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.