PREFER-CMR RegistryThe PREFER-CMR registry is a novel and innovative research project that aims to investigate the potential of four-dimensional (4D) flow cardiac magnetic resonance (CMR) imaging in various clinical scenarios. 4D flow CMR is a cutting-edge technique that allows the visualization and quantification of blood flow patterns and velocities in the heart and great vessels, providing valuable information about cardiac function and hemodynamics. The PREFER-CMR registry is one of the only 4D flow CMR registries in the world, and the largest one in terms of recruitment and diversity of cardiovascular conditions.
The PREFER-CMR registry is based at the Norfolk and Norwich University Hospitals, where 4D flow CMR is routinely performed as part of the standard CMR protocol for any patient who has a clinical indication for CMR. This unique set-up enables the registry to capture a wide range of cardiovascular disease conditions, such as valvular heart disease, congenital heart disease, cardiomyopathies, coronary artery disease, and aortic disease. The registry also includes healthy controls who undergo CMR for screening or research purposes. The registry is expanding at a rapid rate of 100 participants per month, and has already recruited more than 800 patients/controls since its inception in 2022. The PREFER-CMR registry follows an opt-out ethics approach, where patients and controls are well informed prior to taking part in research about the registry’s protocol and research methods. This information is communicated when the participant receives an appointment letter for their CMR scan, and includes a leaflet explaining the purpose, benefits, and risks of 4D flow CMR, as well as a contact number for any queries or concerns. Participants are also given the opportunity to opt out of the research at any time, either before, during, or after their CMR scan, without affecting their clinical care or future research participation. The opt-out ethics approach ensures that the registry is inclusive, respectful, and transparent. This data-bank has huge potential for the following: 1. Case controlled studies 2. Case reports - we have always got cases which need written up! 3. Mechanistic studies and deep phenotyping of cardiovascular flow in different disease states 
Video 1. This video demonstrates transvalvular flow across all four valves for the same averaged cardiac cycle. Quantification of trans-valvular flow for the same cardiac cycle for all 4 valves is only possible by 4D flow CMR techniques. We are building these techniques with our industry and research partners across the globe.
Phenotyping HFpEFIs HFpEF solely a disease of the myocardium?
Healthy aortic flow
Aortic flow in HFpEF
Unlocking the Power of Heart MRI: Predicting Heart Failure and Cardiovascular Events in general populationIn our latest study, published in ESC Heart Failure, we dive into the world of cardiovascular magnetic resonance (CMR) imaging to explore its potential in predicting heart failure (HF) and major adverse cardiovascular events (MACE) through the measurement of Pulmonary Capillary Wedge Pressure (PCWP). This study is one of the largest of its kind, drawing insights from over 39,000 participants in the UK Biobank, offering ground-breaking revelations that could reshape clinical practices.
The Objective: Why We Did It Cardiovascular disease remains a leading cause of morbidity and mortality worldwide. Accurate, non-invasive predictors are crucial for early intervention and improved patient outcomes. This study aimed to investigate whether CMR-modelled PCWP could serve as a reliable predictor of heart failure and other major cardiovascular events on a population level. The Methods: How We Did It We utilized advanced CMR imaging data from a vast cohort of 39,163 participants, incorporating variables such as left atrial volume, left ventricular mass, and sex into our models. Logistic regression and Cox regression analyses were employed to evaluate the relationship between traditional cardiovascular risk factors and CMR-modelled PCWP, focusing particularly on its predictive value for HF and MACE. The Results: What We Found Our findings reveal that raised CMR-modeled PCWP is a significant independent predictor of both heart failure (with a hazard ratio [HR] of 2.91) and MACE (HR 1.48). These results underscore the potential of CMR-modeled PCWP as a critical metric in assessing cardiovascular risk. Additionally, we identified other key factors associated with elevated CMR-modeled PCWP, including hypertension, higher body mass index (BMI), older age, male sex, and regular alcohol consumption. The Conclusion: Why It Matters This study highlights the importance of incorporating CMR-modeled PCWP into routine cardiovascular assessments. By doing so, clinicians can better identify patients at high risk for heart failure and major cardiovascular events, allowing for earlier and more targeted interventions. As cardiovascular disease continues to pose a global health challenge, our research provides a powerful tool in the fight against heart failure. The inclusion of CMR-modeled PCWP in clinical practice could lead to more personalized and effective patient care, ultimately improving outcomes for millions. Looking Forward Our team is excited about the implications of these findings and the potential they hold for enhancing patient care. We look forward to further research and collaboration in this area, aiming to refine and expand the use of CMR imaging in cardiovascular risk assessment. Stay tuned for more updates, and feel free to reach out with your thoughts and questions about this exciting study! More information: Ross J. Thomson et al, Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: Prognostic insights, ESC Heart Failure (2024). DOI: 10.1002/ehf2.15011
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