Beside its key role in research, CMR is most frequently used clinically for the carotid arteries where it can be used to characterize thrombus, [
41] plaque components, [
42] plaque vulnerability, atheroma burden, natural history of progression, and response to treatment. However, peripheral artery angiography, [
43‐
45] and the role in investigation of pulmonary hypertension, [
46] vasculitis and systemic hypertension, [
47] is also making progress. This is an area of CMR where contrast agents, [
48] and 3 T has had an impact [
49,
50]. CMR is widely used for assessment of the aorta in both congenital, [
51] genetic, [
52] and acquired conditions and is particularly well suited longitudinal follow-up of aortic dimensions, [
53] and more complex aspects of aortic function, [
54] such as pulse wave velocity, [
55] distensibility and shear stress [
56]. The design of arterial phantoms has proved useful for modelling [
57]. The application of CMR to the assessment of valvular heart disease continues to increase, [
58] particularly in aortic stenosis [
59‐
61]. This is in part due to greater appreciation of its complementary roles in relation to echocardiography, which is commonly the first line investigative technique.
Feasibility study of electrocardiographic and respiratory gated, gadolinium enhanced magnetic resonance angiography of pulmonary veins and the impact of heart rate and rhythm on study quality
Three dimensional respiratory and end systolic ECG gated, gadolinium enhanced magnetic resonance angiography was performed on a 3 Tesla (3 T) scanner in 101 consecutive patients, 35 of them in AF, prior to ablation [
62]. Image and segmentation quality were scored. All studies except one (99 %) were considered diagnostic, 91 of them (90.1 %) being of good or excellent quality. Quality was not found to depend on heart rate or rhythm for this free breathing, radiation free strategy, which offers an alternative to current MRA or CT based approaches.
HIV is an independent predictor of aortic stiffness
Cardiovascular events and cardiovascular related mortality increased in HIV-infected patients treated with effective antiretroviral therapy [
66]. Identifying those at higher cardiovascular risk is therefore of great clinical importance. This study showed that, after matching for potential confounders, HIV infection is independently associated with increased aortic PWV and decreased aortic distensibility measured by CMR, both sensitive markers of reduced aortic elastic function. In addition HIV infection is an independent predictor of both increased pulse wave velocity and decreased aortic distensibility, clinical measures of aortic stiffness linked to increased cardiovascular mortality. The size of this detrimental effect is similar to that seen with the metabolic syndrome, a powerful cardiovascular risk factor. The authors showed that HIV and the metabolic syndrome are additive in their negative effects on PWV and aortic distensibility, suggesting that both are risk factors that act in different ways to impair vascular elasticity. The mechanism of vascular alterations in patients with HIV may be secondary to direct effects of the HIV virus on vascular function, including direct alteration in endothelial function, inflammation, and modification of aortic wall vascular smooth muscle cell behaviour and extra-cellular matrix composition. Due to the observational nature of this study, it is not possible to confirm causality or mechanisms which might underlie the increased aortic PWV and decreased aortic distensibility in patients with HIV. The study was also not powered to detect differences in HAART-naïve and treated subjects. Nor was it possible to determine the effects of individual anti-retroviral medications on vascular function.
Robust volume-targeted balanced steady-state free-precession coronary magnetic resonance angiography in a breathhold at 3.0 Tesla: a reproducibility study
The purpose of this work was to refine, implement, and test a robust, practical single-breathhold bSSFP coronary MRA sequence at 3.0 T and to test the reproducibility of the technique [
71]. Results showed that the 3D bSSFP acquisition, using a state-of-the-art MR scanner equipped with recently available technologies such as multi-transmit, 32-channel cardiac coil, and localized B0 and B1+ shimming, allows accelerated and reproducible multi-segment assessment of the major coronary arteries at 3 T in a single breathhold. The study is limited by small patient population (three patients with coronary artery disease and 15 healthy volunteers) and the imaging sequence was not evaluated in both the right and left coronary systems in every volunteer.