These data suggest that myocyte storage starts in childhood and accumulates faster in men before triggering 2 processes: a sex-independent scar/inflammation regional response (LGE) and, in men, apparent myocyte hypertrophy diluting the T1 lowering of sphingolipid.

Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) sequences have evolved. Free-breathing motion-corrected (MOCO) LGE has potential advantages over breath-held (bh) LGE including minimal user input for the short axis (SAX) stack without breath-holds. It has previously been shown that MOCO-LGE delivers high image quality compared to bh-LGE. We sought to conduct an independent validation study to investigate real-world performance of bh-LGE versus MOCO-LGE in a high-throughput CMR center immediately after the introduction of the MOCO-LGE sequence and with elementary staff induction in its use. Four-hundred consecutive patients, referred for CMR and graded by clinical complexity, underwent CMR on either of two scanners (1.5 T, both Siemens) in a UK tertiary cardiac center. Scar imaging was by bh-LGE or MOCO-LGE (both with phase sensitive inversion recovery). Image quality, scan time, reader confidence and report reproducibility were compared between those scanned by bh-LGE versus MOCO-LGE. Readers had > 3 years CMR experience. Categorical variables were compared by χ2 or Fisher’s exact tests and continuous variables by unpaired Student’s t-test. Inter-rater agreement of LGE reports was by Cohen’s kappa. Image quality (low score = better) was better for MOCO-LGE (median, interquartile range [Q1–Q3]: 0 [0–0] vs. 2 [0–3], P < 0.0001). This persisted when just clinically complex patients were assessed (0 [0–1] vs. 2 [1–4] P < 0.0001). Readers were more confident in their MOCO-LGE rulings (P < 0.001) and reports more reproducible [bh-LGE vs. MOCO-LGE: kappa 0.76, confidence interval (CI) 0.7–0.9 vs. 0.82, CI 0.7–0.9]. MOCO-LGE significantly shortened LGE acquisition times compared to bh-LGE (for left ventricle SAX stack: 03:22 ± 01:14 vs 06:09 ± 01:47 min respectively, P < 0.0001). In a busy clinical service, immediately after its introduction and with elementary staff training, MOCO-LGE is demonstrably faster to bh-LGE, providing better images that are easier to interpret, even in the sickest of patients.

No abstract

Aims Remodelling of the cardiovascular system (including heart and vasculature) is a dynamic process influenced by multiple physiological and pathological factors. We sought to understand whether remodelling in response to a stimulus, exercise training, altered with healthy ageing. Methods A total of 237 untrained healthy male and female subjects volunteering for their first time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent tests including 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided by age into under or over 35 years (U35, O35). Results Injury and completion rates were similar among the groups; 138 runners (U35: n = 71, women 49%; O35: n = 67, women 51%) completed the race. On average, U35 were faster by 37 minutes (12%). Training induced a small increase in left ventricular mass in both groups (3 g/m2, P < 0.001), but U35 also increased ventricular cavity sizes (left ventricular end-diastolic volume (EDV)i +3%; left ventricular end-systolic volume (ESV)i +8%; right ventricular end-diastolic volume (EDV)i +4%; right ventricular end-systolic volume (ESV)i +5%; P < 0.01 for all). Systemic aortic compliance fell in the whole sample by 7% ( P = 0.020) and, especially in O35, also systemic vascular resistance (–4% in the whole sample, P = 0.04) and blood pressure (systolic/diastolic, whole sample: brachial –4/–3 mmHg, central –4/–2 mmHg, all P < 0.001; O35: brachial –6/–3 mmHg, central –6/–4 mmHg, all P < 0.001). Conclusion Medium-term, unsupervised physical training in healthy sedentary individuals induces measurable remodelling of both heart and vasculature. This amount is age dependent, with predominant cardiac remodelling when younger and predominantly vascular remodelling when older.

No abstract