Eby Daniel

The cardiology community has lost a giant. We honor the extraordinary legacy of Eugene Braunwald, MD, MACC, a visionary leader and pioneer whose outstanding contributions shaped the foundation of cardiovascular medicine as we know it today. Read more: bit.ly/41NEXGp

Take-home • Not everyone needs CMR • Use it selectively—but use it well • Detect subclinical injury early • Guide therapy decisions ⚠️ In ICI myocarditis → early diagnosis = life-saving 👉 Right patient. Right time. Right modality.

Practical use of CMR Most patients → Echo + biomarkers CMR in selected cases: • Suspected myocarditis (esp. Immune check point inhibitors) • Discordant findings • Unexplained troponin rise • Radiation / infiltrative disease 📌 Protocol: Cine + T1/T2 ± LGE (tailored to indication)

CMR: where it adds value ✔ Gold standard volumes & function ✔ High reproducibility ✔ Tissue characterization (edema, fibrosis, inflammation) 👉 Not a screening tool— 👉 A precision tool for problem-solving

An interesting talk by @barthur_ashita on role of cardiac MRI in #cardioOncology #Cardiooncology is not about more imaging—it’s about the right imaging. With rising cancer survival → CV toxicity is increasing. But we can’t do CMR for everyone. 👉 So where does CMR actually fit? #CardioOncology #whycmr @IaciIndia @SCMRorg

Amazing work by @qzhang_cs Cardiac MRI: No contrast. No delay. Still LGE. 🤯 AI-powered Virtual Native Enhancement (VNE) reconstructs scar imaging from native CMR data. → Faster scans → No gadolinium → Strong agreement with LGE We might be looking at the future of CMR workflows.

🧠 Why CMR is a game-changer One scan gives: ✔ Morphology ✔ Function ✔ Tissue characterization ✔ Malignancy prediction 👉 Truly a “one-stop shop”

⚡ Step 3: Benign vs Malignant 🔴 Red flags for malignancy: •Right-sided (RA 👀) •Irregular, infiltrative •Multi-chamber involvement •Pericardial effusion •Perfusion + heterogeneous LGE 👉 Score ≥5 (CMR mass score) = likely malignant

🫀 Cardiac masses on CMR by @vineetao17 — a simple algorithm that can save you from major diagnostic errors @SCMRorg Most common cardiac mass? 👉 NOT tumor 👉 It’s thrombus Here’s a practical way to approach every case 👇 #CardioTwitter #whyCMR

Pericarditis: where CMR really shines 🔥 ✔ LGE = active inflammation ✔ ↓ LGE over time = treatment response ⚠️ Trick: Pericardial fat ≠ inflammation 👉 Use fat-sat PSIR •Signal disappears → fat •Persists → inflammation 💡 CMR = diagnosis + disease activity + guidance

📊 ACC 2024: 👉 CMR = PIVOTAL diagnostic test •Combines: •Edema (T2) •Injury (T1/LGE) •Alongside biomarkers ± biopsy 💡 We’ve shifted from: “Maybe CMR” → “Do CMR early”

CMR in Myocarditis & Pericarditis — what actually matters in practice by Dr. Vanessa Ferreira #whycmr @SCMRorg @vineetao17 From the #AdvancedCMR course 👇 👉 We’ve moved from qualitative imaging → quantitative tissue characterization And CMR is now a pivotal test, not just supportive. Let’s break it down 🧠⬇️

Key takeaway: 👉 Don’t just treat the EF
👉 Don’t just label “DCM” Diagnose the disease behind the dilated LV Because sometimes—
you’re not treating heart failure…
you’re treating a curable condition.

LV thinning doesn’t always mean non-viability in ischaemic cardiomyopathy

From @chiarabd’s talk on approach to left ventricular dilatation and phenocopies in the advanced CMR Workshop #whycmr @SCMRorg @vineetao17