RPS 703 - CMR for myocardial tissue characterisation and function: myocardial fibrosis, mapping and hemodynamic forces in CMR

Author Block: M. Hu¹, X. Yue¹, J. Qi¹, Y. Chen², T. Li³, K. He¹, S. Gui⁴; ¹BeiJing/CN, ²Shanghai/CN, ³Beijing/CN, ⁴Wuhan/CN
Purpose: To determine whether early cardiac MRI–derived haemodynamic force (HDF) parameters predict adverse left-ventricular remodelling (ALVR) after primary PCI for STEMI, and to assess their incremental prognostic value beyond conventional markers.
Methods or Background: In this retrospective multicentre cohort, 147 STEMI patients (92 internal, 55 external) underwent CMR within 14 days post-PCI and at 5 months. HDFs were computed non-invasively from cine sequences (Medis). ALVR was defined as a ≥15% increase in LV end-systolic volume. Group differences were analysed and multivariable logistic regression identified independent predictors. Incremental value of systolic HDF metrics over traditional predictors was assessed using likelihood-ratio tests, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Results or Findings: Independent predictors of ALVR were peak troponin-T (OR 1.079, 95% CI 1.004–1.160; p=0.038), infarct percentage (OR 1.139, 95% CI 1.039–1.249; p=0.026), systolic lateral HDF RMS (OR 0.370, 95% CI 0.138–0.991; p=0.048) and systolic HDF impulse (OR 0.661, 95% CI 0.462–0.946; p=0.024). Adding systolic HDF parameters significantly improved model performance across base models, AUC increased from 0.704 to 0.778 in the derivation cohort and from 0.655 to 0.807 in the validation cohort (NRI 0.714 and 1.012; IDI 0.122 and 0.284; likelihood-ratio p=0.007 and 0.009), indicating meaningful reclassification over conventional predictors.
Conclusion: Systolic HDF metrics—particularly lateral HDF RMS and impulse—are independent predictors of ALVR after STEMI and provide incremental prognostic value beyond established markers, supporting their use for post-infarction risk stratification and clinical decision-making.
Limitations: The retrospective nature of the study introduces a potential for selection bias. Therefore, larger prospective studies are needed to validate HDF prediction models and their therapeutic guidance.
Funding for this study: This work was supported in part by the National Key R&D Program of China under Grant 2024YFF0505704.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This retrospective multicentre study complied with the Declaration of Helsinki; institutional approvals/consent waivers were obtained where required.

Author Block: Y. Hou, H. Zhou, L. Weihua; Changsha/CN
Purpose: To investigate the potential role of left ventricular (LV) hemodynamic force (HDF) for detecting cardiac dysfunction in acute myocarditis patients.
Methods or Background: We retrospectively enrolled 173 consecutive acute myocarditis patients without heart failure (non-HF) along with 64 age- and sex-matched healthy controls. HDF parameters were calculated (I) as the root mean square during systole [HDF(Sys)] and diastole [HDF(Dia)]; (II) as the mean forces during distinct phases—systolic thrust [HDF(A)], systole-diastole transition [HDF(B)], diastolic deceleration [HDF(C)], and late diastolic filling [HDF(D)]. Additionally, LV global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were measured using a CMR feature tracking technique.
Results or Findings: Compared with controls, non-HF patients exhibited impaired diastolic HDF parameters, including reduced HDF(Dia) (13.27±5.07 vs 16.00±6.40，p=0.007), decreased mean force in phase B [HDF(B)] (11.09±3.75 vs 12.92±4.51，p=0.026), phase C [HDF(C)] (12.61±5.94 vs 16.07±6.82, p=0.001), and elevated mean force in phase D [HDF(D)] (2.82±2.19 vs 1.25±1.60, p<0.001); while systolic HDF parameters, including HDF(Sys) (24.19±4.57 vs 24.25±5.43, p=0.314) and HDF(A) (22.15±4.93 vs 23.02±6.18, p=0.885) showed no statistically significant variations. There was also no significant difference in LV ejection fraction (EF) or strain between healthy controls and non-HF patients (p =0.099 for LVEF, p = 0.934 for GLS, p = 0.608 for GCS, and p = 0.155 for GRS).
Conclusion: In contrast to healthy controls, non-HF acute myocarditis patients already showed early LV HDF parameters impairment, while maintaining normal LVEF and strain measurements.
Limitations: This study is a retrospective study with potential selection bias.
Funding for this study: This study was supported by the National Natural Science Foundation of China (82071984, 82071894, and 91959117)，the Science and Technology Innovation Program of Hunan Province (2020RC4007), and The Scientific Research Program of FuRong Laboratory 2024PT5110.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Medical Ethics Review Committee of Xiangya Hospital Central South University (No. 2025061065)

Author Block: C. Reiter, G. Reiter, A. Schmidt, E. Kolesnik, D. Scherr, M. Fuchsjäger, U. Reiter; Graz/AT
Purpose: To evaluate the utility of a high temporal resolution 2D phase-contrast (PC) MRI sequence for the assessment of the isovolumic relaxation time (IVRT) - a key parameter in evaluation of left ventricular diastolic dysfunction - compared to a standard 2D PC sequence using echocardiography as reference.
Methods or Background: Twenty-five healthy subjects (13 females; age 60 ± 9 years) were prospectively recruited for cardiac MRI at 3T and echocardiography. Echocardiographic evaluation of the IVRT (IVRT-Echo) was performed according to current guidelines. A retrospective ECG-gated high temporal resolution cine in-plane 2D PC measurement (measured temporal resolution = 18 ms interpolated to 70 frames per cardiac cycle) was acquired in the 3-chamber view under free breathing. The IVRT was evaluated as interval between the end of aortic flow and onset of transmitral inflow from this measurement (IVRT-highTR). To study the impact of temporal resolution, the IVRT was also evaluated from a standard transmitral 2D PC measurement (measured temporal resolution = 45 ms interpolated to 30 frames per cardiac cycle; IVRT-standard). Results were analyzed using paired t-tests and correlation analysis.
Results or Findings: Cardiac intervals did not differ between modalities and measurements (899 ± 127 ms, 880 ± 127 ms and 889 ± 123 ms for echocardiography, IVRT-highTR and IVRT-standard, respectively; p, 0.267-0.674). Echocardiographic IVRT (79 ± 16 ms) showed no significant bias compared to neither IVRT-highTR (77 ± 15 ms, p = 0.054) nor IVRT-standard (75 ± 17 ms, p = 0.101). A stronger correlation was observed between IVRT-highTR (0.944, p<0.001) and echocardiography than IVRT-standard (0.745, p<0.001).
Conclusion: High temporal resolution 2D PC MRI allows precise assessment of the IVRT compared to echocardiography as reference, outperforming a standard temporal resolution transmitral 2D flow measurement.
Limitations: Small sample size.
Funding for this study: OeNB Anniversary Fund 17934
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Local ethic number: 24-126 ex 11/12

Author Block: D. Filatova, E. Mershina, E. Gagarina, R. Myasnikov, O. Kulikova, A. Meshkov, A. Kiseleva, V. Е. Sinitsyn; Moscow/RU
Purpose: Non-compaction of left ventricular myocardium (NCLVM) is a morphological variant characterized by myocardial two-layer structure. Patients often develop contractile dysfunction, leading to heart failure. However, increased trabeculation is observed in other diseases, such as dilated cardiomyopathy (DCM), making diagnosis challenging when LV ejection fraction (LVEF) is preserved and LV dilation is minimal.
The study purpose: to determine the role of myocardial strain, assessed by cardiac magnetic resonance imaging (CMR), in identifying subclinical contractile dysfunction in patients with NCLVM and preserved LVEF.
Methods or Background: Study enrolled patients with genetically confirmed NCLVM and preserved LVEF, patients with DCM, and individuals without cardiovascular disease (control group). All participants underwent CMR with intravenous contrast administration. Myocardial strain analysis was performed using cvi42 software.
Results or Findings: The study included 112 participants: 16 patients with NCLVM and preserved LVEF (mean age 37.8±13.8 years;9 men), 51 control subjects with no pathological findings on CMR (37.7±13 years;31 men), and 45 patients with DCM (45.6±14.8 years;29 men).
Significant reduction in global and segmental strain was observed in DCM. Patients with NCLVM demonstrated reduced global strain, decreased longitudinal and circumferential strain (LS, CS) in mid and apical segments (10,12-14 and 6,7,10-12,14, respectively). Radial strain (RS) was reduced in most segments (1,4-16) compared to control group (p<0.05).
ROC analysis revealed that global LS, RS and CS provided the optimal AUC values for differentiating NCLVM from DCM. The optimal AUC values were obtained for global LS, RS and CS, as well as for LS in segment 15, RS in segment 5, and CS in segment 9.
Conclusion: Myocardial strain assessment is valuable diagnostic tool for detecting contractile dysfunction in patients with NCLVM and preserved LVEF. It is more sensitive to functional impairment than LVEF measurement alone.
Limitations: N/A
Funding for this study: N/A
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by local ethic commitee of Medical Research and Educational Institute of Lomonosov Moscow State University.

Author Block: B. Tütüncüoğlu, F. Alpaslan, M. F. Kazanbaş, E. İsmailov, T. Y. Kılıç, T. Banaz, F. Köse, M. Kadıoğlu, S. Ozkök; Istanbul/TR
Purpose: To investigate genotype–phenotype relationships and cardiac magnetic resonance (CMR) correlates in pediatric patients with cardiomyopathy, focusing on fibrosis and ventricular dysfunction.
Methods or Background: This retrospective cohort included 32 pediatric patients diagnosed with cardiomyopathy and followed at our center. Clinical data, genetic testing and CMR results were analyzed. Patients were classified as dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM) or other subtypes including restrictive and noncompaction. Genetic testing was performed in 25 patients, identifying pathogenic variants. Imaging evaluation emphasized late gadolinium enhancement (LGE) as a marker of myocardial fibrosis and ventricular functional parameters.
Results or Findings: The cohort comprised 15 patients with DCM (46.9%), 13 with HCM (40.6%) and 4 with other subtypes (12.5%). Pathogenic variants were detected in 14 of 25 tested patients (56%). In HCM, genotype-positive patients demonstrated greater wall thickness (mean 19.5 mm vs. 17 mm) and a higher fibrosis prevalence. LGE was present in 87.5% of genotype-positive versus 20% of genotype-negative cases. In DCM, TTN splice variants were predominant genetic etiology, consistent with their known familial role. All DCM patients with LGE exhibited severely reduced systolic function (LVEF <30%), underscoring the combined prognostic impact of fibrosis and contractile impairment. Notably, in HCM, hypertrophy severity did not directly correlate with fibrosis burden, highlighting the limitation of wall thickness alone as a risk marker.
Conclusion: Integration of genetic and imaging data provides a comprehensive framework for assessing pediatric cardiomyopathies. Pathogenic variants were associated with more severe phenotypes and higher fibrosis prevalence, as quantified by CMR. Fibrosis in HCM represents an independent risk marker beyond hypertrophy, while in DCM, scar formation consistently paralleled advanced dysfunction. Combined genetic testing and CMR enhance risk stratification and guide personalized management in this vulnerable population.
Limitations: Small sample size and retrospective design
Funding for this study: Not receive any financial support
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: E. Locatelli, S. Figliozzi, F. Catapano, A. Laghi, M. Francone; Milan/IT
Purpose: To investigate the potential association between long-term exposure to airborne particulate matter (PM2.5 and PM10) and early cardiac changes with cardiac magnetic resonance (CMR) mapping in individuals with structurally normal hearts, to elucidate the link between air pollution and myocardial remodeling.
Methods or Background: The impact of air pollution on early myocardial remodeling in individuals without overt cardiovascular disease remains incompletely understood. CMR mapping provides sensitive markers of myocardial fibrosis and inflammation that may reveal subclinical injury.
We retrospectively studied 231 patients undergoing CMR with structurally normal hearts, preserved function, and no LGE. PM2.5 and PM10 exposure was derived from the nearest European Environment Agency monitoring stations. CMR parameters included left ventricular end-diastolic volume indexed, left ventricular ejection fraction, native T1, and T2 mapping. Associations with pollutant exposure were tested with multivariable linear and logistic regression adjusted for demographic, clinical, and socioeconomic factors.
Results or Findings: Higher PM2.5 exposure was associated with higher native T1 values ( p = 0.020); no associations were found with other CMR parameters or with PM10 exposure. Patients with high PM2.5 exposure had significantly higher T1 compared with those with low exposure. PM2.5 was associated with pathological T1, with male sex and diabetes being other independent associates.
Conclusion: In individuals with structurally normal hearts, chronic PM2.5 exposure was independently associated with higher native T1 values and pathological T1, suggesting early diffuse myocardial fibrosis.
Limitations: Its retrospective, single-center design and relatively small sample size; secondly, exposure assessment was based on residential proximity to air quality monitoring stations, which may not represent individual variability in exposure; finally, the association with PM2.5 was statistically significant but the absolute effect size was modest and most T1 values remained within the normal range.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study protocol was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board's Ethics Committee.

Author Block: Z. Tian¹, T. Liu², M. Lu¹; ¹Beijing/CN, ²Shenyang/CN
Purpose: This study aimed to assess whether the extent of late gadolinium enhancement (LGE), quantified as myocardial infarction percentage (MI%), influences long-term outcomes under different therapeutic strategies in patients with chronic multivessel coronary artery disease (MVD) without prior revascularization.
Methods or Background: A multicenter retrospective cohort of 715 patients with chronic MVD who underwent contrast-enhanced cardiac magnetic resonance was analyzed. Patients were stratified according to LGE-derived MI% and subsequently grouped by therapeutic management with optimal medical therapy (OMT), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). The primary endpoint was cardiac death. Secondary endpoints were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). Kaplan–Meier and multivariable Cox regression analyses were performed to evaluate associations between treatment strategies, infarct burden, and outcomes.
Results or Findings: During a median follow-up of 6.7 years, patients with higher MI% exhibited significantly increased risks of cardiac death, all-cause mortality, and MACCE. Within this subgroup, both PCI and CABG were associated with lower event rates compared with OMT (P < 0.001 for all). Moreover, PCI was associated with a more favorable prognosis than CABG, reflected by lower rates of cardiac death and MACCE. In patients with lower MI%, no significant differences in outcomes were observed across treatment strategies.
Conclusion: In patients with chronic MVD without prior revascularization, CMR-derived infarct burden identifies a high-risk population in whom revascularization, particularly PCI, provides superior long-term survival compared with medical therapy or CABG. These findings emphasize the importance of integrating myocardial tissue characterization into contemporary Heart Team decision-making to refine therapeutic selection.
Limitations: This study is limited by its retrospective design and the possibility of residual confounding despite multivariable adjustment.
Funding for this study: This study was supported by National Natural Science Foundation of China (grant number 82471973); Beijing Natural Science Foundation (grant number 7242110); National High Level Hospital Clinical Research Funding (grant number 2022-GSP-QZ-5).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee of Fuwai Hospital, CAMS&PUMC 2022-1770

Author Block: N. Zhang, X. Yue; Shanghai/CN
Purpose: To investigate myocardial microstructural alterations in ejection fraction-preserved hypertrophic cardiomyopathy (HCM) using second-order motion-compensated spin echo cardiac diffusion tensor imaging (M2-cDTI), and to determine whether cDTI can reveal abnormalities beyond conventional markers of hypertrophy and fibrosis.
Methods or Background: Forty-one patients with HCM and 22 healthy volunteers underwent 1.5T CMR including cine, late gadolinium enhancement (LGE), and M2-cDTI. Mean diffusivity (MD), fractional anisotropy (FA), and secondary eigenvector angle (E2A) were quantified.
Results or Findings: The segments from HCM patients were categorized into three groups: LGE-positive segments (n = 176), LGE gray-zone segments (n = 161), and LGE-negative segments (n = 89). The LGE-negative segments and LGE-positive segments showed significantly elevated myocardial E2A and FA values (mean, E2A: 43.64° ± 7.23 vs. 39.54° ± 6.47; FA: 0.55 ± 0.07 vs. 0.53 ± 0.06; P < 0.001 and P = 0.0002, respectively), while MD was significantly reduced (mean, MD: 1.54 × 10−3 mm2/sec ± 0.29 vs. 1.56 × 10−3 mm2/sec ± 0.31; P < 0.001). More notably, the LGE-negative segments also exhibited a slight reduction in MD, along with significantly increased FA and E2A values (mean, MD: 1.52 × 10−3 mm2/sec ±0.28 vs. 1.56 ± 0.31; E2A: 42.80° ± 5.64 vs. 39.54° ± 6.47; FA: 0.55 ± 0.06 vs. 0.53 ± 0.06; P < 0.001, P < 0.0009 and P = 0.0037).
Conclusion: In vivo M2-cDTI enables detecting myocardial disarray and altered microstructural organization in HCM, even in regions without hypertrophy or fibrosis. These findings highlight the potential of cDTI as a sensitive biomarker for early tissue characterization in HCM.
Limitations: The relatively small sample size—a common constraint in in vivo cDTI investigations—reflects the current technical challenges in mitigating cardiac motion artifacts and processing cDTI data.
Funding for this study: No
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: H. Zhang, M. Lu; Peking/CN
Purpose: This study aimed to analyze the clinical and imaging features of end-stage arrhythmogenic cardiomyopathy (ACM) with left ventricular (LV) involvement, and distinguish it from dilated cardiomyopathy (DCM).
Methods or Background: We retrospectively studied heart transplantation (HTx) recipients with pathology-confirmed ACM (n=29) or DCM (n=36). All patients underwent comprehensive clinical, imaging and pathological evaluation. Cardiac magnetic resonance (CMR) protocols included cine, late gadolinium enhancement (LGE), and T1 mapping sequences. Explanted hearts received gross and histologic evaluations.
Results or Findings: The ACM cohort had earlier symptom onset (30.5 years) and longer diagnostic delay (27.8 months vs. DCM 0.1 months, p=0.006). The misdiagnosis rate of ACM before HTx was 27.6%, predominantly misclassified as DCM. Qualitative and quantitative CMR analyses revealed distinct differences between ACM and DCM in morphological, functional, and tissue-specific parameters. Specifically, ACM patients exhibited more frequent right ventricular (RV) motion abnormalities, greater RV dilation (185.8 mL/m² vs. 101.4 mL/m², p<0.001) and larger LV-LGE extent (31.3% ± 12.4% vs. 18.8% ± 14.5%, p<0.001). These hallmark variables were selected to construct a three-step diagnostic model, which achieved an exceptional performance for ACM diagnosis (area under the curve 0.98, sensitivity 100%). Pathologic analysis confirmed severe RV fibrofatty replacement in ACM.
Conclusion: A CMR-guided stepwise model combining qualitative, quantitative, and tissue characterization parameters effectively differentiates ACM with LV involvement from DCM, offering high diagnostic accuracy and sensitivity. This approach addresses diagnostic challenges in end-stage heart failure, enabling precise diagnosis in transplant candidates and optimizing treatment strategies.
Limitations: The retrospective nature of data and specimen collection precluded genotype-phenotype and precise radiological-pathological correlation analysis.
Funding for this study: National Natural Science Foundation of China (grant no. 82471973)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the local Institutional Ethics Committee (No. 2022-1770).

Author Block: T. Geyer, P. Franke, R. Lorbeer, B. J. Wintersperger; Munich/DE
Purpose: Right atrial (RA) dysfunction is an important prognostic factor in heart failure, but its significance in dilated cardiomyopathy (DCM) is often overlooked. Although CMR-derived RA strain has become a sensitive indicator of right heart impairment, its connection with common DCM comorbidities remains unclear. We aimed to explore the relationship between RA strain and major cardiovascular comorbidities to improve risk assessment in DCM.
Methods or Background: Datasets of 162 patients with non-ischemic DCM, all undergoing standardized 1.5T/3T CMR from the prospective German Centre for Cardiovascular Research (DZHK) nationwide multicenter databank, were analyzed. RA and right ventricular (RV) strain—reservoir (RS), longitudinal (LS), and circumferential (CS)—were quantified using feature tracking (cvi42, Circle CVI). Multivariable linear regression models, adjusted for age and sex, examined associations between strain parameters and predefined cardiovascular comorbidities, including heart failure, valvular disease, and atrial fibrillation (AF).
Results or Findings: Lower RA-RS was a consistent and significant finding in patients with comorbidities that increase right heart load. Specifically, RA-RS was independently associated with heart failure (β=−14.96%; 95% CI: −25.42 to −4.49), valvular disease (β=−13.68%; 95% CI: −24.65 to −2.72), AF (β=−10.16%; 95% CI: −18.95 to −1.38), and combined valvular disease + AF (β=−11.38%; 95% CI: −19.36 to −3.39), all p<0.05. Associations between RV strain and comorbidities were less consistent. Notably, RV-RS was unexpectedly higher in coronary artery disease (CAD), a finding that warrants further study (β=6.14%; 95% CI: 0.35 to 11.93; p<0.05).
Conclusion: In this large, prospectively phenotyped DCM cohort, RA reservoir strain is a robust, non-invasive CMR marker consistently reduced in patients with comorbidities that impose additional right heart load. These findings support RA strain as a useful parameter for identifying higher-risk patients with DCM.
Limitations: Limitations include the cross-sectional design and lack of outcome data.
Funding for this study: None.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the ethics committee of the Bavarian Chamber of Physicians and the ethics committee of the Ludwig-Maximilians-University Munich and complies with the Declaration of Helsinki.

Author Block: P. Franke, T. Geyer, B. J. Wintersperger, R. Lorbeer; Munich/DE
Purpose: The association of physical inactivity with subclinical alteration of cardiac structure and function is not wellcharacterized. We investigated the impact of physical inactivity on left ventricular (LV) strain assessed byfeature-tracking cardiac MRI in a population-based cohort free of overt cardiovascular disease (CVD).
Methods or Background: We analyzed 360 participants (156 women; 39–73 years) from the MRI sub-study of the community-basedKORA (Cooperative Health Research in the Region of Augsburg) cohort. Physical activity was assessed atbaseline (Exam 1), 7-year follow-up (Exam 2), and 14-year follow-up (Exam 3). CMR with cine imagingand feature-tracking strain analysis was performed at Exam 3. Global longitudinal, circumferential, andradial strain were quantified. Associations of current and past inactivity with strain values were evaluatedin cross-sectional and longitudinal models adjusted for demographics and risk factors.
Results or Findings: Current physical inactivity (Exam 3) was associated with reduced longitudinal strain (β=-1.09%; 95%CI-2.02; -0.15; p=0.023), radial strain (β=-2.64%; 95%CI -4.79; -0.49; p=0.016) and circumferential strain(β=-0.90%; 95%CI -1.60; -0.20; p=0.012). Physical inactivity at baseline (Exam 1) also predicted lowerstrain values at Exam 3. Repeated reports of inactivity across two or more examinations were associatedwith progressively lower radial (β −2.09%; 95%CI −3.71 to −0.47; p=0.012) and circumferential strain (β−0.69%; 95%CI −1.22 to −0.16; p=0.011). Associations were more pronounced in men than in women.
Conclusion: Current and long-term physical inactivity were linked to impaired LV strain in asymptomatic adults withoutcardiovascular disease, with more pronounced effects in men. CMR strain thus provides sensitive markersof subclinical LV dysfunction associated with lifestyle factors.
Limitations: Limitations include MRI data acquisition only at one time point in a subsample, questionnaire-based assessment of physical activity, and restriction to a European ancestry cohort.
Funding for this study: None.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the ethics committee of the Bavarian Chamber of Physicians, Munich (Exam 1: EC No. 99186 and 05004, Exams 2 and 3: EC No. 06068). The MRI examination protocol was approved by the ethics committee of the Ludwig Maximilian University Hospital, Munich.

Author Block: F. Carusi, V. Vespucci, S. Ciambellini, P. Palumbo, E. Di Cesare; L'Aquila/IT
Purpose: The aim of the study is to investigate the prognostic relevance of CMR-derived ventricular and atrial strain and strain rate, and tissue composition via late gadolinium enhancement (LGE), in patients with HCM.
Methods or Background: This retrospective observational study included 56 patients. Functional assessment included bi-atrial and bi-ventricular volumetric indices, along with myocardial strain and strain rate analysis (global longitudinal [GLS], circumferential [GCS], and radial strain [GRS], and peak early diastolic strain rate [PEDSR]). Also atrial reservoir, conduit and booster pump strain and SR were analyzed. Myocardial fibrosis was quantified using LGE. Clinical follow-up was conducted via clinical interviews. Binary logistic regression was used to identify predictors of adverse events.
Results or Findings: In univariate analysis, left ventricular ejection fraction (LVEF), right and left atrial volumes, extent of LGE, GLS, GCS, GRS, PEDSR and strain reservoir were all significantly associated with adverse clinical outcomes. However, in multivariate analysis, only PEDSR remained an independent predictor of adverse events (p = 0.037; OR < 0.001, 95% CI: 0.000–0.22). LVEF (p = 0.08) and %LGE (p = 0.074) demonstrated a trend toward statistical significance. Among different model including conventional functional marker (model I)(AUC = 0.82), %LGE (model II = model I + %LGE) (AUC = 0.83), strain value (model III = model II + all strain)(AUC = 0.84) and PEDSR (model IV = model III + PEDSR), best C-index was reached only whit PEDSR evaluation (AUC = 0.92).
Conclusion: In patients with HCM, CMR-derived parameters of ventricular mechanics and myocardial fibrosis provide significant prognostic value. Among them, impaired diastolic function, as indicated by reduced PEDSR, emerges as a strong and independent predictor of adverse clinical outcomes, underscoring the importance of advanced functional assessment for effective risk stratification.
Limitations: Small sample size.
Funding for this study: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: F. Cadour¹, J. Caudron², A. Gillibert³, S. Normant³, J-N. Dacher³; ¹Toronto, ON/CA, ²Le Havre/FR, ³Rouen/FR
Purpose: The purpose of this study was to determine the normal variations of myocardial T1, T2, and T2*
relaxation times on cardiac MRI obtained at 1.5 T in healthy, sex-balanced volunteers aged between 18 and 69
years.
Methods or Background: A total of 172 healthy volunteers were recruited prospectively. They were further divided
into seven sex-balanced age groups (18–19 years, 20–24 years, 25–29 years, 30–39 years, 40–49 years, 50–59
years, and 60–69 years). T1, T2, and T2* mapping were acquired in a single short-axis slice at the mid-level of the
left ventricle. Global T1, T2, and T2* values were the mean of all segments. Comparisons between females and
males were performed in each age group using independent samples t-test or Wilcoxon rank sum test, as
appropriate. Multivariable linear effects models were used to analyze the effect of heart rate, body mass index,
left ventricular mass, age, and sex on T1, T2, and T2* values.
Results or Findings: There were 83 males and 89 females, with a mean age
of 37.3 ± 15.6 years. Females had greater T1 values (980.9 ± 26.2 ms) compared
to males (949.7 ± 18.3 ms) (P < 0.001). T1 values decreased with age (P < 0.001), with smaller sex-related differences in older
participants. Male sex and age were independently associated with lower values of T1 mapping. Age in females
was independently associated with lower T1, T2, and T2* values.
Conclusion: T1, T2, and T2* values are influenced by age and sex, emphasizing the need to read and calibrate MRI
values with respect to patient characteristics to avoid misdiagnosis.
Limitations: The limitations of the study are T1 values evaluated only in mid-ventricle, absence of extreme age recruitment, absence of extracellular volume performance and single vendor evaluation.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by institutional ethic committee, and study was registered under NCT01712581.