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SCMR/EuroCMR Plenary Session

Non-invasive Imaging: Magnetic Resonance Imaging

Sesame street roosters, European travel vaccination advice, the marriage of zeugmatographic imaging and advice that women have small hearts and attenuating breasts. The opening plenary session of this years meeting had it all.

After the uplifting statistics of the welcome address including record membership in both societies Professor Fuster delivered a dynamic and stimulating ‘Round Trip of Motivation by MRI’.
He began with a focus on laboratory MRI research developing real changes in clinical cardiology. We journied from CE-MRI and FDG PET on rabbits to human studies of diabetics with multivessel coronary disease. The next journey traversed the Atlantic from the US to Spain. Entrepreneurial input has allowed two countries to work together to promote scientific investigation in the youth and he emphasised that motivation is the key to successful working. A pig model in New York City has led to clinical trials in Spain the results of which are currently ‘in press’ but reveal exciting possibilities of early treatment of MI with beta-blockers to reduce infarct size.
MRI is assisting in predicting progression and events of subclinical disease raising the possibility of encouraging lifestyle alterations before an event occurs. And where better to start but in the young? Teaching healthy lifestyles to children and ‘promoting health rather than preventing disease’ reveals a real positivity for future generations.
All in all the talk could be summarised in six words: ’MRI does not have a ceiling’.

Professor Pennel followed next with a summary of where we are now with CMR and the diagnosis and treatment of non-ischaemic cardiomyopathies. And boy has MRI had an impact! A staggering 71% reduction in cardiac death of thallassaemia patients in the UK since the introduction of T2* imaging. And it doesn’t stop there. Late gadolinium enhancement imaging in DCM could improve patient selection for ICD implantation resulting in more appropriate implants in high risk patients with high scar burden but astonishingly a lower overall implantation rate. The same can also be said for patients with ARVC and increasing numbers of MRI abnormalities. MRI has led to better diagnostic guidelines for myocarditis, sarcoid, amyloid, Anderson-Fabry’s disease and the rare but clinically important ALVC. Already CMR has increased diagnosis, improved our ability to specify prognosis and will, in the future, help change the face of treatment.

Next on, Dr Marc Fogel demonstrated the use of CMR in congenital heart diseases, identifying where CMR is mostly useful.  Specifically in Tetralogy of Fallot CMR, plays a key role in the prognosis and follow-up of these patients after surgical correction. The future of CMR in congenital heart disease is open wide with 4D flow analysis and the possibility of obtaining 3D models for virtual surgery with open new opportunities in the field. Dr Fogel finalized his talk by stating that CMR should be the standard of care in nearly all congenital heart diseases

To round up the session, Dr Chiara Bucciarelli-Ducci summarized the scientific evidence for using CMR in both acute and chronic chest pain and infarct investigation. In her opinion “CMR can fully phenotype the heart, with pictures that carry a meaning”. This remark will be further emphasized with significant data that is being gathered by the upcoming  MR-Inform, CE-Mark 2 and Ischemia trials. In a dedicated analysis of heart disease in women, she showed that CMR plays a special role compared to other modalities as demonstrated by the results of MR-Impact II and the CE-MARC substudy. Finally, the results of all the efforts of the CMR community could be appreciated by the publications of clinical guidelines now incorporating CMR as an important imaging method in the evaluation of CAD as shown by the recent NICE, ACC/AHA and ESC guidelines on CAD and Myocardial Revascularization.


SCMR/EuroCMR Plenary Session
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.