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CMR42 v5.6.2 is a comprehensive cardiovascular magnetic resonance (CMR) software suite developed by Circle Cardiovascular Imaging. It provides advanced tools for the analysis and visualization of CMR data. The software supports a range of CMR imaging techniques and enables quantitative assessment of cardiac function, perfusion, and tissue characterization.

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5 protocols using cmr42 v5

1

Quantification of Myocardial Strain and Infarct Size

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All strain parameters were quantified by two experienced observers blinded to all patient data. These analyses were carried out retrospectively using CVI (cmr42 v5.6.4, Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada). Tissue-Tracking was used to analyze LV myocardial strain from short-axis, two-chamber, three-chamber, and four-chamber cine images. Briefly, LV endocardial and epicardial borders were manually traced in the multi-plane, excluding the aorta and LV outflow tract at the end-diastolic phase (Claus et al., 2015 (link)). The software automatically tracks on-screen pixels during the cardiac cycle. The peak value of radial strain, circumferential strain, and longitudinal strain was set as the GRS, GCS, and GLS for statistical analysis, respectively (Figure 2).
LVEF was measured using the CVI short 3D module by drawing the endocardium and epicardium in the diastolic and systolic phases. Using the CVI Tissue char module calculated the infarct size by outlining infarct myocardium and normal myocardium (Figure 3). The infarct area was defined as five or more standard deviations (SD).
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2

Cardiac MRI Imaging Protocol for LV Quantification

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CMR imaging was performed using standardised acquisition protocols using a 1.5-T CMR system with a 32-channel cardiac phased array surface coil (Philips Healthcare, Best, The Netherlands) 15 . The standard clinical CMR study consisted of a stack of breath-hold short axis cine steadystate free precession slices covering the LV (slice thickness 8mm, in plane spatial resolution 448x448). These were acquired for quantification of left ventricular (LV) volumes, function and mass according to standardised post-processing methods 16 . An inversion-recovery gradientecho pulse sequence for LGE assessment was used to acquire a stack of short axis slices 15-20 minutes after contrast injection (Gadobutrol, Bayer-Schering Pharma, Berlin, Germany, 0.2mmol/kg body weight). Typical acquisition parameters for LGE imaging were TR/TE/turbo gradient factor of 3.5ms/2.0ms/25, enabling a temporal resolution of 88 ms.
LGE images were used to identify and measure the extent of ischaemic scar (percentage of total LV mass) and for texture analysis post-processing. To this purpose, a commercially available software package was used (CMR42, v5.6.4, Circle Cardiovascular Imaging, Calgary, Canada).
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3

Cardiac MRI Reader Experience Analysis

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All CMR analyses were performed by two level-3 trained CMR readers (with approximately 1 and 11 years of experience, respectively) using CMR42 v5.6.2 (Circle Cardiovascular Imaging, Inc., Calgary, Canada).
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4

Blinded CMR Analysis Protocol

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All CMR analyses were performed by a level-3 trained CMR reader on CMR42 v5.6.2 (Circle Cardiovascular Imaging, Inc., Calgary, Canada). The readers were blinded to the clinical data. The specific details related to the calculation of baseline EF, strain from feature-tracking, and infarct size are provided in the Methods section of the Supplement.
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5

Cardiac MRI Analysis by Trained Readers

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All CMR analyses were performed by a level-3 trained CMR reader (S.L. and T.R.) on CMR42 v5.6.2 (Circle Cardiovascular Imaging, Inc., Calgary, Canada). The readers were blinded to the clinical data.
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