June 24, 2020
Foundations of CMR - Level I SCMR Workshop
Dear Friends and Colleagues,

In an effort to propel our mission of improving cardiovascular health by advancing the field of CMR through education, SCMR expanded its efforts in supporting remote learning during these challenging social-distancing times. Recently, we offered open-access to basic CMR educational materials that were previously only available to members – including tips on starting a CMR service, the “How I do” series, and SCMR Case of the Week. These resources continue to be available to SCMR members.

Now for the first time, SCMR is also offering an online-only Foundations of CMR Level I SCMR Workshop. We have dedicated great effort to this initiative, as increased understanding of the value of CMR is particularly important at this time when access to resources is limited and the need for optimized patient work-up is greatest.

The SCMR Level I CMR Course will review the fundamentals of CMR, focusing on its added value in clinical practice with liberal use of clinical cases throughout.

I wish I could host the attendees in beautiful San Francisco this fall, but I want to reassure attendees that the entire course faculty is committed to providing a high-level educational program including pre-recorded lectures, expert live case reviews and a final live debate session as well as plenty of time for questions and answers. This workshop, including the live sessions, will be available on-demand through SCMR's Online Learning Portal.

I hope to see you soon in “virtual San Francisco”.

Karen Ordovas
Vice Secretary Treasurer, SCMR
Co-chair, Foundations of CMR - Level I SCMR Workshop, July 2020
SCMR Communications Committee Update
by Jay Campbell, Chair, SCMR Communications Committee

Greetings from the SCMR Communications Committee! The committee has been busy getting out the message about the great imaging that CMR provides.

Purvi Parwani has developed a Social Media team that has been increasing the social media profile of CMR. Please look for our posts on your favorite platform and help us by responding and retweeting. Thanks to Purvi and her team for all of their great efforts in this regard!
The SCMR Case of the Week (COTW) team led by Sylvia Chen has continued to put out great cases for the SCMR website. They are always looking for new interesting cases so please consider submitting cases. The team is also now taking submissions for CMR cases in COVID-19 to build an educational rapid reference repository. This year, COTW cases will be published together in a once/year publication in JCMR. Thanks to the COTW and JCMR editorial teams for making this possible! Please also look for this great resource of “Why CMR?” discussing the many great uses of CMR.
CMR News
Stress CMR Perfusion Imaging in the United States (SPINS) Study

The Stress CMR Perfusion Imaging in the United States (SPINS) Study is the first study of the SCMR Registry and has provided important clinical insights of CMR assessing stable chest pain syndromes by publishing several manuscripts in leading cardiovascular journals. Led by Dr. Raymond Kwong (Brigham and Women’s Hospital), SPINS enrolled one of the largest stress CMR cohorts, including 2,349 intermediate-risk patients from 13 participating US sites, spanning 11 states (Kwong et al. JACC 2019). In this study, 1,583 patients (67%) had a normal stress CMR and were observed to experience low annual risk of cardiovascular death or acute MI (<1%/year), low clinical likelihood or need for coronary revascularization, and low associated healthcare cost spending.  In a subsequent just-published study using the SPINS registry, a cost-effectiveness model was created to compare multiple current imaging strategies in the contemporary US setting - stress CMR was favorable when compared to other imaging modalities (including SPECT and CCTA) and coronary angiography (Ge et al. JACC Imaging. 2020). Building upon this momentum, a third study focusing on the clinical impact of stress CMR in patients without known CAD, has demonstrated that CMR can successfully reclassify patients across ACC/AHA guideline-based risk categories, beyond clinical risk factors (Antiochos et al. JAMA Card. In press). Finally, a fourth study focusing on a high-risk subset of the SPINS cohort, those with reduced LVEF (<50%), again demonstrated the incremental predictive value of stress CMR over traditional clinical risk models (Ge et al. JACC Imaging. In press). Many other analyses from this comprehensive dataset are ongoing to answer additional key clinical questions.
COVID-19 Survey from SCMR & EACVI
The Society for Cardiovascular Magnetic Resonance (SCMR) and the European Association of Cardiovascular Imaging (EACVI) have developed a COVID-19 CMR survey. This survey aims to provide a rapid tool to capture the use of CMR in COVID-19 around the globe. The design of the survey is deliberately limited to a small number of data fields to allow completion on a mobile device or computer within a few minutes. 
To contribute, please complete a separate survey for each CMR scan performed in a patient with confirmed, or a high-probability of, COVID-19 (regardless of the local COVID-19 test). You can also complete a survey for patients you have scanned in the past.
SCMR COVID-19 Registry
There is a clinical need to understand CV complications of COVID-19 and few centers will have large numbers of scans from which to draw substantive conclusions.
Our goal of the SCMR COVID-19 Registry are:
  1. Characterize prevalence and patterns of CV complications of COVID-19
  2. Align CMR imaging protocols (minimum pulse sequence set)
  3. Align clinical data collection/reporting (minimum data element set)
  4. Increase generalizability and statistical power of observations (numbers/geographic representation)
If you wish to join and contribute images and clinical data to the SCMR COVID-19 Registry, the first step is for your institution to sign the Participation Agreement:
SCMR has created a repository of CMR cases in patients with COVID-19 infection. The goal is to provide a rapid reference of common CMR findings associated with the infection and a new educational resource. Submitted cases will be fast-tracked through peer-review and can be listed as a peer reviewed web publication on CV’s. Cases will initially be posted on the SCMR homepage and then be available in an archive. All cases will include brief clinical information and key CMR images, with other information added where available. We need your help in making this a helpful resource for anyone reporting COVID-19 cases. Please submit your cases below.
SCMR is proud to announce its collaboration with CAPACITY ( C ardiac complic A tions in P atients With S A RS C orona v I rus 2 regis T r Y ), an international global registry led by Professor Folkert Asselbergs .

CAPACITY-COVID offers a comprehensive data collection tool that facilitates uniform data collection of patients infected with SARS-CoV-2. The registry builds upon the Case Report Form (CRF) released by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) and World Health Organisation (WHO) in response to the COVID-19 outbreak. Within CAPACITY-COVID, the ISARIC-WHO CRF has been extended with multiple additional data collection instruments on cardiovascular risk factors, the use of cardiovascular medication and NSAIDs, cardiac biomarkers, ECG, echocardiography, cardiac MRI, chest CT, invasive cardiac procedures and cardiac complications.

SCMR is endorsing CAPACITY-COVID as the largest international cardiovascular registry which includes cardiac MRI data collection, among many other parameters. The aim of this collaboration is to work closely in aligning the CAPACITY CRF for cardiac MRI data to our SCMR COVID-19 Registry to collect the largest database of cardiac MRI in the COVID infection worldwide.

In addition to joining our SCMR COVID-19 Registry , SCMR members are invited to consider joining CAPACITY to contribute to a larger cardiovascular data collection effort and advance the field for our patients.
CMS AUC Reminder

As featured in last month’s newsletter, the CMS AUC program enters the educational testing phase from the beginning of July 2020. This means ordering providers must consult AUC through a clinical decision support mechanism (electronic tool) prior to ordering an advanced diagnostic imaging service (CT, MR, nuclear and PET). In this educational testing phase, no claims will be denied for improper AUC information – but full implementation is scheduled to begin in January 2021 at which point claims will be audited.
Member Success Stories
Establishing CMR in Malta
by Dr. Alexander Borg, MD, FRCP, FESC &
Dr. Luise Reichmuth, MD, FRCR

Malta is a tiny island in the Mediterranean Sea, one of the southernmost states of the European Union. Behind the sun-soaked façade, the main hospital struggles with heart disease, the number one killer. CMR was introduced in 2014 when the health service recruited Alexander Borg, cardiologist, specialised in Manchester, UK, and Luise Reichmuth, radiologist, trained in Harefield Hospital, London, UK. Upgrading the existing 3T scanner was relatively easy; tougher challenges were training radiographers and educating referrers. It was a venture into virgin territory, but the cardiology-radiology collaboration was a good starting point. As radiographers had to grasp ECG basics, familiarise with cardiac planes, and recognise new artefacts, they went through a culture shock after realising that CMR is unlike routine radiology. Medical colleagues were unsure what to do with this new investigation but, after a grudging start, it exploded beyond expectations as budding specialists in congenital heart disease, inherited conditions and sports cardiology enthusiastically embraced the technology.
The current annual output of 600 scans falls short for our population of 490,000. We have three upcoming CMR specialists, and trainees are provided with a complete multimodality repertoire of cardiac imaging. A new scanner, equipped with accelerated image acquisition and tissue mapping, is due to be installed. As the service matures, we aspire to recruit fellows from neighbouring Mediterranean countries.
SCMR Education Corner
Call for Abstracts
Submission Now Open
Submission Deadline is September 22, 2020
Online Educational Opportunities
Join us for the CMR Level I SCMR Workshop, as experts guide the participants through the fundamentals of CMR, reflecting on the added value of using CMR in clinical practice. This virtual experience will emphasize the clinical applications of CMR, with review of the appropriate use criteria and patients who might benefit most from the unique technology. Clinical cases will be used liberally throughout the course to emphasize key concepts. In addition to  Level I certification, participants will be eligible to claim CME, MOC, and ASRT credits for the time spent in the course. In addition, attendees will have access to eight (8) hours of on-demand content for 60 days. If you are unable to attend, this workshop, including the live sessions, will be available on-demand through SCMR's Online Learning Portal.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Society for Cardiovascular Magnetic Resonance and Sapienza, University of Rome. The Society for Cardiovascular Magnetic Resonance is accredited by the ACCME to provide continuing medical education for physicians.

The Society for Cardiovascular Magnetic Resonance (SCMR) designates this live activity for a maximum of 4.5  AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Click here for more information.
JCMR Journal Club

Wednesday, July 8 @ 11:00 am ET

Paper to be discussed:

Bandettini et. al

Journal Club Editor: Matthias Stuber

Presenting Authors: W. Patricia Bandettini and Adrienne Campbell
As featured in last month’s newsletter, the case-based webinar series that occurred through May & June was a huge success. Several received over 500 participants and feedback has been excellent. If you missed any or want to review in further detail, the full series is now available as online recordings open to all members in the SCMR Online Learning Portal . Please also review the blog for associated Q&As.  

Cardiac Sarcoidosis
Cardiac Amyloidosis
Cardiac Masses
CMR for Functionally Single Ventricle
CMR in Patients with Pacemakers/ ICD
CMR in Thoracic Vessels
HCM and Hypertrophic Phenotypes
Ischemic Heart Disease (IHD)
MINOCA: Positive Troponin, Negative Cath: What Now?
Non-ischemic Cardiomyopathy
The Right Heart
Valvular Heart Disease

The MRI Signal
Relaxation and Echoes
The MRI Hardware
K Space
Movies of the Beating Heart with CINE-MRI
Flow MRI using Phase Contrast
LGE Methods

Join Todd Villines MD, FACC & Chris Kramer MD, FACC on June 25 for a webinar looking at the current & emerging diagnostic role of CMR & CT in clinical cardiology. They will also review present training opportunities for both modalities.
SCMR Case of the Week
The Latest Cases
Number 20-03: Ventricular Tachycardia and Endocardial Fibroelastosis in Congenital Pulmonic Stenosis

A 24 year old male with a history of neonatal pulmonic stenosis requiring emergent valvotomy shortly after delivery presented for evaluation of palpitations and presyncope. A 12-lead electrocardiogram revealed sinus rhythm, right atrial abnormality, and diffuse nonspecific ST changes. Event monitoring revealed 105 seconds of sustained ventricular tachycardia associated with presyncope. 
Number 20-04: It's not ARVD!

A 20 year old man with past medical history of spontaneous left pneumothorax presented with atypical chest pain, palpitations and lightheadedness. His transthoracic echocardiogram (TTE) showed normal left ventricle ejection fraction (LVEF), with prominent right ventricle (RV) trabeculations with mildly reduced right ventricular function, and right ventricular dilation. 
SCMR Early Career Section
The Early Career (EC) Section is looking for interested SCMR members (cardiologist, radiologist, basic scientists and allied health professionals) in the early part of their CMR careers to apply. The section is dedicated to the professional advancement and development of early career and trainee physicians, scientists, researchers, and industry professionals. We aim to provide resources, mentorship, and specialized initiatives for CMR professionals in their early phase of their career. Please apply here.
Type of activities and projects will include:

  • Work together with the Membership Committee to specifically increase recruitment and retainment of EC members (nationally and internationally). Specific strategies include marketing, re-examining membership dues, FSCMR designation
  • Social media initiatives
  • Scientific Sessions planning for EC Section

  • Developing and executing mentorship programs at annual scientific sessions (one-on-one sessions, group sessions, etc) and long-term remote/virtual mentoring  
  • Development of “How to” tool kit for EC members
  • Leadership seminar for EC members

Publications :
  • Develop manuscripts e.g. “Challenges and opportunities for early career professional in CMR” & “How to kickstart CMR program”
  • Curate content for EC Section website (guidelines, important review/teaching papers and “how-to” content

  • Promote cardiology radiology collaboration and expand membership to all CMR EC professionals and thus promote the future of CMR
#WhyCMR | Social Media
June 1 to June 20
#WhyCMR Activity
by Pushpa Shivaram
Each month our social media committee correspondents update us on the latest #WhyCMR activity stats, most popular tweets or threads. Join the conversation and use the #WhyCMR in your social media posts!
JCMR Articles
CMR Literature Search
Please use this link for a filtered PubMed list of all CMR-related manuscripts for June 2020 – more than 180 in total!