Imaging the adolescent heart

This information is useful for clinical practice and help in the differential diagnosis of cardiac diseases.

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Cardiovascular magnetic resonance (CMR) is an accurate method for determining the heart’s architecture, function, and tissue makeup. There aren’t many studies that provide CMR reference levels for adolescents, though.

A new study by the scientists at the Centro Nacional de Investigaciones Cardiovasculares (CNIC), aims to provide sex-specific CMR reference values for biventricular and atrial dimensions and function and myocardial relaxation times in this population.

Using MRI, scientists could accurately picture a healthy heart in adolescence. They also determined reference values for anatomical and functional parameters in the heart during adolescence.

CNIC General Director Dr. Valentín Fuster, a co-author on the study, said, Magnetic resonance imaging has become a very important method for studying the heart because it avoids exposing patients to radiation and provides more information, and with greater precision than ultrasound, currently the most frequently used cardiac imaging technique.”

“Nevertheless, most published MRI data from adolescent subjects come from patients with congenital heart defects or other conditions. As a result, there is a lack of knowledge about the ‘normal’ values of cardiac parameters in the general adolescent population.”

Lead study author Dr. Rodrigo Fernández-Jiménez said, “These reference values are essential for a proper interpretation of cardiac MRI studies in this population group.”

Atrial tracing in cardiovascular magnetic resonance cine sequences
Atrial tracing in cardiovascular magnetic resonance cine sequences. Representative 2-chamber (A, B, C) and 4-chamber (D, E, F) long-axis views. For the calculation of atrial function, the left atrium (LA) and right atrium (RA) were assessed in the maximum-volume, pre-contraction-volume, and minimum-volume phases. Credit: Centro Nacional de Investigaciones Cardiovasculares (CNIC)

The CNIC team specifically aimed to define these reference values. Amid the Covid-19 pandemic, the team was able to enlist 123 adolescents (64 girls and 59 boys) from 7 public secondary schools in the Comunidad de Madrid as participants in the EnIGMA project (Early ImaginG Markers of hazardous lifestyles in Adolescents). The schools and adolescents had already agreed to participate in the SI! Program for Secondary Schools, an initiative to encourage healthy lifestyle choices, is run by Fundación SHE- “la Caixa” in collaboration with the CNIC and the University of Barcelona.

First author Dr. Carlos Real, a CNIC investigator and a resident cardiologist at Hospital Clínico San Carlos, said, “The response of the participants and their families was incredible. Some of the schools are located more than 60 km from the city, and the participants and at least one parent or guardian visited the CNIC’s advanced imaging facility voluntarily. Without their willingness to participate, the project would not have been possible.”

Dr. Borja Ibáñez, CNIC Scientific Director and a co-author on the study, stressed that “the results have direct implications for clinical practice because they providde a list of reference values for multiple cardiac parameters used in daily practice, including measures of the size and functioning of the heart chambers (atria and ventricles) and cardiac tissue composition.”

Dr. Fernández-Jiménez concluded that “with this information, physicians at any center can determine if cardiac MRI data from an adolescent’s heart fall within the normal range for this age group, and prescribe closer follow-up and additional tests if needed.”

Journal Reference:

  1. Carlos Real, Rocío Párraga et al. Magnetic resonance imaging reference values for cardiac morphology, function and tissue composition in adolescents. EClinicalMedicine. DOI: 10.1016/j.eclinm.2023.101885