Late gadolinium enhancement is a useful tool for scar detection, based on differences in the volume of distribution of gadolinium, an extracellular agent. The presence of fibrosis in the myocardium amenable to be detected with late gadolinium enhancement MRI is found not only in ischemic cardiomyopathy, in which it offers information regarding viability and prognosis, but also in a wide variety of non-ischemic cardiomyopathies. In the following review we will discuss the methodological aspects of gadolinium-based imaging, as well as its applications and anticipated future developments.

Aims A multitude of cardiac magnetic resonance (CMR) techniques are used for myocardial strain assessment; however, studies comparing them are limited. We sought to compare global longitudinal (GLS), circumferential (GCS), segmental longitudinal (SLS), and segmental circumferential (SCS) strain values, as well as reproducibility between CMR feature tracking (FT), tagging (TAG), and fast‐strain‐encoded (fast‐SENC) CMR techniques. Methods and results Eighteen subjects (11 healthy volunteers and seven patients with heart failure) underwent two CMR scans (1.5T, Philips) with identical parameters. Global and segmental strain values were measured using FT (Medis), TAG (Medviso), and fast‐SENC (Myocardial Solutions). Friedman's test, linear regression, Pearson's correlation coefficient, and Bland–Altman analyses were used to assess differences and correlation in measured GLS and GCS between the techniques. Two‐way mixed intra‐class correlation coefficient (ICC), coefficient of variance (COV), and Bland–Altman analysis were used for reproducibility assessment. All techniques correlated closely for GLS (Pearson's r: 0.86–0.92) and GCS (Pearson's r: 0.85–0.94). Intra‐observer and inter‐observer reproducibility was excellent in all techniques for both GLS (ICC 0.92–0.99, CoV 2.6–10.1%) and GCS (ICC 0.89–0.99, CoV 4.3–10.1%). Inter‐study reproducibility was similar for all techniques for GLS (ICC 0.91–0.96, CoV 9.1–10.8%) and GCS (ICC 0.95–0.97, CoV 7.6–10.4%). Combined segmental intra‐observer reproducibility was good in all techniques for SLS (ICC 0.914–0.953, CoV 12.35–24.73%) and SCS (ICC 0.885–0.978, CoV 10.76–19.66%). Combined inter‐study SLS reproducibility was the worst in FT (ICC 0.329, CoV 42.99%), while fast‐SENC performed the best (ICC 0.844, CoV 21.92%). TAG had the best reproducibility for combined inter‐study SCS (ICC 0.902, CoV 19.08%), while FT performed the worst (ICC 0.766, CoV 32.35%). Bland–Altman analysis revealed considerable inter‐technique biases for GLS (FT vs. fast‐SENC 3.71%; FT vs. TAG 8.35%; and TAG vs. fast‐SENC 4.54%) and GCS (FT vs. fast‐SENC 2.15%; FT vs. TAG 6.92%; and TAG vs. fast‐SENC 2.15%). Limits of agreement for GLS ranged from ±3.1 (TAG vs. fast‐SENC) to ±4.85 (FT vs. TAG) for GLS and ±2.98 (TAG vs. fast‐SENC) to ±5.85 (FT vs. TAG) for GCS. Conclusions We found significant differences in measured GLS and GCS between FT, TAG, and fast‐SENC. Global strain reproducibility was excellent for all techniques. Acquisition‐based techniques had better reproducibility than FT for segmental strain.

We sought to: (1) determine the agreement in cardiovascular magnetic resonance (CMR) and speckle tracking echocardiography (STE) derived strain measurements, (2) compare their reproducibility, (3) determine which approach is best related to CMR late gadolinium enhancement (LGE). While STE-derived strain is routinely used to assess left ventricular (LV) function, CMR strain measurements are not yet standardized. Strain can be measured using dedicated pulse sequences (strain-encoding, SENC), or post-processing of cine images (feature tracking, FT). It is unclear whether these measurements are interchangeable, and whether strain can be used as an alternative to LGE. Fifty patients underwent 2D echocardiography and 1.5 T CMR. Global longitudinal strain (GLS) was measured by STE (Epsilon), FT (NeoSoft) and SENC (Myocardial Solutions) and circumferential strain (GCS) by FT and SENC. GLS showed good inter-modality agreement (r-values: 0.71–0.75), small biases (< 1%) but considerable limits of agreement (− 7 to 8%). The agreement between the CMR techniques was better for GLS than GCS (r = 0.81 vs 0.67; smaller bias). Repeated measurements showed low intra- and inter-observer variability for both GLS and GCS (intraclass correlations 0.86–0.99; coefficients of variation 3–13%). LGE was present in 22 (44%) of patients. Both SENC- and FT-derived GLS and GCS were associated with LGE, while STE-GLS was not. Irrespective of CMR technique, this association was stronger for GCS (AUC 0.77–0.78) than GLS (AUC 0.67–0.72) and STE-GLS (AUC = 0.58). There is good inter-technique agreement in strain measurements, which were highly reproducible, irrespective of modality or analysis technique. GCS may better reflect the presence of underlying LGE than GLS.

Background: Our goal was to evaluate the ability of cardiovascular magnetic resonance for detecting and predicting cardiac dysfunction in patients receiving cancer therapy. Left ventricular ejection fraction, global and regional strain utilizing fast-strain-encoded, T1 and T2 mapping, and cardiac biomarkers (troponin and BNP [brain natriuretic peptide]) were analyzed. Methods: Sixty-one patients (47 with breast cancer, 11 with non-Hodgkin lymphoma, and 3 with Hodgkin lymphoma) underwent cardiovascular magnetic resonance scans at baseline and at regular intervals during 2 years of follow-up. The percentage of all left ventricular myocardial segments with strain ≤−17% (normal myocardium [%]) was analyzed. Clinical cardiotoxicity (CTX) and sub-CTX were defined according to standard measures. Results: Nine (15%) patients developed CTX, 26 (43%) had sub-CTX. Of the 35 patients with CTX or sub-CTX, 24 (69%) were treated with cardioprotective medications and showed recovery of cardiac function. The amount of normal myocardium (%) exhibited markedly higher accuracy for the detection of CTX and sub-CTX compared with left ventricular ejection fraction, T1, and T2 mapping as well as troponin I (Δareas under the curve=0.20, 0.24, and 0.46 for normal myocardium (%) versus left ventricular ejection fraction, troponin I, and T1 mapping, P <0.001 for all). In addition, normal myocardium (%) at baseline accurately identified patients with subsequent CTX ( P <0.001), which was not achieved by any other markers. Conclusions: Normal myocardium (%) derived by fast-strain-encoded cardiovascular magnetic resonance, is an accurate and sensitive tool that can establish cardiac safety in patients with cancer undergoing cardiotoxic chemotherapy not only for the early detection but also for the prediction of those at risk of developing CTX. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03543228.

Background: Hypertensive cardiomyopathy is characterized by myocyte hypertrophy and interstitial fibrosis. The effects of renal denervation ( RD ) on the heart are poorly understood. New magnetic resonance imaging techniques (extracellular volume fraction) permit the quantitative assessment of myocardial fibrosis. Our aim was to study the effects of RD on myocardial fibrosis. Methods and Results: Twenty‐three patients with resistant hypertension undergoing RD and 5 resistant hypertensive controls were prospectively included. Cardiac magnetic resonance imaging at 1.5 T was performed before RD and at 6‐month follow‐up. Indexed left ventricular mass, septal extracellular volume fraction, and indexed absolute extracellular volume (a quantitative measure of extracellular matrix) were quantified. All data are reported as mean±SD deviation (median). Decreases in systolic (161.96±19.09 [160] versus 144.78±16.48 [143] mm Hg, P <0.0001) and diastolic (85.61±12.88 [83] versus 80.39±11.93 [81] mm Hg, P =0.018) blood pressures and in indexed left ventricular mass (41.83±10.20 [41.59] versus 37.72±7.44 [38.49] g/m ^1.7 , P =0.001) were observed at follow‐up only in RD patients. No significant differences in extracellular volume were found (26.24±3.92% [26.06%] versus 25.74±4.53% [25.63%], P =0.605). A significant decrease in absolute extracellular volume was observed after 6 months in RD patients exclusively (10.36±2.25 [10.79] versus 9.25±2.38 [9.79] mL/m ^1.7 , P =0.031). This effect was observed independently of blood pressure reduction. Conclusions: RD significantly decreases left ventricular mass, while extracellular volume remains stable. Our results suggest that the observed left ventricular mass decrease was due not exclusively to a reversion of myocyte hypertrophy but also to an additional reduction in collagen content, indicating interstitial myocardial fibrosis.