This week we review a recent CMR study assessing changes in myocardial fibrosis identified with CMR T1 mapping seen in TOF patients with a single nucleotide polymorphism (SNP) of hypoxia inducible factor 1 alpha. Is myocardial fibrosis in the TOF patient due to hemodynamic factors alone or are there genetic factors that predispose to differences that can be measured on CMR? Professor Lars Grosse-Wortmann of OHSU shares his deep insights into this fascinating topic in which our understanding is rapidly evolving. doi: 10.1016/j.ijcard.2021.12.047
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