{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T19:55:11Z","timestamp":1772654111364,"version":"3.50.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Contractile reserve assessment assesses myocardial performance and prognosis. The microstructural mechanisms that facilitate increased cardiac function have not been described, but can be studied using diffusion tensor cardiovascular magnetic resonance. Resting microstructural contractile function is characterized by reorientation of aggregated cardiomyocytes (sheetlets) from wall-parallel in diastole to a more wall-perpendicular configuration in systole, with the diffusion tensor cardiovascular magnetic resonance parameter E2A defining their orientation, and sheetlet mobility defining the angle through which they rotate. We used diffusion tensor cardiovascular magnetic resonance to identify the microstructural response to dobutamine stress in healthy volunteers and then compared with patients with recovered dilated cardiomyopathy (rDCM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In this first-of-its-kind prospective observational study, 20 healthy volunteers and 32 patients with rDCM underwent diffusion tensor cardiovascular magnetic resonance at rest, during dobutamine, and on recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      In healthy volunteers, both diastolic and systolic E2A increased with dobutamine stress (13\u00b13\u00b0 to 17\u00b15\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001 and 59\u00b111\u00b0 to 65\u00b17\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002). Sheetlet mobility remained unchanged (45\u00b111\u00b0 to 49\u00b110\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.19), but biphasic mean E2A increased (36\u00b16\u00b0 to 41\u00b14\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). In rDCM, diastolic E2A at rest was higher than in healthy volunteers (20\u00b18\u00b0 versus 13\u00b13\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), and sheetlet mobility was reduced (34\u00b112\u00b0 versus 45\u00b111\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). During dobutamine stress, rDCM diastolic and systolic E2A increased compared with rest (20\u00b18\u00b0 to 24\u00b110\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001 and 54\u00b113\u00b0 to 63\u00b111\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.005). However, sheetlet mobility in patients with rDCM failed to increase with dobutamine to healthy levels (39\u00b113\u00b0 versus 49\u00b110\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.005).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>This is the first report describing how the myocardial microstructure facilitates cardiac reserve. In health, sheetlet mobility moves further toward the wall-perpendicular plane to drive increased contractility, rather than increased magnitude of sheetlet mobility. Despite clinical recovery in patients with rDCM, microstructural function at rest and during dobutamine remains impaired. Further understanding of microstructural remodeling at rest and during stress may help refine risk stratification of patients with rDCM at risk of relapse.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.125.018226","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T10:00:15Z","timestamp":1765533615000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Diffusion Tensor CMR Assessment of the Microstructural Response to Dobutamine Stress in Health and Comparison With Patients With Recovered Dilated Cardiomyopathy"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0977-4796","authenticated-orcid":true,"given":"Zohya","family":"Khalique","sequence":"first","affiliation":[{"name":"Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."},{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7656-3123","authenticated-orcid":true,"given":"Andrew D.","family":"Scott","sequence":"additional","affiliation":[{"name":"Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."},{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0436-3496","authenticated-orcid":true,"given":"Pedro F.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."},{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0843-8026","authenticated-orcid":true,"given":"Maria","family":"Molto","sequence":"additional","affiliation":[{"name":"Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."},{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0412-2796","authenticated-orcid":true,"given":"Sonia","family":"Nielles-Vallespin","sequence":"additional","affiliation":[{"name":"Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."},{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5523-1314","authenticated-orcid":true,"given":"Dudley J.","family":"Pennell","sequence":"additional","affiliation":[{"name":"Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Part of Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, United Kingdom (Z.K., A.D.S., P.F.F., M.M., S.N.-V., D.J.P.)."},{"name":"National Heart and 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