Andreas Sigfridsson

Background: Impaired cardiac function often results in heart failure which represents a major burden of morbidity and mortality. Cardiac magnetic resonance imaging (CMR) is the reference method for assessment of cardiac volumes and function and in vivo tissue characterization. However, the relatively long scan times makes CMR sensitive to motion. Most current CMR techniques require multiple breath holds and a stable heart rhythm. Patients, in particular patients who suffer from heart failure, who are unable to hold their breath as required, or present with atrial fibrillation, are thus precluded from undergoing a successful CMR exam. Objective The purpose of this project is to increase the accessibility of CMR in heart failure patients with arrythmias such as atrial fibrillation and inability to hold their breath. We aim to do this by deploying a novel acquisition paradigm, based on adaptive image acquisition where the pulse sequence is controlled by online motion estimators. We hypothesize that the introduction of an adaptive imaging technology that is resilient to motion and arrhythmias will lead to a higher success rate for CMR examinations in the broad range of patients with heart failure. Work plan Our technical development to date has provided preliminary results that enable us to commence with implementation and validation at the start of the project. The methods will be evaluated both in healthy volunteers (n=10) and patients with known or suspected heart failure (n=100, of which 50 specifically HFpEF). We will also include 50 patients with atrial fibrillation and inability to hold their breath. The project is immersed in the clinical environment at the Karolinska University Hospital with access to dedicated cardiac MRI scanners and patient populations. Significance Due to the inherent limitations of currently available cardiac MRI techniques, patients who cannot reliably hold their breath or suffer from arrhythmia are excluded from valuable examinations. The ability to cater to these patients represent a considerable accomplishment and a major milestone in the evolution of CMR. The new technology will be implemented directly in the clinical setting, and thus immediately available for use upon completion of the project. The technical development is also valuable for other patient settings, e.g. fetal CMR where imaging can be triggered by the mother´s breathing and the fetus´s motion.

Background: Impaired cardiac function often results in heart failure which represents a major burden of morbidity and mortality. Cardiac magnetic resonance imaging (CMR) is the reference method for assessment of cardiac volumes and function and in vivo tissue characterization. However, the relatively long scan times makes CMR sensitive to motion. Most current CMR techniques require multiple breath holds and a stable heart rhythm. Patients, in particular patients who suffer from heart failure, who are unable to hold their breath as required, or present with atrial fibrillation, are thus precluded from undergoing a successful CMR exam. Objective The purpose of this project is to increase the accessibility of CMR in heart failure patients with arrythmias such as atrial fibrillation and inability to hold their breath. We aim to do this by deploying a novel acquisition paradigm, based on adaptive image acquisition where the pulse sequence is controlled by online motion estimators. We hypothesize that the introduction of an adaptive imaging technology that is resilient to motion and arrhythmias will lead to a higher success rate for CMR examinations in the broad range of patients with heart failure. Work plan Our technical development to date has provided preliminary results that enable us to commence with implementation and validation at the start of the project. The methods will be evaluated both in healthy volunteers (n=10) and patients with known or suspected heart failure (n=100, of which 50 specifically HFpEF). We will also include 50 patients with atrial fibrillation and inability to hold their breath. The project is immersed in the clinical environment at the Karolinska University Hospital with access to dedicated cardiac MRI scanners and patient populations. Significance Due to the inherent limitations of currently available cardiac MRI techniques, patients who cannot reliably hold their breath or suffer from arrhythmia are excluded from valuable examinations. The ability to cater to these patients represent a considerable accomplishment and a major milestone in the evolution of CMR. The new technology will be implemented directly in the clinical setting, and thus immediately available for use uon completion of the project. The technical development is also valuable for other patient settings, e.g. fetal CMR where imaging can be triggered by the mother´s breathing and the fetus´s motion.

Impaired cardiac function often results in heart failure which represents a major burden of morbidity and mortality. Cardiac magnetic resonance imaging (MRI) is considered to be the reference method for assessment of cardiac function. However, the relatively long scan times makes MRI sensitive to motion. Most current cardiac MRI techniques require multiple breath holds, which many patients with heart failure are unable to perform., resulting in non-diagnostic image quality. The aim of this project is to develop a novel framework for adaptive image acquisition, where the pulse sequence is controlled by online motion estimators. This will enable acquisition that is robust to respiratory motion and arrhythmia, as well as fetal motion during examination of fetal hearts. The methods will be evaluated both in healthy volunteers, heart failure patients, and in pregnant women. The pulse sequence and corresponding image reconstruction will be implemented directly on the clinical scanner platform, making it immediately available for clinical use. The research will take place immersed in a clinical environment at the Karolinska University Hospital, with full access to dedicated cardiac MRI scanners and relevant patient populations. The proposed approach is highly original, fills an important unmet clinical need in medicine, and involves novel approaches that push the technical limits of image acquisition and reconstruction beyond state-of-the-art.