· MRI is the most accurate modality for imaging ventricular function.

· The steady-state free precession (SSFP) technique provides excellent image contrast, coupled with high spatial and temporal resolution with short acquisition times.

· Techniques such as myocardial tagging and feature tracking may help in accurate detection of wall motion abnormalities.

· Global and regional ventricular systolic function assessment is used in assessment of participant risk and guiding medical therapy.

Physicians and MR technologists interested in learning about the methods and applications of the latest and advanced MR imaging techniques for systolic function assessment.To provide an understanding of systolic function assessment using MRI that goes beyond left ventricular ejection fraction. We will delve in detail on strain quantification for regional myocardial function assessment. The attendee will be able to definition the meaning of strain and understand how to interpret the different components of strain. Each topic will include acquisition methods, post-processing and analysis methods. We will finally end with examples of a few applications of systolic function assessment from MRI.

We will start off with a discussion on Left ventricular ejection fraction assessment. Aspects of image acquisition will be discussed. We will cover the acquisition of breath-hold segmented k-space spoiled gradient echo (GRE) and Steady-State Free Precession (SSFP) cine MRI –the current standard technique for cine imaging. The differences and the usefulness of SSFP and GRE imaging in various scenarios will be discussed. Free-breathing (FB) techniques – we will learn about the possibility of new techniques such as FB techniques employing radial acquisition and compressed sensing. Real-time imaging is useful when all else fails, when patients have difficulty in breath-holding procedures or when arrhythmias persist throughout the scan. A short overview of manual vs automated planimetry methods for quantification of cine MRI will be discussed. Quantification accuracy of MRI compared to other imaging modalities will be discussed. The next section will be devoted to the measurement of regional ventricular function from MRI, and looking beyond ejection fraction for systolic function assessment. We will start off with an introduction to strain imaging, by introducing the audience to the concept of myocardial strain. We will learn the most common representation of left ventricular myocardial strains and how they are measured, by looking at three most commonly measured strains– circumferential strain, longitudinal strain and radial strain. A brief introduction to torsion will be provided, of how to quantify torsion and what it signifies. We will then look at what are principal strains and how the direction of principal strains are associated with myofiber orientation. Finally, we will look at how to measure mechanical left ventricular dyssynchrony and what it signifies. After the description of parameters that are measure by myocardial strain imaging, we will look at some of the most commonly used methods. This will start with myocardial tagging - the basic principles underlying myocardial SPAMM (spatial modulation of magnetization) tagging acquisition will be explained. Tagged image post-processing – a few of the basic techniques for myocardial tagged image post-processing including phase-based (harmonic phase MRI), optical flow and template-matching techniques will be discussed. We will also look at how 3-dimensional strain can be estimated from 2-dimensional tagged images. A list of other MR methods such as displacement encoded stimulated echoes (DENSE), complementary SPAMM, and strain-encoded imaging (SENC) that may be of interest to the audience will be provided for interested audience for further reading. Feature tracking techniques – the latest methods looking at feature tracking of cine MRI for regional function assessment will be reviewed. These methods are simpler to implement than conventional tagged imaging and can be obtained from routinely obtained cine MRI for ejection fraction evaluation. The perceived advantages and disadvantages of this method as compared to myocardial tagging techniques will be discussed. We will also assess the comparison of assessments to other modalities – by highlighting the perceived advantages and disadvantages of MRI to other modalities such as echocardiography and computed tomography. The last section will discuss the applications of MRI based systolic function assessments. We will start of by looking at studies that provide normal reference ranges of systolic function and strain patterns in large populations using MRI. (a) Applications is assessment of viability - the application of regional and global function assessment in chronic and acute myocardial infarction for predicting functional recovery of the stunned myocardium in acute MI and post-revascularization recovery of remote and ischemic regions in chronic MI. (b) Applications in assessment of myocardial ischemia – the application of dobutamine stress MR and regional function assessment in coronary artery disease to detect silent myocardial ischemias. (c) We will discuss the usefulness of MRI derived systolic function in cardiac resynchronization therapy. (d) We will review some of the applications of systolic function assessment in non-ischemic cardiomyopathies – such as in muscular dystrophies, hypertrophic cardiomyopathy, and dilated cardiomyopathies. (e) Assessment in clinical trials – the use as an endpoint in clinical trials: a couple of examples will be provided of the use of MR-derived global and regional systolic function as an endpoint. (f) Other interesting observations from the Multi-ethnic Study of Atherosclerosis (MESA) – a large epidemiological study.