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Emerging Clinical Applications

This session was jointly organised with the Asian Society of Cardiovascular Imaging and discussed the emerging clinical application of Cardiovascular Magnetic Resonance (CMR).

This interesting session was opened by Dr. Said Mohiddin (London, UK) given a talk on the role of CMR in inpatients. CMR is an essential component of the acute cardiac service and is a versatile tool. CMR can be a key imaging modality in specific case presentations as non-coronaric causes of acute myocardial injury, cardiac arrest, heart failure without absent coronary artery disease and to test viability pre-revascularization strategy. Furthermore, CMR represents the most comprehensive imaging technique providing information on function, morphology, stress perfusion, scar ad oedema. Dr Mohiddin reported the experience of his hospital and the Bristol hospital, where CMR has significant clinical impact in daily clinical practice. In almost two third of the cases CMR allows to make new diagnosis and provide an overt contibution on the inpatient management.

My talk (Dr Viviana Maestrini, Rome, Italy) was focused on the role of CMR in athletes. The differential diagnosis between the athlete’s heart and some phenotype of cardiomyopathies represents a clinical diagnostic challenge. CMR provides an added value in morphology and function evaluation, however, the added value of the technique is the possibility to tissue characterise the myocardium providing diagnostic and prognostic information especially in athletes presenting with complex ventricular tachycardia. T1 mapping added a new dimension in tissue characterization allowing to differentiate cellular and extracellular component. Preliminary data showed that the left ventricle hypertrophy is cellular rather than extracellular adaptation and hold the potential to differentiate between athlete’s heart and cardiomyopathy. A high prevalence of myocardial fibrosis is reported in life-long endurance athletes, both as minor patterns but also with ischemic and non-ischemic pattern. Future applications includes also the use of exercise CMR by in scanner ergometer to detect exercise cardiac reserve,

The third talk was presented by Dr. Francisco Alarcòn Sanz (Barcelona, Spain). The talk was focused on the role that CMR has for the elctrophysiologists. CMR and CT are both useful tool. CT is providing more reliable information on anatomy while CMR on tissue characterization. LGE-CMR is a common and useful tool for the arrhythmia management. There are different clinical applications depending on the cardiac chamber of interest. CMR allows to detect the presence of left atrial fibrosis, identify the presence pulmonary vein gaps after pulmonary vein ablation and the identification of critical isthmuses in atrial atypical flutter. The tissue characterization of the left ventricle detecting scar is the base of the dechanneling. This technique implies to detect the scar prior the ablation and the merge of the electronatomical map with LGE by CMR in order to electrically isolate the scar and avoid LV scar related tachycardia.

The last talk was given by Dr Carmen Chan (Hong Kong; HK) on the role of CMR in valvular heart disease. The talk was focused specifically on the evaluation of prosthesis heart valve (PHV). Cardiac imaging tests are crucial not only for pre pre-implant evaluation but also for an early follow-up to detect residual regurgitation or paravalvular leak or to detect complications as thrombus, pannus or endocarditis. While echocardiography remains the first-line imaging technique,  CT has increasing roles in PHV evaluation also for the post-implant evaluation. The imaging quality is good by CT and appears to be better that CMR in term of artefacts originated from valve prosthesis. CMR is a good option to assess volume, function and the severity of the regurgitation and its potential role need to be explored.

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.