Purpose/ Objective

The recovery of injured myocardium following acute myocardial infarction is unpredictable. Existing approaches rely on recognition of adverse outcomes after the acute phase of myocardial infarction, when myocardial injury is irreversible. Therefore, early recognition of a high-risk subgroup may enable patient selection for specific therapies to improve early outcomes and reduce future risk.

Following this activity, learns will be able to:

1. Native T1 mapping can provide a quantitative assessment of myocardial tissue composition in the setting of acute myocardial infarction. It can identify patients with larger extent of microvascular obstruction and infarct size at both 24 hours and 6 months follow-up.

2. Understand the lack of association between the native T1 at 24hrs and the standard infarct characteristics at 24hr and 6 months. This is an important negative finding that the community should be aware of, so that attention can be focused away from native T1 in this scenario

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations:

Bibliography
Please see the bibliography at the end of the journal article.

Purpose/ Objective

Clinical CMR is relatively inaccessible based on its cost and technical requirements. Lower field MRI systems could improve the accessibility of clinical CMR. The general assumption is that low field MRI offers low quality imaging, however new high-performance low-field MRI systems may offer good image quality for clinical application. Some advantages of lower magnetic field MRI include the scaling of T1 and T2 tissues parameters, improved field homogeneity, and reduced RF-induced heating. The optimization of low field MRI imaging methods, including the use of modern acquisition and reconstruction strategies, can enable high quality CMR imaging that provides equivalent diagnostic capabilities. Following this CME activity learners should be able to: 1. Describe how a high-performance low field MRI system performs for quantitative cine CMR imaging, compared to conventional methods. 2. Describe how protocol optimization can be performed to improve image quality using low field MRI.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations: None

Bibliography
Please see the bibliography at the end of the journal article.

There is a complete bibliography in the journal article. Some publications of particular relevance are: 1. Simonetti OP, Ahmad R. Low-Field Cardiac Magnetic Resonance Imaging: A Compelling Case for Cardiac Magnetic Resonance's Future. Circ Cardiovasc Imaging. 2017;10(6). 2. Marques JP, Simonis FFJ, Webb AG. Low-field MRI: An MR physics perspective. J Magn Reson Imaging 2019;49(6):1528-1542. 3.. Rashid S, Han F, Gao Y, Sung K, Cao M, Yang Y, et al. Cardiac balanced steady-state free precession MRI at 0.35 T: a comparison study with 1.5 T. Quant Imaging Med Surg. 2018;8(7):627-36. 4.. Campbell-Washburn AE, Ramasawmy R, Restivo MC, Bhattacharya I, Basar B, Herzka DA, et al. Opportunities in Interventional and Diagnostic Imaging by Using High-performance Low-Field-Strength MRI. Radiology. 2019:190452.

Purpose/ Objective

What is the current state/problem in practice? No definite evidence found in myocardium of patients with liver cirrhosis.

What is the ideal state/ if the problem is gone? Early myocardial changes in patients with liver cirrhosis (usually referred to as cirrhotic cardiomyopathy) can be diagnosed.

Following this activity, learners will:

1. Understand structural and functional changes in myocardium observed in cardiac magnetic resonance and echocardiography
2. Understand why myocardial structural and functional changes take place in patients with liver cirrhosis (i.e. pathophysiology)

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was designed to improve understanding myocardial changes in patients with liver cirrhosis awaiting liver transplantation and intended to highlight what changes can be observed in cirrhotic cardiomyopathy.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures

This study was supported by the grant of CJ healthcare 2016 research fund. CJ HealthCare is a South Korean Medicine and Biotechnology company based in Seoul that manufactures synthetic medicines, general medicines, and Health drinks.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations:

Bibliography
Please see the bibliography at the end of the journal article.

1) Kim HM, Kim HK, Lee JH et al. Myocardial Structural and Functional Changes in Patients with Liver Cirrhosis Awaiting Liver Transplantation ; A Comprehensive Cardiac Magnetic Resonance and Echocardiography Study . JCMR 2020. In press

2) Unseth JH, Olmstead EG, Abboud F. A study of heart disease in one hundred eight hospitalized patients dying with portal cirrhosis. AMA Arch Intern Med. 1958;102(3):405-13

3) Moller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J. 2013;34(36):2804-11.

Description

This article discusses the role of exercise stress imaging in differentiating cardiac remodeling due to exercise and dilated cardiomyopathy.

Purpose/ Objective

Cardiac remodeling from exercise and dilated cardiomyopathy have overlapping rest-based phenotypic features. Differentiating the two conditions can be challenging. Following this activity, learners will recognize:

1. Spectrum of dilated cardiomyopathy includes isolated ventricular dilatation, hypokinetic non dilated cardiomyopathy and dilated cardiomyopathy. 
2. Exercise-induced cardiac remodeling is common in active non-athletes who are otherwise healthy. 
3. Potential role of exercise stress imaging to differentiate exercise-induced cardiac remodeling and dilated cardmyopathy.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations: None

Bibliography
Please see the bibliography at the end of the journal article.

Description

T1ρ-weighted MRI can provide endogenous contrast and has shown promising results to detect myocardial infarction. However, current T1ρ mapping technique either suffers from limited coverage or long scan time, prohibiting its clinical application. We've proposed a whole-heart T1ρ mapping, which used an image navigator to enable high acquisition efficiency and undersampled acquisition to further reduce the scan time, achieving a clinically feasible MRI scan time of 6 mins in the end.

Purpose/ Objective

Improve learners' competence in T1ρ-weighted MRI.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations: None

Bibliography
Please see the bibliography at the end of the journal article.

https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-020-0597-5 

Description

Experience in CMR imaging in S-ICD patients is limited and a lot of physicians do not dare to perform CMR in these patients due to safety concerns and/or relevant imaging artefacts precluding a meaningful analysis. Considering the present data in our manuscript, we illustrate that CMR can be safely performed in patients with S-ICD and substantially helps in clinical-decision making.

Purpose/ Objective

To close the gap outlined above, learners will:

1. Better assess the potential challenges in performing CMR studies in patients with an S-ICD

2. Better know when and how image artefacts caused by the device will occur and how they can be limited.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations: None

Bibliography
Please see the bibliography at the end of the journal article.

Current publication: Holtstiege et al, JCMR-D-19-00270R2

Description

T2 and T2* mapping provide information regarding edema and iron deposition in the myocardium. Although many studies reported mapping values of patients with cardiomyopathies and heart transplantation, the actual clinical utility of T2 and T2* mapping values in clinical practice is generally not acknowledged yet. By performing this meta-analysis we provided an overview of all current literature reporting T2 and T2* mapping in heart diseases. Furthermore we evaluated their significance to contribute to insights regarding the clinical applicability.

Purpose/ Objective

To close the gap outlined above, learners will:

After reading the article, readers will have a better understanding of T2 and T2* mapping in clinical practice as:

1. In each imaging center reference values of T2 and T2* mapping values should be obtained with similar imaging methods as in patients,

2. Comparison of mapping values with external centers should be avoided,

3. Readers should take knowledge of the clinical recommendations published by Messroghli et al. to standardize image acquisition.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
This activity received no commerical support.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations: none

Bibliography
The list of relevant publications is stated in the reference list of the meta-analysis at the end of the article. One specific article with recommendations in parametric imaging chosen to be stated explicitly: Messroghli et al. – J Cardiovasc Magn Reson (2017) - DOI 10.1186/s12968-017-0389-8

Purpose/ Objective

The evolution of LV strain after STEMI within infarcted and remote myocardium has not yet been investigated with feature-tracking CMR. Accordingly, the present sub-analysis of the METOCARD-CNIC trial evaluated the changes in regional LV peak circumferential strain with feature tracking CMR at 1 week and at 6 months after STEMI. Specifically, the effects of the early intravenous metoprolol treatment, microvascular obstruction, intramyocardial hemorrhage and adverse LV remodeling on the evolution of infarct and remote zone strain were investigated.

Reader of this article will improve their knowledge by gaining several important insights into the role of feature-tracking CMR to investigate the evolution of the infarct zone and the remote zone circumferential strain in STEMI patients.

Following this activity, readers of this article will get new insights into the evolution of regional LV systolic function (in terms of circumferential LV strain) after STEMI:

1. Early intravenous metoprolol has a long-lasting cardioprotective effect on the infarct zone circumferential strain and no significant effect on the remote zone circumferential strain.
2. The infarct zone circumferential strain is significantly impaired in patients with MVO and IMH, but it improves between 1 week and 6 months after STEMI regardless of the presence of MVO or IMH.
3. In patients with adverse LV remodeling, defined as ≥20% increase in LV end-diastolic volume, the infarct zone circumferential strain improves but the remote zone circumferential strain worsens between 1 week and 6 months after STEMI.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures

SCMR received funding to support this activity from the following organizations: None.

Disclosure of Commercial Support

The planners and faculty for this activity did not have any relationships to disclose.

Bibliography
Please see the bibliography at the end of the journal article.

Purpose/ Objective

This article reports a comparison of novel real-time and conventional MOLLI native T1 and ECV mapping and their relationship with histological fibrosis assessment derived from endomyocardial biopsies. Taking the relationship of CMR surrogate parameters of myocardial fibrosis and histology as well as the available literature into account, the discussion of the article debates the potential prognostic impact of CMR tissue characterization on cardiovascular events in patients with severe aortic stenosis prior to valve replacement.

This CME activity was designed to understand concepts of CMR surrogate analyses for myocardial fibrosis assessment compared to the reference-standard of histological evaluations.

Gap analysis:

1. What is the current state/problem in practice? CMR surrogate parameters of myocardial fibrosis such as T1 and ECV do not directly quantify myocardial fibrosis. Whilst CMR surrogates assess overall myocardial changes, endomyocardial biopsies describe histological changes in detail considering a specific localized endocardial lesion only.
2. What is the ideal state/ if the problem is gone? Identification of an accurate CMR surrogate parameter for comprehensive non-invasive myocardial fibrosis assessment.
3. What would practice look like if clinicians had the knowledge and capability to make these changes? Implementation of non-invasive tissue characterization within clinical routine in AS patients.

 To close the gap:

1. The reader should learn about cardiac remodeling in aortic stenosis and the relationship of CMR derived surrogate parameters with histology.
2.  Learners need to know how about the challenges to interpret changes of CMR surrogate parameters considering the different surrogate parameters available as well as their limited relationship to histologically quantified fibrosis. Furthermore, the reader should learn about novel technical approaches for their assessment (real time mapping).
3.  Learners need to perform multiple tissue characterization strategies (native T1/ECV/LGE) to enable comprehensive tissue characterization.

Designed to change: This CME activity should inform the reader about different CMR surrogate parameters for tissue characterization as well as novel technical concepts for their assessment.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Read and fully comprehend the article
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
SCMR received funding to support this activity from the following organizations: None.

Disclosure of Commercial Support
The planners and faculty for this activity did not have any relationships to disclose. 

Bibliography
Please see the bibliography at the end of the journal article.

Purpose/ Objective

Myocardial perfusion with cardiovascular magnetic resonance (CMR) imaging is an established diagnostic test for evaluation of myocardial ischaemia. For quantification purposes, however, the 16 segment American Heart Association (AHA) model poses limitations in terms of extracting relevant information on the extent/severity of ischaemia as perfusion deficits will not always fall within an individual segment, which reduces its diagnostic value, and makes an accurate assessment of outcome data or a result comparison across various studies difficult. The article will therefore focus on how subsegmentation of the myocardium improves diagnostic accuracy and facilitates an objective cut-off-based description of hypoperfusion.

What is the ideal state/ if the The 16 segment American Heart Association (AHA) model poses limitations in terms of extracting relevant information on the extent/severity of ischaemia as perfusion deficits will not always fall within an individual segment, which reduces its diagnostic value, and makes an accurate assessment of outcome data or a result comparison across various studies difficult. By further dividing the myocardial segments into epi- and endocardial layers and a further circumferential subdivision, the accuracy of detecting myocardial hypoperfusion is improved.problem is gone?

Following this activity, learners will be aware of the advantages / disadvantages of the different subsegmentation approaches and they will understand how to use the 96 (sub-)subsegments approach.

This activity was designed to make the learner familiar with the advantages / disadvantages of subsegmentation approaches based on transmural segments (16 AHA and 48 segments) vs. subdivision into epi- and endocardial (32) subsegments vs. further circumferential subdivision into 96 (sub-)subsegments.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations: None.

Bibliography1. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019 Aug 31. https://doi.org/10.1093/eurheartj/ehz425. 2. Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37:267–315. 3. Hendel RC, Friedrich MG, Schulz-Menger J, Zemmrich C, Bengel F, Berman DS, Camici PG, Flamm SD, Le Guludec D, Kim R, Lombardi M, Mahmarian J, Sechtem U, Nagel E. CMR first-pass perfusion for suspected inducible myocardial ischemia. JACC Cardiovasc Imaging. 2016;9(11):1338–48. 4. Puntmann VO, Valbuena S, Hinojar R, Petersen SE, Greenwood JP, Kramer CM, et al. Society for Cardiovascular Magnetic Resonance (SCMR) expert consensus for CMR imaging endpoints in clinical research: part I - analytical validation and clinical qualification. J Cardiovasc Magn Reson. BioMed Cent. 2018;20:67. 5. Nagel E, Greenwood JP, McCann GP, Bettencourt N, Shah AM, Hussain ST, et al. Magnetic resonance perfusion or fractional flow reserve in coronary disease. N. Engl. J. Med. Mass Med Soc. 2019;380:2418–28. 6. Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, et al. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson. 2013;15:35. 7. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS. American Heart Association writing group on myocardial segmentation and registration for cardiac imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circ. 2002;105(4):539–42. 8. Shaw LJ, Blankstein R, Brown DL, Dhruva SS, Douglas PS, Genders TSS, et al. controversies in diagnostic imaging of patients with suspected stable and acute chest pain ayndromes. JACC: Cardiovasc Imaging. 2019;12:1254–78. 9. Selvadurai BSN, Puntmann VO, Bluemke DA, Ferrari VA, Friedrich MG, Kramer CM, et al. Definition of left ventricular segments for cardiac magnetic resonance imaging. JACC Cardiovasc Imaging. 2017;11:926–8. 10. Shaw LJ, Berman DS, Picard MH, Friedrich MG, Kwong RY, Stone GW, et al. Comparative definitions for moderate-severe ischemia in stress nuclear, echocardiography, and magnetic resonance imaging. JACC Cardiovasc Imaging. 2014;7:593–604. 11. Hsu L-Y, Groves DW, Aletras AH, Kellman P, Arai AE. A quantitative pixel-wise measurement of myocardial blood flow by contrast-enhanced first-pass CMR perfusion imaging. JACC Cardiovasc Imaging. 2012;5:154–66. 12. Ta AD, Hsu L-Y, Conn HM, Winkler S, Greve AM, Shanbhag SM, et al. Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis. J Cardiovasc Magn Reson. 2018;20:16–1. 13. Chung S, Shah B, Storey P, Iqbal S, Slater J, Axel L. Quantitative perfusion analysis of first-pass contrast enhancement kinetics: application to MRI of myocardial perfusion in coronary artery disease. PLoS One. 2016;11:e0162067. 14. Ishida M, Schuster A, Morton G, Chiribiri A, Hussain S, Paul M, et al. Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:28. 15. Puntmann VO, Carr-White G, Jabbour A, Yu C-Y, Gebker R, Kelle S, et al. Native T1 and ECV of noninfarcted myocardium and outcome in patients with coronary artery disease. J Am Coll Cardiol. 2018;71:766–78.

Purpose/ Objective

This CME activity was designed to understand the characterization of the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes.

The article discusses how intensive endurance exercise may induce a broad spectrum of right ventricular remodelling patterns. The aim of this work is to characterize the features of contrast CMR (patterns of late gadolinium enhancement distribution and T1 and extracellular volume values) in a cohort of highly trained endurance athletes. Late gadolinium enhancement has also been described in cardiac magnetic resonance (CMR) of some endurance athletes and its clinical meaning remains controversial. Our aim was to characterize the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes.

To close the gap:

1. Learners need to know about cardiac remodelling caused by intensive endurance exercise.
2. Learners need to know how to apply (intention to put into practice) LGE and T1 mapping CMR sequences.
3. Learners need to do (perform): CMR in highly-trained athletes to study if they are developing fibrosis.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
None.

Planners

Dr. Blanca Domenech Ximenos; Dr. Warren Manning (JCMR Editor)

Disclosure of Commercial Support
None.

Bibliography

There is a bibliography in the material.

Purpose/ Objective

The articles will help understanding of clinical value of cardiac magnetic resonance (CMR) in patients with idiopathic inflammatory cardiomyopathy (IIM). The study found that both myocardial and skeletal muscles in newly diagnosed IIM patients show distinct characteristics on multiparametric CMR. In addition, significant changes were observed in patients showing clinical remission after effective treatment, which suggests that quantitative T1, T2, and ECV techniques may have potential clinical value in IIM patients.

What is the current state/problem in practice? Idiopathic inflammatory myopathy (IIM) manifest as systematic muscle involvement. Multiparametric cardiovascular magnetic resonance (CMR) could be a useful technique to detect systemic involvement and disease progression in IIM patients. There is still a lack of dynamic monitoring of myocardial and skeletal histological changes during therapy. What is the ideal state/ if the problem is gone? In the present study, we hypothesized that multiparametric CMR would help identify myocardial and skeletal involvement in patients with IIM and facilitate further dynamic monitoring of the effect of therapy during the clinical convalescence period of the disease.

1. The study demonstrates that multiparametric CMR could allow early detection of myocardial and skeletal muscles involvement in IIM patients, and help monitor dynamic changes after effective treatment. CMR research needs to be combined with the patient's clinical symptoms and biomarker to highlight its clinical significance. 2.The study demonstrates that CMR also has extra cardiac findings.

To close the gap, learners will be better realized that the clinical value of CMR in systematic diseases with a few aspects:

1. CMR help early detection of subclinical cardiac involvement
2. CMR help monitoring therapeutic effect
3. The extra cardiac findings of CMR should not be ignored, especially in systematic diseases.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Planners

Dr. Yucheng Chen; Dr. Warren Manning (JCMR Editor)

Disclosure of Commercial Support
None.

Bibliography

There is a bibliography in the material.

Description

Phase contrast cine MRI of the coronary sinus can be used to measure the coronary flow reserve. Measurement of CFR may be useful to detect high risk DM patients developing future cardiovascular events.

Treatment of epicardial coronary artery disease (e.g percutaneous coronary intervention) is not perfect to improve clinical outcome of patients with coronary artery disease, as some of them have microvascular disease. Measurement of coronary flow reserve, an index of microvascular function, may be useful to detect the patients with imparired coronary microvascular function. Aggressive treatment strategy should be considered for these patients.

To close the gap above:

1. Learners need to know about: Coronary flow resereve is an important index for patients with diabetes mellitus in terms of risk stratification.
2. Learners need to know how to apply: Phase contrast cine MRI of the coronary sinus can be used to measure the coronary flow reserve.
3. Learners need to do (perform): Measurement of CFR may be useful to detect high risk DM patients developing future cardiovascular events.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Read the article
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures

The planners and faculty for this activity did not have any relationships to disclose. 

Disclosure of Commercial Support

This activity received no commerical support.

Bibliography

1. Shingo Kato, Kazuki Fukui, Kouichi Tamura et al. Coronary Flow Reserve by Cardiac Magnetic Resonance Imaging in Patients With Diabetes Mellitus. JACC Cardiovasc Imaging. 2019;12:2579-258
2. Shingo Kato, Naka Saito, Kouichi Tamura et al. Reply: Importance of Resting Coronary Blood Flow as the Main Determinant of Coronary Flow Reserve. J Am Coll Cardiol. 2017;70:2839-2840
3. Shingo Kato, Naka Saito, Kazuo Kimura et al. Stress Perfusion Coronary Flow Reserve Versus Cardiac Magnetic Resonance for Known or Suspected CAD. J Am Coll Cardiol 2017;70:869-879

Description

There is a lack of knowledge regarding the presence of myocardial fibrosis in patients with chronic primary mitral regurgitation before onset of symptoms and left ventricular dysfunction. The relationship between myocardial fibrosis and imaging detection is important, as additional methods are need to optimise care and outcomes in relation to timing intervention. Awareness of the presence of fibrosis and knowledge of associated factors that may drive the fibrotic process.

The CME activity aims to narrow the knowledge gap in terms of histological evidence of myocardial fibrosis and the relationship to imaging markers.

To close the gap above:

1. Learners need to know about the presence of myocardial fibrosis in asymptomatic and symptomatic patients with severe chronic primary MR.
2. Learners need to know how to apply this knowledge when interpreting cardiovascular imaging and tissue characterisation in these patients.
3. Learners need to recognise changes in tissue characterisation and associated factors in imaging these patients.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Read the article
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any financial disclosures.

Disclosure of Commercial Support

This activity received no commerical support.

Bibliography

1. Liu B, Edwards NC, Pennell D, Steeds RP: The evolving role of cardiac magnetic resonance in primary mitral regurgitation: ready for prime time? European heart journal cardiovascular Imaging 2019, 20(2):123-130.
2. Fuster V, Danielson MA, Robb RA, Broadbent JC, Brown AL, Elveback LR: Quantitation of left-ventricular myocardial fiber hypertrophy and interstitial-tissue in human hearts with chronically increased volume and pressure overload. Circulation 1977, 55(3):504-508.
3. Edwards NC, Moody WE, Yuan MS, Weale P, Neal D, Townend JN, Steeds RP: Quantification of Left Ventricular Interstitial Fibrosis in Asymptomatic Chronic Primary Degenerative Mitral Regurgitation. Circ-Cardiovasc Imaging 2014, 7(6):946-953.
4. Kitkungvan D, Nabi F, Kim RJ, Bonow RO, Khan MA, Xu JQ, Little SH, Quinones MA, Lawrie GM, Zoghbi WA et al: Myocardial Fibrosis in Patients With Primary Mitral Regurgitation With and Without Prolapse. J Am Coll Cardiol 2018, 72(8):823-834

Description

Reliable evaluation of mitral regurgitation (MR) is critical in assessing the severity of hypertrophic cardiomyopathy (HCM) patients. Nevertheless, recent studies demonstrated high variability and limited reproducibility in the MR measurements using the standard-of-care CMR indirect volumetric method in HCM patients. This article evaluates 4D flow CMR jet tracking as a potential alternative method for assessing MR severity in HCM patients compared to the conventional CMR indirect method, with respect to reproducibility, analysis time, and agreement with transthoracic echocardiograph.

Purpose/ Objective

What is the current state/problem in practice?

While mitral regurgitation (MR) evaluation is critical in assessing hypertrophic cardiomyopathy (HCM) severity, current standard-of-care CMR indirect volumetric method demonstrated high variability and limited reproducibility in the MR measurements in HCM patients.

What is the ideal state/ if the problem is gone?

Article presents 4D flow CMR direct jet tracking as a potential alternative method to quantify MR severity in HCM patients with excellent inter- and intra-observer reproducibility and higher agreement with echocardiography compared to the conventional CMR indirect method.

Learning Objectives

To close the gap outlined above:

1. Learners need to review the challenges of the current CMR method in evaluating MR in HCM.

2. Learners need to understand sources of variability in the conventional CMR method for MR quantification in HCM patients.

3. Learners need to understand the presented alternative 4D flow CMR jet tracking method and how it can improve reliability of MR quantification in HCM patients.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
None

Bibliography
Please see the bibliography at the end of the journal article.

Description

Atrial fibrillation is associated with profound structural and functional changes in the atria. In the present study, the authors investigated the association between left atrial phasic function and the extent of left atrial fibrosis using advanced cardiovascular magnetic resonance imaging techniques, including 3-dimensional late gadolinium enhancement and feature tracking.

Purpose/Objective

Recognize that an impaired passive LA function (conduit and reservoir strain) can be an expression of extensive LA fibrosis, which might possibly have implications for the succesrate of an PVI ablation procedure.

Learning Objectives

To close the gap outlined above:

1. Learners need to know about the relation between LA strain and LA fibrosis.

2. Learners need to know how to apply and assess atrial strain analysis in patients scheduled for an PVI ablation procedure.

3. Learners need to consider performing atrial strain analysis to get insight into the status of left atrial remodeling in AF patients.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations:

Bibliography
Please see the bibliography at the end of the journal article.

Description

This article relates to the changes in left ventricular mass and strain parameters detected following intensive pharmacological treatment of grade II-III hypertension.

Purpose/Objective

What is the current state/problem in practice?

Current ESC guidelines recommend rapid treatment of moderate and severe hypertension, though the consequences of this for the myocardium is unknown. Hypertensive heart disease is also a leading cause of heart failure - a lack of understanding of the effects of hypertension on myocardial structure and function may influence treatment inertia in this regard.

What is the ideal state/ if the problem is gone?

A greater understanding of the benefits of intensive treatment of hypertension would promote the adoption of this strategy amongst clinicians, conforming with contemporary guidelines and potentially improving patient outcomes.

Learning Objectives

To close the gap outlined above:

1. Learners need to know about: Regression of left ventricular hypertrophy and changes in myocardial function with intensive antihypertensive treatment.

2. Learners need to know how to apply: The concept of time-critical treatment of hypertension, as recommended in current guidelines.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support

None

Bibliography
Please see the bibliography at the end of the journal article.

Description

The resting coronary sinus blood flow quantified by phase contrast magnetic resonance imaging may be a useful non-invasive method for the risk stratification of patients with known or suspected coronary artery disease without any radiation exposure, contrast media, or pharmacological vasodilator agents.

Purpose/Objective

What is the current state/problem in practice?

Risk stratification of patients with coronary artery disease is not sufficient.

What is the ideal state/if the problem is gone?

Good non-invasive risk marker is present.

Learning Objectives

To close the gap outlined above:

1. Learners need to know about: Current status and unmet needs for the risk stratification of coronary artery disease

2. Learners need to know how to apply: Cardiac magnetic resonance as an excellent tool for risk stratification

3. Learners need to do: Use cardiac magnetic resonance more for clinical practice

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Suppor

None

Bibliography
Please see the bibliography at the end of the journal article.

Description

Mapping of left ventricular (LV) native T1 is a promising non-invasive, non-contrast imaging biomarker. Native myocardial T1 times are prolonged in patients requiring dialysis, but there are concerns that the dialysis process and fluctuating fluid status may confound results in this population. We aimed to assess the changes in cardiac parameters on 3T cardiovascular magnetic resonance (CMR) before and after haemodialysis, with a specific focus on native T1 mapping.

Purpose/Objective

What is the current state/problem in practice?

Structural cardiac abnormalities are well described in people with advanced chronic kidney disease requiring dialysis. However, it is unclear what effect the dialysis process itself has on the reported abnormalities.  In particular, mapping of native myocardial T1 is a promising non-invasive, non-contrast imaging biomarker. Native myocardial T1 times are prolonged in people requiring dialysis compared to controls without kidney disease and this is thought to be due to interstitial myocardial fibrosis. However, there are concerns that the dialysis process and fluctuating fluid status may confound results in this population and contribute to the raised T1 times observed. 

What is the ideal state/ if the problem is gone?

The present study raises awareness that acute changes in cardiac volumes and myocardial composition are detectable on 3T cardiovascular MRI following a single session of haemodialysis in people who undergo regular haemodialysis. In particular, small but consistent reductions in myocardial native T1 times are observed after dialysis, meaning that in clinical practice care should be taken to standardise the timing of the scan in relation to a person's usual dialysis schedule, especially if serial scanning is required.

Learning Objectives

To close the gap outlined above:

1. Learners need to know about: Being aware of the ability of a single haemodialysis session to modulate cardiovascular MRI findings in relation to myocardial volumes and tissue composition.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Suppor

None

Bibliography
Please see the bibliography at the end of the journal article.

Description

This CME activity will present and discuss online an accepted manuscript in JCMR with the title, "Pulmonary blood volume measured by cardiovascular magnetic resonanc: influence of pulmonary transit time methods and left atrial volume."

Purpose/Objective

What is the current state/problem in practice?

Objective quantification of congestive heart failure is challenging. The current state is that most cardiologists and other health care providers, including those within the field of CMR, does not know that it is possible to quantify pulmonary blood volume (PBV) as a biomarker of congestive heart failure, and that this measure can be achieved as a by-product of first-pass perfusion sequences by multiplying the pulmonary transit time with the cardiac output.

What is the ideal state if the problem is gone?

Measurement of the pulmonary blood volume (PBV), as a by-product of standard first-pass myocardial perfusion and cardiac output, becomes standard procedure and provides incremental value in terms of diagnosis, staging of various heart diseases, and evaluation of therapeutic response.

Learning Objectives

Following this activity:

1. Learners need to know that 1) an increase in pulmonary blood volume (PBV) is a biomarker of congestive heart failure, 2) that the PBV can be quantified by CMR whenever myocardial first-pass perfusion exams are performed, and 3) that the PBV assessed by first-pass perfusion is overestimated by the volume of the left atrium. 

2. Learners need to apply calculation of the pulmonary transit time (PTT) and pulmonary blood volume (as PTT x cardiac output) when first-pass perfusion exams are performed. 

3. Learners need to assess when to incorporate the pulmonary blood volume into clinical reports and to clarify if the left atrial volume (LAV) is included in the PBV measurement.

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Read the article in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support

None

Bibliography
Please see the bibliography at the end of the journal article.