RPS 2003 - Flow, perfusion and functional assessment in cardiac imaging

Author Block: L. R. Koetzier¹, N. R. van der Werf², P. M. Tetteroo¹, B. K. Velthuis¹, D. Suchá¹; ¹Utrecht/NL, ²Best/NL
Purpose: To evaluate the effect of a myocardium-specific reconstruction filter on myocardial texture analysis in static spectral cardiac CT perfusion.
Methods or Background: In this retrospective single-center study, 108 patients underwent prospective ECG-triggered coronary CT angiography (CCTA) with spectral dual-layer CT to assess coronary artery disease. Images were reconstructed using two filters (coronary-optimized CB, myocardium-specific MCA), and conventional 120 kVp and iodine density images at 3-mm slice thickness. The left ventricular myocardium was automatically segmented, with intensities normalized and quantized to 64 gray-levels. Texture analysis included six histogram-based features (intensity distribution, ignores spatial context) and three gray-level co-occurrence matrix features (GLCM; captures relationships between neighboring voxels). MCA was compared against CB on conventional and iodine density images using paired Wilcoxon signed-rank tests with Benjamin-Hochberg correction (α=0.05) and reported as median difference divided by the interquartile range per feature across patients.
Results or Findings: Eighteen patients were excluded with insufficient quality CCTA. Ninety-two patients were analyzed. On conventional images, the MCA filter significantly altered all texture features compared to CB. The largest effects were seen for entropy (−2.71), contrast (−2.12), and homogeneity (+4.10), whereas mean intensity (+0.02) and skewness (+0.43) showed only small effects. On iodine density images, the impact of the MCA filter was more pronounced. Strongest effects were observed for entropy (−5.99), variance (−3.83), kurtosis (+4.74), and homogeneity (+6.07). In contrast, mean intensity (−0.03) and correlation (−0.73) were minimally affected.
Conclusion: The MCA filter significantly increased myocardial homogeneity on conventional and iodine density images. Although MCA reduces noise and improves homogeneity, it simultaneously changes texture. Standardized reconstruction choices are therefore necessary when applying texture analysis for myocardial characterization in cardiac CT.
Limitations: This retrospective single-center study did not assess the impact of reconstruction protocols on myocardial disease detection.
Funding for this study: N/A
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Author Block: T. in de Braekt¹, P. R. Roos², H. van den Bosch¹, H. J. Lamb², J. Westenberg²; ¹Eindhoven/NL, ²Leiden/NL
Purpose: To investigate scan-rescan reproducibility of mitral valve (MV) and pulmonary vein (PV) flow velocities using 4D flow MRI in healthy volunteers for diastolic function assessment.
Methods or Background: Twenty-one volunteers (mean age 27 ± 3 years) underwent whole-heart 4D flow MRI at 3T twice with a 10-minute interval, allowing repositioning. One group (n=11) was scanned during free-breathing without respiratory motion compression, while the other (n=10) used weighted-gating respiratory motion compensation, with an additional 4D flow acquisition without respiratory motion compensation. MV parameters included E wave, A wave, E/A ratio, annular e’ velocity, and E/e’ ratio. PV velocities included S wave, D wave, S/D ratio, and AR wave. Parameters were derived from flow velocity-time curves and compared between acquisitions using Pearson’s correlation coefficient (ρ). Due to spatial resolution limitations and anatomical variation, PV flow was measured in the same PV (preferably right inferior PV) per volunteer. Subanalysis in the second group compared the effect of respiratory weighted-gating versus free-breathing on flow measurements. Intra- and interobserver agreement was assessed with intraclass correlation coefficient (ICC).
Results or Findings: Scan-rescan comparison showed moderate-to-good agreement for MV parameters (ρ=0.51–0.74), except e’ velocity and E/e’ ratio (ρ=-0.13 and -0.14, respectively). PV flow velocities showed strong reproducibility (ρ=0.88–0.92), except AR wave (ρ=0.47). Subanalysis showed moderate-to-strong agreement for MV parameters (ρ=0.69–0.92), and good-to-excellent agreement for PV parameters (ρ=0.82–0.99). Intraobserver agreement was moderate-to-excellent for MV and PV parameters (ICC=0.62–0.97), except S/D ratio (ICC=0.48). Interobserver agreement was moderate-to-excellent for MV parameters (ICC=0.59–0.94), and poor for PV parameters (ICC=-0.12–0.33).
Conclusion: For most diastolic flow parameters, 4D flow MRI demonstrated moderate-to-excellent reproducibility, with or without respiratory motion compensation, supporting its potential for diastolic function assessment.
Limitations: Data was not compared to gold standard echocardiography.
Funding for this study: Funding for this study was part of an unrestricted grant (number 1261584) provided by the Dutch Society for Radiology (NVvR).
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Author Block: C. Mantini, C. Di Barbora, D. Costantini, S. Paolini, F. Ricci; Chieti/IT
Purpose: To assess the incremental value of a stress CMR perfusion study in the diagnostic workup of master athletes with suspected cardiovascular pathology
Methods or Background: Between 2020–2024, we enrolled master athletes referred for stress CMR following abnormal sports pre-participation screening.All underwent vasodilator stress CMR with visual and semi-quantitative myocardial perfusion analysis.A multidisciplinary team adjudicated diagnoses as either normal heart (including exercise-induced cardiac remodeling) or abnormal heart (ischemic disease, non-ischemic left ventricular scar, or cardiomyopathy).Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC) and global chi-squared statistics across sequential models:baseline function/volumes,baseline+LGE (model 1),model 1+visual perfusion (model 2),model 2+myocardial perfusion reserve index (MPRI) (model 3)
Results or Findings: We enrolled 68 recreational master athletes (57±11 yo, 82% male),with 18(26%) training more than 8 hours per week.Referral reasons included chest pain(47%),premature ventricular contractions (18%),abnormal ECG (16%),abnormal exercise stress testing (11%),and abnormal resting echocardiography (8%).Vasodilator stress CMR was performed using regadenoson(57%),adenosine(42%), or dipyridamole(1%).The final adjudicated diagnosis classified 26 (38%) cases as having a normal heart, while42(62%) were diagnosed with heart disease,including ischemic heart disease(n=24),nonischemic left ventricular scar(n=10), and cardiomyopathy(n=8).LGE was present in 53% of cases,and stress-induced myocardial perfusion defects were visually identified in 17%.Myocardial perfusion reserve index was lower in abnormal hearts compared to normal hearts(1.6±0.3vs1.3±0.3;p<0.001), yielding alone an AUC of 0.76 with best cut-off of 1.29.The diagnostic yield improved with sequential imaging integration:baseline assessment had limited discrimination(AUC 0.67),+LGE(AUC 0.87),+visual stress perfusion(AUC 0.93),+MPRI(AUC 0.97).The global chi-squared statistic increased stepwise from 7.4 to 49.5 across models (p < 0.0001 for all comparisons).At a median follow-up of 31 months,no deaths occurred
Conclusion: Stress CMR perfusion provides significant incremental value in distinguishing physiological remodeling from ischemic and nonischemic disease in master athletes with abnormal pre-participation screening
Limitations: Small sample size
Funding for this study: No Founding
Has your study been approved by an ethics committee? Not applicable
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Author Block: Z. Magomedova, V. Meshkov, E. Pershina, M. Serova, E. Ploschenkov; Moscow/RU
Purpose: Dynamic stress CT myocardial perfusion imaging (CT MPI) combines anatomic and physiologic coronary assessment in a single test. Its performance in patients with prior myocardial infarction (MI) and residual, non–infarct related artery (non IRA) stenoses is not well defined. We evaluated CT MPI against invasive instantaneous wave free ratio (iFR) in post MI patients with visually intermediate non IRA stenoses.
Methods or Background: 61 consecutive post PCI MI patients with at least one 50–90% non IRA stenosis underwent adenosine (160 µg·kg⁻¹·min⁻¹) stress and rest dynamic CT MPI (16 cm coverage; Revolution CT, GE Healthcare) with 10 minute delayed iodine enhancement for scar detection, followed by invasive angiography with selective iFR in 50–90% lesions. Hemodynamically significant stenosis was defined as iFR <0.90. Voxel based quantitative myocardial blood flow (MBF) maps were generated; MBF <100 mL·min⁻¹·100 mL⁻¹ was considered abnormal. Diagnostic performance was calculated per vessel using iFR as reference and per patient.
Results or Findings: Hemodynamically significant stenoses by iFR were present in 21/61 patients (34%). Delayed enhancement identified postischemic scar in 48/61 (79%). Against iFR, CT MPI yielded per vessel sensitivity 99%, specificity 97%, and accuracy 98%; per patient - 97%, 90%, 94%. Hemodynamically significant stenoses by iFR were present in 21/61 patients (34%). Delayed enhancement identified postischemic scar in 48/61 (79%). CT MPI yielded per vessel sensitivity 99%, specificity 97%, and accuracy 98%; per patient sensitivity 97%, specificity 90%, and accuracy 94%. Three patients (5%) with iFR ≥0.90 showed regional hypoperfusion with reduced MBF, consistent with microvascular dysfunction.
Conclusion: Whole heart dynamic stress CT MPI demonstrates excellent vessel level sensitivity and specificity and high patient level accuracy for detecting functionally significant non IRA stenoses in post MI patients when benchmarked to iFR.
Limitations: Single centre study
Funding for this study: No funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional board

Author Block: Z. Zhong, J. Zhang; Shanghai/CN
Purpose: This study aimed to develop a combined model, including clinical risk factors, coronary atherosclerotic characteristics, and radiomic features derived from CT myocardial perfusion imaging (CT-MPI), to predict major adverse cardiovascular events (MACEs).
Methods or Background: Accurate prediction of MACEs is crucial for risk stratification in patients with suspected coronary artery disease. CT-MPI provides various parameters, which may help comprehensively characterize perfusion features. 712 patients who underwent coronary CT angiography (CCTA) and CT-MPI from seven hospitals were enrolled. Radiomic analysis was performed on eight perfusion parameter maps. Three prediction models were established accordingly: Model 1 (clinical risk factors and coronary atherosclerotic characteristics), Model 2 (incorporating myocardial blood flow values upon Model 1), and Model 3 (integrating radiomic scores upon Model 2).
Results or Findings: The C-indices for Model 3 in the training, internal validation, and external validation sets were 0.901 (95% confidence interval [CI]: 0.856–0.947), 0.841 (95% CI: 0.783–0.899), and 0.832 (95% CI: 0.761–0.903), respectively, demonstrating significant improvements over Model 1 and Model 2 (all p < 0.05). In the external validation set, Model 3 had the largest time-dependent areas under the curve (AUC) values for 1-, 3-, and 5-year MACEs prediction (0.878 [95% CI: 0.775-0.981], 0.851 [95% CI: 0.756-0.946], and 0.747 [95% CI: 0.603-0.891]), compared to Model 1 and Model 2.
Conclusion: The radiomic features from multiparametric CT-MPI maps simultaneously captured perfusion features associated with MACEs at both macrovascular and microvascular levels. The combined model exhibited superior MACEs prognostic performance compared with conventional models while maintaining high interpretability.
Limitations: Studies involving patients at lower pretest probability of obstructive CAD and multivendor CT-MPI data are needed to confirm the utility and reproducibility of the radiomic model for MACEs prediction in broader populations and different scanner platforms or protocols.
Funding for this study: This study is supported by National Natural Science Foundation of China (Grant No.: 82471982, 82271990), National Key Research and Development Program of China (Grant No.: 2021YFF0501402), Shanghai Municipal Science and Technology Commission Discipline Leader Project (Grant No.: BJKJ2024052), Shanghai Health Commission Discipline Leader Project (Grant No.: 2022XD031) and the Key Project of Shanghai Municipal Education Commission (Grant No.: 2024AIZD017).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The ethics committee of Shanghai General Hospital

Author Block: C. Min, Y. Gao, Y. Jiang, Y. Li, Y. Zhigang; Chengdu/CN
Purpose: Metabolic syndrome (MetS) can increase the risk of morbidity and mortality of obstructive coronary artery disease (OCAD). This study aimed to explore the impact of MetS and its components on myocardial microvascular dysfunction in OCAD patients by first‑pass perfusion cardiac magnetic resonance.
Methods or Background: 127 patients with OCAD{ [OCAD(MetS+), n = 86] and [OCAD(MetS−), n = 41]} and 46 sex- and age-matched controls were enrolled in the study. CMR perfusion parameters, including Upslope, max signal intensity (MaxSI), and time to maximum signal intensity (TTM) in global, left anterior descending arterial (LAD), left circumflex coronary arterial (LCX), and right coronary arterial (RCA) perfusion segments were compared among observed groups. Univariable and multivariable regression analyses were used to investigate the correlations of MetS and perfusion parameters. Lasso regression analysis was used to evaluate the effect of MetS components on CMR perfusion parameters.
Results or Findings: Compared with the OCAD(MetS-) group, Upslope decreased in global, LAD, LCX and RCA perfusion segments (all p < 0.05). The MaxSI reduced in the OCAD(MetS+) group in global, LAD and LCX perfusion segments(all p < 0.05)., From the controls to the OCAD(MetS-)group to the OCAD(MetS+) group, the TTM sequentially prolonged in global (all p < 0.05).After adjustment for covariates in OCAD patients, MetS was an independent factor of upslope(g) (β=−0.309, p<0.001), MaxSI (g) (β=−0.200, p=0.023)and TTM(g) (β=0.206, p=0.014). Besides, MetS was independently associated with Upslope(LAD), Upslope(LCX) , and Upslope(RCA) (all p < 0.05). Based on the lambda.1se threshold, High density lipoprotein cholesterol(HDL) were ultimately selected as significant predictors in Upslope(g) and MaxSI(g).
Conclusion: MetS aggravated the myocardial microcirculation perfusion dysfunction in OCAD patients. HDL, as a component of MetS, may be of great significance in patients with OCAD complicated with MetS.
Limitations: Not applicable
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
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Author Block: B. Longere¹, H. Caseneuve¹, C. V. Gkizas¹, A. Rodriguez Musso¹, C. Croisille², M. Haidar¹, F. A. Pontana¹; ¹Lille/FR, ²Bordeaux/FR
Purpose: To evaluate the feasibility and diagnostic performance of stress myocardial perfusion imaging (MPI) using a first-generation dual-source photon-counting CT (PCCT),compared to reference standards.
Methods or Background: Consecutive patients referred for coronary CT angiography (CCTA) with concomitant stress MPI using PCCT scanner and at least one functional reference test within one month were included. Static PCCT-MPI with regadenoson was acquired 12s after
intravenous injection of 40mL of iodine contrast medium and paired with myocardial delayed enhancement imaging. Reference tests for ischemia included stress cardiac magnetic resonance imaging, stress echocardiography, single-photon emission computed tomography, or invasive coronary angiography. Diagnostic accuracy was evaluated using ROC curve analysis and Youden index-derived thresholds.
Results or Findings: Forty-one patients (28 males, median age=62 years) were included; 35 (85.4%) had obstructive coronary artery disease (CAD) on CCTA. PCCT-MPI identified myocardial hypoperfusion in 18 patients (43.9%) with a median dose-length product of 97mGy.cm
(Q1, 76.8.0; Q3, 155.8mGy.cm). Visual assessment yielded 100% sensitivity (95%CI: 81.5–100.0%), 95.7% specificity (95%CI: 78.1–99.9%), PPV 94.7%, and NPV 100%, with an AUC of 0.98. An optimal defect-to-remote iodine ratio cutoff of 0.79 showed
excellent accuracy (97.6%, AUC=0.995). Integration of PCCT-MPI with CCTA could have obviated additional functional testing or invasive angiography in up to 50% of patients with obstructive CAD.
Conclusion: Stress static PCCT-MPI is feasible and demonstrates excellent diagnostic accuracy for detecting myocardial ischemia. Defect-to-remote iodine ratio from spectral imaging further enhances performance, establishing PCCT as a comprehensive imaging
modality that unifies anatomic and functional coronary assessment at a reasonable radiation dose, within a single examination.
Limitations: Retrospective, single-center study
Modest sample
Heterogeneity of reference standards
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: IRB number: CMR-2408-417

Author Block: C. V. Gkizas¹, B. Longere¹, A. Rodriguez Musso¹, C. Croisille², O. Domanski¹, F. Godart¹, F. A. Pontana¹; ¹Lille/FR, ²Bordeaux/FR
Purpose: Coronary anomalies and neo-aortic root dilatation are recognized as late complications after the arterial switch operation for transposition of the great arteries (TGA), although most patients remain asymptomatic for many years.
The purpose of this study was to assess the feasibility and diagnostic performance of CT stress myocardial perfusion imaging (CT-MPI) compared with reference standards in patients with repaired TGA.
Methods or Background: Consecutive patients referred for clinically indicated coronary CT angiography (CCTA) underwent CT-MPI—either static with a photon-counting detector CT (PCCT) or dynamic with a third-generation dual-energy CT (DECT)— with regadenoson administration followed by myocardial late iodine enhancement. Within 1 month, each patient underwent ≥1 reference test (stress CMR, stress echocardiography, SPECT, or invasive coronary angiography). Visual analysis thresholds were derived from the Youden index. Radiation dose metrics were compared between scanners.
Results or Findings: Thirty patients were included (25 males; median age,= 30 years). Median neo-aortic diameter was 42 mm. CT-MPI detected hypoperfusion in 6/30 patients (20%), all of whom had obstructive coronary disease on CCTA. Diagnostic performance versus reference standards was excellent: sensitivity 85.7% (95% CI, 48.7–97.4), specificity 100% (95% CI, 85.7–99.9), positive predictive value 100%, and negative predictive value 95.8%. Integrating CT-MPI with CCTA could have obviated additional functional testing or invasive angiography in 23/30 patients (77%). Radiation dose was significantly lower with PCCT-MPI than with DECT-MPI (DLP −39%, CTDI −47%; p < 0.05).
Conclusion: CT stress perfusion is feasible and demonstrates excellent diagnostic performance in patients with repaired TGA and may represent a valuable tool for clinical decision-making during long-term follow-up.
Limitations: Single-center retrospective study
Modest sample
Heterogeneity of reference modalities
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
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Author Block: J. Jahn, H. Thomas, M-N. Von Itter, M. Reisert, S. Rospleszcz, C. Schuppert, C. L. Schlett; Freiburg Im Breisgau/DE
Purpose: Patients with cardiovascular disease often exhibit concomitant liver changes, yet their systematic evaluation in cardiac MRI remains limited. We developed and validated a deep learning approach for automated liver segmentation in cardiac T1 maps to investigate associations between liver T1 times and cardiac function within the German National Cohort (NAKO) study.
Methods or Background: A patchwork-based convolutional neural network (CNN) was trained on 323 manually annotated cardiac short-axis T1 maps spanning the mid of the left ventricle [LV] and independently tested on 68 cases. Segmentation performance was assessed using the Dice similarity coefficient and Pearson correlation with manual liver T1 measurements. Associations between automated liver T1 times and cardiac parameters (biventricular volumes, ejection fractions, stroke volumes, and LV mass) were analyzed using linear regression adjusted for age, sex, body mass index, liver fat, and liver iron. Restricted cubic spline (RCS) models tested for nonlinearity.
Results or Findings: The CNN achieved a Dice coefficient of 0.92 and excellent correlation with manual liver T1 segmentations (r=0.95). Among 26,662 participants (47.8±12.3 years, 46.8% female), median liver T1 values were higher in women (841±77 ms) than in men (787±97 ms, p<0.001). Higher liver T1 was strongly associated with smaller biventricular volumes, stroke volumes, LV mass, and lower ejection fractions (all p<0.01). For example, each 100 ms increase in liver T1 was associated with lower indexed LV end-diastolic volume (β=-1.41, p<0.001) and LV ejection fraction (β=-0.17, p<0.01). RCS analyses confirmed significant nonlinear relationships for most outcomes.
Conclusion: We present a robust deep learning approach for automated liver segmentation in cardiac T1 mapping. Liver T1 times are independently and nonlinearly associated with cardiac structure and function in a large cohort and may provide novel insights into cardio-hepatic interactions.
Limitations: No histological confirmation was performed.
Funding for this study: The NAKO is funded by the Federal Ministry of Research, Technology and Space (BMFTR) [project funding reference numbers: 01ER1301A/B/C, 01ER1511D, 01ER1801A/B/C/D and 01ER2301A/B/C], federal states of Germany and the Helmholtz Association, the participating universities and the institutes of the Leibniz Association.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study received institutional review board approval and written informed consent was obtained from all participants.

Author Block: E. İsmailov, T. Y. Kılıç, Y. B. Uluman, K. B. Bekaroğlu, F. Köse, B. Tütüncüoğlu, T. Banaz, M. Kadıoğlu, S. Ozkök; Istanbul/TR
Purpose: To investigate the relationship between MAPSE values and myocardial fibrosis in patients with cardiac sarcoidosis, and to compare MAPSE with conventional CMR-derived cardiac function parameters.
Cardiac involvement in sarcoidosis is associated with poor prognosis, and because early functional impairment may precede detectable fibrosis on CMR, MAPSE, as a sensitive marker of longitudinal function, could offer valuable diagnostic insight at an earlier stage.
Methods or Background: 47 patients with histologically confirmed systemic sarcoidosis underwent 1.5 Tesla CMR with CİNE, T1/T2 mapping, and LGE were retrospectively analyzed. MAPSE was measured at the medial and lateral mitral annulus in the 4-chamber CİNE view. Ventricular function, and LGE extent/localization were also measured. ECG/Holter were used to assessed arrhythmia. Correlation analyses were performed using Spearman’s rank test, and the predictive performance of MAPSE was assessed using ROC curve analysis.
Results or Findings: A total of 47 patients with systemic sarcoidosis (mean age 50.6±12.7 years, 45% male) were analyzed. MAPSE was significantly reduced compared with healthy controls (7.25 vs. 11.60 mm, p<0.001), indicating impaired longitudinal function. A significant inverse correlation was found between MAPSE and myocardial fibrosis assessed by LGE percentage (r=–0.43, p=0.003). Patients with arrhythmia had significantly lower MAPSE values than those without (p=0.026), and LGE percentage correlated positively with arrhythmia presence (r=0.37, p=0.012). ROC analysis demonstrated fair diagnostic accuracy of MAPSE for arrhythmia (AUC=0.70, p=0.01). An optimal cutoff ≤ 6 mm yielded high specificity (93%) but limited sensitivity (42%).
Conclusion: These findings suggest MAPSE as a practical marker of fibrosis and arrhythmic risk. MAPSE is significantly reduced in sarcoidosis patients, correlates inversely with myocardial fibrosis and arrhythmia, and may serve as a simple CMR-derived marker of subclinical involvement and arrhythmic risk even in the absence of overt systolic dysfunction.
Limitations: Single-center design
Funding for this study: Not receive any financial support
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical Board: Başakşehir Cam and Sakura City Hospital Ethİcal Board (Date: 26.06.2024 ; No: E-96317027-514.10-25144424)

Author Block: R. Chen, J. Westenberg, E. van den Burg, M. Schoonakker, S. Cessie, H. Pijl, H. J. Lamb; Leiden/NL
Purpose: Fasting-mimicking diet (FMD) has shown positive effects in reducing risk factors for diabetes, cardiovascular disease, and aging. However, it is unclear whether FMD improves cardiovascular function. We evaluated the effects of periodic use of a five-day FMD each month on left ventricular (LV) geometry and function in patients with type 2 diabetes mellitus (T2DM).
Methods or Background: The study involved 100 patients (aged 63±8 years) with T2DM treated in primary care. We compared patients who received the FMD for five consecutive days each month as adjunct to usual care with those who received usual care alone as controls over twelve months. Magnetic resonance imaging(MRI) data was acquired on a 3.0-T MRI scanner at baseline, six months, and twelve months. LV geometry and systolic function were assessed from cine short-axis images, while diastolic function was analyzed using trans mitral flow curves from 4D flow MRI.
Results or Findings: Intention-to-treatment analysis, using linear mixed model, demonstrated FMD cycles had a significant effect on LV mass (from 116.6±23.6 to 115.4±25.5g for FMD vs. 109.6±27.1 to 112.7±27.9g for controls, p=0.022) at six months. The early-to-late peak filling ratio (E/A) increased at twelve months, from 0.87±0.25 to 1.03±0.33 for FMD, versus 0.89±0.24 to 0.88±0.26 for controls, p=0.006). Additionally, the mitral annulus through-plane velocity at early peak filling (e’) also increased at twelve months, from 5.8±2.1 to 6.0±1.8 cm/s for FMD versus a decline from 6.4±1.7 to 5.5±1.7 cm/s for controls, indicating improved diastolic function.
Conclusion: Fasting mimicking diet cycles over 12 months have a beneficial effect on LV mass, and improve LV diastolic function in T2DM patients.
Limitations: This study lasted twelve months, which limits the ability to evaluate long-term effects of treatment on cardiovascular health.
Funding for this study: Health~Holland
Top Sector Life Sciences & Health
the Dutch Diabetes Foundation and L-Nutra
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The Medical Research Ethics Committee of Leiden University Medical Centre approved the protocol and amendments.

Author Block: W-r. Li, R. Shi, J-k. Li, H. Xu, Y. Li, Z-G. Yang; Chengdu/CN
Purpose: Left ventricular (LV) dilatation has been found to be associated with poor prognosis in patients with reduced left ventricular ejection fraction (LVEF). However, the relationship between LV dilatation and LV myocardial dysfunction in patients with diabetes mellitus (DM) and reduced LVEF unclear.
Methods or Background: Patients who underwent CMR scanning in our hospital for clinically diagnosed DM between 2017 and 2024. According to LVEF and LV dilatation status, these patients were divided: DM with preserved LVEF (DMpEF) group, DM with reduced LVEF and no LV dilatation (DMrEF-NLVD) group, and DM with dilated cardiomyopathy (DMrEF-DCM) group. LV global radial strain (LVGRS), LV global circumferential strain (LVGCS), and LV global longitudinal strain (LVGLS) were evaluated and compared among the three groups. Additionally, multiple linear regression analysis was performed to assess the independent effect of LV dilatation on LV strains in DM patients with reduced LVEF.
Results or Findings: 122 DMpEF group, 51 DMrEF-NLVD group, and 92 DMrEF-DCM group were included. Significant differences were observed in LV strain parameters among the three groups. LV global strains progressively declined from the DMpEF group to the DMrEF-NLVD group and further to the DMrEF-DCM group (all p < 0.001). In DM patients with reduced LVEF, multivariable linear regression analysis revealed that LV dilatation was independently associated with reduced LVGCS (β = 0.176, p = 0.009).
Conclusion: In DM patients with reduced LVEF, LV dilatation has an additive deleterious effect on LV dysfunction. LV dilatation was found to be associated with impaired LVGCS. These findings support that early identification and initiation of treatment for LV dilatation in these patients may improve risk stratification in this high-risk population.
Limitations: The retrospective study design limits the ability to evaluate temporal changes in cardiac structure and function.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: D. Verna¹, G. Argento¹, T. D'Angelo², M. Olivieri³, L. Blasi¹, M. Moretti¹, R. Aroasio¹, R. Faletti⁴, M. Gatti¹; ¹Turin/IT, ²Messina/IT, ³Chieti/IT, ⁴Candiolo/IT
Purpose: To evaluate the concordance between cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) in the assessment of left ventricular (LV) function and global myocardial strain (GLS, GCS, GRS) in post-STEMI patients.
Methods or Background: Forty-eight patients (mean age 62 ± 11 years, 87.5% male) were prospectively enrolled in the multicenter CT-STEMI study (NCT05941585). Patients were randomized to undergo either CCT or CMR within 6.8 ± 1.8 days after STEMI, followed by the complementary exam within 5.3 ± 2.8 days. LV volumes and function (LVEDV, LVESV, LVEF, LV mass) and global strain indices (GLS, GCS, GRS) were derived using CVI42 software (Circle Cardiovascular Imaging).
Results or Findings: CCT demonstrated excellent concordance with CMR for LV function: LVEF (45 ± 10.9% vs. 46 ± 11.0%, p = 0.40), LVEDV (167 ± 38 ml vs. 171 ± 38 ml, p = 0.16), and LVESV (93 ± 33 ml vs. 94 ± 32 ml, p = 0.58). Strain analysis showed good concordance, with strong correlations for GLS (r = 0.74; bias −0.022) and GRS (r = 0.82; bias 0.014), and moderate concordance for GCS (r = 0.65; bias −0.001).
Conclusion: CCT provides high concordance with CMR in the evaluation of LV volumes and function, and good concordance for global myocardial strain, particularly GLS and GRS. These results support CCT as a valid alternative to CMR for comprehensive functional assessment of left ventricular performance.
Limitations: Despite its prospective, multicenter design, this preliminary analysis is limited by small sample size and predominant use of a single scanner. Planned expansion to 200 patients, inter-scanner validation, assessment of observer variability, and correlation with prognostic endpoints will strengthen the clinical applicability of these findings.
Funding for this study: This research was supported by a grant from the Italian Ministry of Health under the “Ricerca Finalizzata 2021 – Giovani Ricercatori” program, project number GR-2021-12372092. The funding was allocated to the project titled “Cardiac Computed Tomography for Comprehensive Risk Stratification of Arrhythmic, Atherothrombotic, and Heart Failure Events Following Reperfused ST-Segment Elevation Myocardial Infarction”. The funder had no role in the design, data collection, analysis, or interpretation of this study
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No additional information

Author Block: Z. Zhou, L. Wen, S. Azhe, L. Hu, Y. Zhu, X. Deng; Chengdu/CN
Purpose: This study aimed to quantitatively assess left atrial (LA) function in children with Kawasaki Disease (KD) using feature-tracking CMR.
Methods or Background: This study prospectively enrolled patients with KD in our hospital. The CMR imaging protocols included cine and coronary magnetic resonance angiography. The left atrial strain parameters included total strain (εs), passive strain (εe), and active strain (εa) were acquired by post-processing.
Results or Findings: The study enrolled 214 KD patients (median age 5.50 [3.38, 7.67] years; 66.36% male) and 47 healthy controls (median age 5.67 [4.00, 7.00] years; 63.83% male), with no significant differences in baseline characteristics. A total of 67 children (31.16%) underwent CMR during the acute phase, and 33 children (49.25%) of these patients underwent a follow-up CMR. Compared with the controls and patients in chronic phase, patients in acute phase exhibited significantly reduced left atrial strain parameters, including εs, εe, and εa (all P<0.05). In patients who underwent CMR during the acute phase and follow-up CMR, εs, εe, and εa were all increased in the chronic phase compared to the acute phase (all P<0.05). In the chronic phase, εs and εe remained lower than in the controls (both P<0.05). Additionally, in chronic phase, patients with giant coronary aneurysm (CAA) exhibited lower εe compared to patients without coronary artery dilation and small CAA and the controls.
Conclusion: Decrease of LV diastolic function was found in KD patients, particularly during the acute phase. Although there is a trend toward recovery in the chronic phase, patients in chronic phase still exhibited subclinical LV diastolic dysfunction, primarily in those with giant CAA.
Limitations: The primary limitation of this study is its small single-center sample size.
Funding for this study: This work was supported by the National Natural Science Foundation of China (82471970), Sichuan Science and Technology Program (2024YFFK0258).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The ethics was approved by the Ethics committee of West China Second University Hospital.