ROIs were drawn to delineate caudate nucleus (CN), putamen (PU), globus pallidus (GP) and substantia nigra (SN) on the co-registered maps. The SN was divided in 3 descending levels (SL 1-3). The most significant parameters were used for a flexible discrimination analysis (FDA) in a training collective consisting of 25 randomized subjects from each group in order to predict the classification of remaining subjects. PD-all showed significant increases in MD, R2 and R2* within SN and its subregions as well as in MD and R2* within different basal ganglia regions. Compared to the HC group, the PD≤5 and the PD>5 group showed significant MD increases within the SN and its lower two subregions, while the PD≤5 group exhibited significant increases in R2 and R2* within SN and its subregions, and tended to elevation within the basal ganglia. The PD>5 group had significantly increased MD in PU and GP, whereas the PD≤5 group presented normal MD within the basal ganglia. FDA achieved right classification in 84% of study participants. Micro-structural damage affects primarily the SN of PD patients and in later disease stages the basal ganglia. Iron contents of PU, GP and SN are increased at early disease stages of PD.

CASE REPORT A 68-year-old woman was referred to our department for treatment-resistant hypertension. The patient was receiving extended-release metoprolol 95 mg, aliskiren 300 mg, and indapamide 1.5 mg per day. Because of intolerance, treatment with calcium antagonists (edema) and angiotensin-converting enzyme inhibitors (cough) was not possible. Ambulatory blood pressure (BP) measurement showed elevated mean daytime values of 151/97 mm Hg (and slightly elevated values of 124/ 70 mm Hg during night). At that time, serum creatinine was 0.89 mg/dL and the patient was normoalbuminuric. Compliance with antihypertensive medication was judged as good, and when rilmenidine (2 mg per day) was added and aliskiren was replaced by 80 mg valsartan, BP slightly decreased to 145/90 mm Hg. Together with the patient and after exclusion of contraindications, we came to the decision to perform RDN. RDN was performed using the Symplicity RDN system by Medtronic (Sandy Hook, CT). After the intervention, vasospasms of the left renal artery were noticed close to the bifurcation, which did not resolve after intravasal donation of nitroglycerin, and continued until the end of the procedure. Over the next 2 days, BP stayed unchanged and no rise in serum creatinine was detected. After 1 month, serum creatinine was 0.87 mg/dL and office BP was 149/90 mm Hg; therefore, doses of valsartan were raised to 160 mg/d. During the following months, serum creatinine increased and hypertension worsened despite an increase in medication (valsartan 320 mg/d, torasemid 10 mg/d, rilmenidine 2 mg/d, nebivolol 5 mg/d, and terazosin 4 mg/d). Magnetic resonance imaging angiography 10 months after RDN revealed an hourglass-like short distance stenosis of the left renal artery and a reduction in length of the left kidney of 1.2 cm. Serum creatinine was 1.65 mg/dL. Reevaluation of renal angiography at the time of the RDN procedure exhibited that the de novo stenosis was located at the position of the acute subendothelial edema. The angiotensin receptor blocker was stopped and serum creatinine subsequently decreased to 1.51 mg/dL and 24-hour measurement of BP exhibited a mean value of 129/79 mm Hg. For quantification of functional significance of the stenosis, isotopic side separate renal clearance was conducted under furosemide stimulation. Overall, glomerular filtration rate was 61 mL/min/1.73m2, with a 77% contribution of the right and 23% of the left kidney. The test was repeated 3 weeks after stop of renin-angiotensin system inhibiton (75 mL/min/1.73m2; 75% right/25% left kidney), suggesting an influence of renin-angiotensin system blockade on both kidneys. Initially, serum creatinine decreased to 1.16 mg/dL but BP rose to 160/90 mm Hg. When valsartan was reinstituted, BP again was sufficiently controlled leading to a slight rise in serum creatinine to 1.31 mg/dL. In order to improve vascularization and function of the left kidney, we decided to perform angioplasty of the stenosis with a drug eluting balloon, which was successfully performed 12 months after RDN (Figures 1 and 2). One week after dismission, the patient was under sufficient therapy (ambulatory BP revealed a mean value of 133/81 mm Hg) with a combination of four antihypertensives (nebivolol 5 mg, rilmenidine 2 mg, valsartan 80 mg, and torasemide 10 mg) and stable serum creatinine of 1.26 mg/dL.

BackgroundAbsence of a hyperintense, ovoid area within the dorsolateral border of the otherwise hypointense pars compacta of the substantia nigra (referred to as dorsolateral nigral hyperintensity) on iron-sensitive high-field magnetic resonance imaging sequences seems to be a typical finding for patients with Parkinson's disease (PD).ObjectiveThis study was undertaken to evaluate the diagnostic value of the dorsolateral nigral hyperintensity in a cohort of patients with neurodegenerative parkinsonism including PD, multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) as well as healthy controls using high-field susceptibility-weighted imaging (SWI) at 3.0 Tesla (T).MethodsAbsence of dorsolateral nigral hyperintensity was assessed on visual inspection of anonymized 3.0T SWI scans in a case-control study including 148 patients with neurodegenerative parkinsonism (PD: n=104; MSA: n=22; PSP: n=22) and 42 healthy controls.ResultsDorsolateral nigral hyperintensity was absent unilaterally in all patients with MSA or PSP, in 83 of 90 patients with PD, but only in one of the healthy controls resulting in an overall correct classification of 95.2% in discriminating neurodegenerative parkinsonism from controls in the per-protocol analysis. Overall correct classification was 93.2% in the intent-to-diagnose analysis, including also SWI scans with poor quality (12.1% of all scans) for nigral evaluation.ConclusionVisual assessment of dorsolateral nigral hyperintensity on high-field SWI scans may serve as a new simple diagnostic imaging marker for neurodegenerative parkinsonian disorders. (c) 2015 International Parkinson and Movement Disorder Society

Background Cardiac stress MRI has grown to a well established method to detect hypokinesia or perfusion deficits due to ischemia. Commonly, myocardial load is generated by the administration of adenosine or dobutamine, which is associated by a higher complication rate compared to exercise stress testing. Our purpose was to evaluate the use of an MR conditional pedal ergometer for cardiac stress MRI.

Background: Mild cognitive impairment (MCI) may represent an early stage of dementia conferring a particularly high annual risk of 15-20% of conversion to Alzheimer's disease (AD). Recent findings suggest that not only gray matter (GM) loss but also a decline in white matter (WM) integrity may be associated with imminent conversion from MCI to AD.Objective: In this study we used Voxel-based morphometry (VBM) to examine if gray matter loss and/or an increase of the apparent diffusion coefficient (ADC) reflecting mean diffusivity (MD) are an early marker of conversion from MCI to AD in a high risk population.Method: Retrospective neuropsychological and clinical data were collected for fifty-five subjects (MCI converters n = 13, MCI non-converters n = 14, healthy controls n = 28) at baseline and one follow-up visit. All participants underwent diffusion weighted imaging (DWI) and T1-weighted structural magnetic resonance imaging scans at baseline to analyse changes in GM density and WM integrity using VBM.Results: At baseline MCI converters showed impaired performance in verbal memory and naming compared to MCI non-converters. Further, MCI converters showed decreased WM integrity in the frontal, parietal, occipital, as well as the temporal lobe prior to conversion to AD. Multiple regression analysis showed a positive correlation of gray matter atrophy with specific neuropsychological test results.Conclusion: Our results suggest that additionally to morphological changes of GM a reduced integrity of WM indicates an imminent progression from MCI stage to AD. Therefore, we suggest that DWI is useful in the early diagnosis of AD.

Recently published studies have elucidated alterations of mitochondrial oxidative metabolism during ageing. The intention of the present study was to evaluate the impact of ageing on cardiac high-energy phosphate metabolism and cardiac function in healthy humans. 31-phosphorus 2-dimensional chemical shift imaging (31P 2D CSI) and echocardiography were performed in 196 healthy male volunteers divided into groups of 20 to 40 years (I, n = 43), 40 to 60 years (II, n = 123) and > 60 years (III, n = 27) of age. Left ventricular PCr/beta-ATP ratio, myocardial mass (MM), ejection fraction and E/A ratio were assessed. Mean PCr/beta-ATP ratios were significantly different among the three groups of volunteers (I, 2.10 +/- 0.37; II, 1.77 +/- 0.37; III, 1.45 +/- 0.28; all p < 0.001). PCr/beta-ATP ratios were inversely related to age (r(2) = -0.25; p < 0.001) with a decrease from 2.65 by 0.02 per year of ageing. PCr/beta-ATP ratios further correlated with MM (r = -0.371; p < 0.001) and E/A ratios (r = 0.213; p < 0.02). Moreover, E/A ratios (r = 20.502, p < 0.001), MM (r = 0.304, p < 0.001), glucose-levels (r = 0.157, p < 0.05) and systolic blood pressure (r = 0.224, p < 0.005) showed significant correlations with age. The ejection fraction did not significantly differ between the groups. This study shows that cardiac PCr/beta-ATP ratios decrease moderately with age indicating an impairment of mitochondrial oxidative metabolism due to age. Furthermore, MM increases, and E/A ratio decreases with age. Both correlate with left-ventricular PCr/beta-ATP ratios. The findings of the present study confirm numerous experimental studies showing an impairment of cardiac mitochondrial function with age.

Background: Pulse wave velocity is a measure of aortic stiffness and an independent predictor of cardiovascular morbidity and mortality. Adiponectin is involved in atherosclerosis and inflammation. In the present study we aimed to explore the association between plasma adiponectin concentrations and pulse wave velocity in the acute phase after ST-segment elevation myocardial infarction (STEMI).Methods: Forty-six consecutive STEMI patients (mean age 57 +/- 11 years) treated with primary percutaneous coronary intervention (PCI) were enrolled in this cross-sectional study. Plasma adiponectin was measured 2 days after index event by enzyme-linked immunosorbent assay. Aortic pulse wave velocity (PWV) was calculated by the transit-time method with the use of a velocity-encoded, phase-contrast cardiac magnetic resonance protocol.Results: Median plasma adiponectin concentration was 2385 ng/ml (interquartile range 1735-5403). Males had lower plasma adiponectin values than females and current smokers had lower values than non-smokers (all p < 0.02). Adiponectin was significantly associated with PWV (r=0.505, p < 0.001), age (r=0.437, p=0.002), and total cholesterol (r=0.468, p=0.001). Multiple linear regression analysis revealed adiponectin as a predictor of PWV independently of age, sex, smoking status, total cholesterol, and N-terminal pro-B-type natriuretic peptide (p=0.027).Conclusions: Plasma adiponectin concentrations are strongly associated with aortic stiffness in patients after acute STEMI treated with primary PCI. Our data support a possible role for adiponectin as an independent risk marker for increased aortic stiffness in STEMI patients.

Until recently, assessment of muscle metabolism was only possible by invasive sampling. 31P magnetic resonance spectroscopy (31P MRS) offers a way to study muscle metabolism non-invasively. The aim of the present study was to use spatially-resolved 31P MRS to assess the metabolism of the quadriceps muscle in sprint-trained, endurance-trained and untrained individuals during exercise and recovery. 5 sprint-trained (STA), 5 endurance-trained (ETA) and 7 untrained individuals (UTI) completed one unlocalized 31P MRS session to measure phosphocreatine (PCr) recovery, and a second session in which spatially-resolved 31P MR spectra were obtained. PCr recovery time constant (τ) was significantly longer in STA (50±17 s) and UTI (41±9 s) than in ETA (30±4 s), (P<0.05). PCr changes during exercise differed between the groups, but were uniform across the different components of the quadriceps within each group. pH during recovery was higher for the ETA than for the UTI (P<0.05) and also higher than for the STA (P<0.01). Muscle volume was greater in STA than in UTI (P<0.05) but not different from ETA. Dynamic 31P MRS revealed considerable differences among endurance and sprint athletes and untrained people. This non-invasive method offers a way to quantify differences between individual muscles and muscle components in athletes compared to untrained individuals.

OBJECTIVE:To investigate the relationship between circulating plasma copeptin values and infarct size as well as myocardial function at baseline and 4 months after mechanical reperfusion for ST segment elevation myocardial infarction (STEMI). DESIGN:Prospective observational cohort study. SETTING:University Hospital of Innsbruck. PATIENTS:54 patients with acute STEMI. MAIN OUTCOME MEASURES:Correlation of plasma copeptin with infarct size as well as left ventricular ejection fraction (LVEF) and remodelling. METHODS:Participants underwent contrast enhanced cardiac MRI at baseline and 4 months thereafter. Blood samples were drawn 2 days after the onset of symptoms. Copeptin values were determined by an immunofluorescent assay. RESULTS:Copeptin concentrations (median 10.4 pmol/l, IQR 6.0-14.4) were associated with early and chronic infarct size (r=0.388, p=0.004 at baseline; r=0.385, p=0.011 at follow-up) and inversely related to LVEF at both times (r=-0.484, p<0.001 at baseline; r=-0.461, p<0.001 at follow-up). Patients with adverse remodelling showed higher baseline copeptin values compared to patients without remodelling (p=0.02). Receiver operating characteristic analysis indicated a cut-off value of 16.7 pmol/l for copeptin to best identify patients with future adverse remodelling. CONCLUSIONS:Increased copeptin values 2 days after STEMI are associated with larger acute and chronic infarct sizes. Moreover, elevated copeptin concentrations at baseline were associated with myocardial function and remodelling 4 months post-STEMI. These findings strengthen the role of copeptin as a biomarker of adverse outcome after STEMI.

Objectives: Cine cardiac magnetic resonance (CMR) represents the gold-standard in the non-invasive determination of left-ventricular function, but might overestimate cardiac output in different pathophysiological conditions. Phase-contrast CMR might provide a fast and robust alternative. We therefore investigated the use of phase-contrast CMR to assess cardiac index in patients early after acute ST-segment elevation myocardial infarction (STEMI). Methods: We included n = 90 patients with first STEMI (mean age: 59 ± 11years) who underwent CMR within 7 days after primary angioplasty for the index event. Cine true-FISP sequences in the left-ventricular short-axis and a free breathing retrospectively gated velocity-encoded, phase-contrast CMR protocol on the level of the ascending aorta were applied. The phase-contrast protocol was validated against cine CMR in 15 healthy volunteers. Inter- and intraobserver agreement was determined in volunteers as well as in n = 16 STEMI patients. The correlations of clinical variables (age, gender, ejection fraction, NT-pro-brain natriuretic peptide [NT-proBNP]) with cardiac index in STEMI patients were calculated. Results: There was a strong agreement of cine CMR with phase-contrast CMR in healthy volunteers (r: 0.818, mean difference: -0.13 l/min/m2, error ±18%). Agreement was lower in STEMI patients (r: 0.611, mean difference: -0.17 l/min/m2, error ±32%). In STEMI patients cardiac index measured with phase-contrast CMR was 2.7 l/min/m2 and showed lower intraobserver (1.4 % vs. 8.8 %) and interobserver variability (8.5 % vs. 11.6 %) than cine CMR. Cardiac index decreased by 16ml/min/m2 per year (r = 0.356, p = 0.001) in STEMI patients. Furthermore, cardiac index was correlated with patients ejection fraction (r = 0.256, p < 0.02) and inversely correlated to NT-proBNP values (r = -0.220, p < 0.05). Conclusion: Phase-contrast CMR is a valid and robust method for the measurement of cardiac index. With the use of phase-contrast CMR we observed a decrease in cardiac index with age and ejection fraction in patients after acute STEMI. Observed differences in STEMI patients might be due to presence of subclinical mitral regurgitation, which occurs in up to 50% of STEMI patients and prompts further investigation. Because of the low agreement with cine CMR, measures should not be used interchangeably in patients after acute STEMI.