Obesity is associated with the development of heart failure and is a major risk factor for heart failure with preserved ejection fraction (HFpEF). Epicardial adipose tissue (EAT) is a unique visceral fat in close proximity to the heart and is of particular interest to the study of cardiac disease. Small poorly differentiated adipocytes with altered lipid:water content are associated with a proinflammatory secretome and may contribute to the pathophysiology observed in HFpEF. Multimodality imaging approaches can be used to quantify EAT volume and characterise EAT composition. Current research studies remain unclear as to the magnitude of effect that EAT plays on myocardial dysfunction and further work using multimodality imaging techniques is ongoing. Pharmacological interventions, including glucagon-like peptide 1 receptor agonists and sodium-dependent glucose linked transporter 2 inhibitors have shown promise in attenuating the deleterious metabolic and inflammatory changes seen in EAT. Clinical studies are ongoing to explore whether these therapies exert their beneficial effects by modifying this unique adipose deposit.

OBJECTIVES: There has been declining interest in cardiothoracic surgery amongst medical graduates. This survey examines the exposure of British medical students to cardiothoracic surgery in various settings and its relationship with students’ interest in the speciality. METHODS: A questionnaire composed of 14 quantitative and qualitative items was distributed amongst 162 medical students. The survey included questions on demographics, interest in cardiothoracic surgery, mechanisms of exposure to the speciality and desire to pursue a career in cardiothoracic surgery before and after exposure. RESULTS: Amongst the surveyed students, 71.0% reported exposure to cardiothoracic surgery as part of their medical school curricula and 24.7% reported extracurricular exposure. Of the students, 46.7% reported clinical exposure. Overall, 27.1% of students reported interest in a career in cardiothoracic surgery, which was higher amongst students who had curricular (29.6%), clinical (35.5%) or extracurricular exposure (50.0%). Amongst interested students, 43.2% engaged in extracurricular cardiothoracic activities compared with 16.1% of students not interested in pursuing the speciality. Confidence in career choice after exposure increased more in interested students (20.4%) than not interested students (1.6%). Students rated exposure and mentorship as the most important factor in promoting a career in cardiothoracic surgery. CONCLUSIONS: Medical students with an interest in cardiothoracic surgery are more likely to organize independent attachments in the speciality and attend extracurricular events; however, many students might fail to identify cardiothoracic surgery as an area of interest because of the lack of exposure at medical school.

Background: Left ventricular (LV) strain measurements can be derived using cardiac MRI from routinely acquired balanced steady‐state free precession (bSSFP) cine images.Purpose: To compare the interfield strength agreement of global systolic strain, peak strain rates and artificial intelligence (AI) landmark‐based global longitudinal shortening at 1.5 T and 3 T.Study Type: Prospective.Subjects: A total of 22 healthy individuals (mean age 36 ± 12 years; 45% male) completed two cardiac MRI scans at 1.5 T and 3 T in a randomized order within 30 minutes.Field Strength/Sequence: bSSFP cine images at 1.5 T and 3 T.Assessment: Two software packages, Tissue Tracking (cvi42, Circle Cardiovascular Imaging) and QStrain (Medis Suite, Medis Medical Imaging Systems), were used to derive LV global systolic strain in the longitudinal, circumferential and radial directions and peak (systolic, early diastolic, and late diastolic) strain rates. Global longitudinal shortening and mitral annular plane systolic excursion (MAPSE) were measured using an AI deep neural network model.Statistical Tests: Comparisons between field strengths were performed using Wilcoxon signed‐rank test (P value < 0.05 considered statistically significant). Agreement was determined using intraclass correlation coefficients (ICCs) and Bland–Altman plots.Results: Minimal bias was seen in all strain and strain rate measurements between field strengths. Using Tissue Tracking, strain and strain rate values derived from long‐axis images showed poor to fair agreement (ICC range 0.39–0.71), whereas global longitudinal shortening and MAPSE showed good agreement (ICC = 0.81 and 0.80, respectively). Measures derived from short‐axis images showed good to excellent agreement (ICC range 0.78–0.91). Similar results for the agreement of strain and strain rate measurements were observed with QStrain.Conclusion: The interfield strength agreement of short‐axis derived LV strain and strain rate measurements at 1.5 T and 3 T was better than those derived from long‐axis images; however, the agreement of global longitudinal shortening and MAPSE was good.Evidence Level: 2Technical Efficacy: Stage 2

A distinctive pattern of cardiac MRI feature-tracking left ventricular early and late diastolic strain rates was observed across the range of diastolic dysfunction severity.

Background: Previous studies have suggested an adverse role of epicardial adipose tissue (EAT) in aortic stenosis (AS), potentially mediated by direct effects on the myocardium. This study aimed to assess whether EAT volume and density are associated with cardiac remodelling and clinical outcomes in a well-phenotyped cohort of patients with initially asymptomatic AS. Methods: In this post hoc exploratory analysis of a multicentre, prospective longitudinal study, asymptomatic patients with moderate-to-severe AS (n=136; age 68.6 (60.1, 75.3) years, 27% female) and control participants (n=39; age 59.0 (54.0, 67.0) years, 38% female) underwent echocardiography, cardiac CT and MRI. EAT volume and mean CT attenuation were measured from non-contrast cardiac CT using an automated deep learning software. The primary outcome was symptoms necessitating valve replacement, cardiovascular death or major adverse cardiac event. Results: Participants with AS had significantly higher indexed EAT volumes (56.5 vs 38.8 cm ³ /m ² , p<0.001) and lower EAT attenuation (−76.3 vs −69.9 Hounsfield units, p<0.001). Both measures were correlated with markers of AS severity. Indexed EAT volume was not associated with cardiac remodelling in AS after correcting for confounding variables; however, a higher mean EAT CT attenuation was associated with higher indexed left ventricular mass. There were 42 (31%) primary outcome events over a median of 370 days. Lower indexed EAT volume and higher mean CT attenuation were associated with the outcome, independent of age and sex. Indexed EAT volume remained negatively associated after further adjustment for AS severity. Conclusion: Indexed EAT volume was higher in patients with AS, but not associated with MRI markers of cardiac remodelling. A higher indexed EAT volume was independently associated with a lower occurrence of symptoms and cardiovascular events. Further studies are needed to corroborate these findings and whether EAT has a potentially protective role in symptom progression in AS. Trial registration numbers: NCT03518645 , NCT03132129 .