Prof. Bernhard Gerber,
In the best abstract session, 6 exciting abstracts were presented.
Dr Treibel from London compared the ability of extracellular volume measurements (ECV) by CMR vs native and post-contrast T1 measurements to predict hospitalization for heart failure or death in 1185 consecutive patients without amyloidosis, hypertrophic or stress cardiomyopathy over a median time of 1.7 years. They found that ECV had significantly higher predictive value to predict adverse effects than native or post-contrast T1 measurement or partition coefficient Lambda. They concluded therefore that ECV should be the method of choice to measure myocardial fibrosis and risk stratify patients with cardiomyopathies.
Dr Duca from Vienna, Austria also measured extracellular volume measurements (ECV) by CMR in 117 patients with heart failure with preserved ejection fraction (HpEF) and followed them over an average duration of X months. They demonstrated that Molli ECV and RV end-diastolic volume, as well as GFR and BNP and pulmonary vascular resistance were independent predictors of outcome and suggested that ECV has the potential to become an important biomarker in HpEF.
Dr Schwitter from Lausanne, Geneva proposed an exciting new technique to overcome problems of respiratory motion in long MR acquisitions. They used high frequency percussive ventilation, a technique which administers small volumes of air, so-called “percussions”, with adjustable pressures and at high frequencies, to replacing spontaneous breathing. They showed in a pilot study that this technique can be adapted to the cMR environment and allows reduction of respiratory motion and simulate long apnoeas up to 10 minutes. This allows to acquire long imaging sequences such as 3D high resolution coronary MR angiography in shorter time with less respiratory motion artifacts.
Dr Ide from the Hospital of Sick Children in Toronto, Canada validated measurements of extracellular volume measurements by cardiac MR in 20 children after heart transplantation, by comparing them to measurements of myocardial fibrosis during endocardial myocardial biopsy with performed on the same day. They demonstrated that both native T1 and ECV were significantly increased in children after heart transplantation and correlated to measurements of myocardial fibrosis. Therefore they concluded that both techniques could allow non-invasive measurements of fibrosis in children after heart transplantation.
In children after arterial switch operation for transposition of great arteries, coronary artery stenosis due to the reimplantation of coronary arteries is common and associated with high morbi- and mortality. Therefore Dr Raimondi from Hopital Necker, Paris, France evaluated in 65 asymptomatic children with surgery for transposition of great arteries 13 years earlier, that a comprehensive CMR protocol with 3D coronary artery imaging and quantitative stress myocardial perfusion can detect perfusion defects, though other tests such as echo and stress test were normal. Thus this comprehensive test could detect children at high risk of complication after such congenital surgery.
Finally, Dr Fridman from the University of Pittsburgh performed a prospective study of 299 patients referred for CMR with known heart disease and sleep apnoea. He found that obstructive sleep apnoea disease severity as measured by apnoea-hypopnea index (AHI) was not significantly associated with ECV, Ejection Fraction, BNP and did not predict events. Yet in these patients with obstructive sleep apnoea, higher ECV had significantly increased risk of events with a dose response relationship and consequently improved cardiovascular risk stratification. ECV thus improves stratification of cardiovascular risk in OSA nearly doubling the risk of hospitalisation for heart failure or death by every increase in 5% in myocardial fibrosis. He concluded that myocardial fibrosis cans be an intermediary mechanism for cardiovascular disease that may be a promising CMR image-guided therapeutic target.
Overall this was an excellent session, with high level of research performed using cardiac MRI and demonstrating the important role of cardiac MR for the understanding and risk stratification of cardiac diseases.
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