Dynamic bicycle exercise to assess cardiac output at multiple exercise levels during magnetic resonance imaging

Heiberg, Johan; Asschenfeldt, Benjamin; Maagaard, Marie; Ringgaard, Steffen

doi:10.1016/j.clinimag.2017.07.010

Cited by 16 publications

(20 citation statements)

References 25 publications

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“…Breath held images can be performed during exercise but are non-physiological and difficult at higher exercise intensities [ 29 ]. Imaging during free breathing can cause significant though plane motion, making obtaining reliable flow measurements difficult, with the pulmonary trunk especially challenging due to its short length before bifurcation [ 55 ]. ECG interference during exercise can create ghosting artefacts with gated images and as previously described, accurate 12 lead ECG monitoring with ST segment analysis cannot be performed during in-scanner exercise [ 29 , 30 , 52 ].…”

Section: Exercise Cmr – Methodology and Developmentmentioning

confidence: 99%

“…Studies by Aschenfeldt and Heiberg et al similarly used real time flow acquisition but with fast EPI and a half scan factor of 0.6, with analysis on in-house developed specialist software. The technique allowed aortic and pulmonary flow acquisition at numerous exercise levels and to 'true' submaximal intensity (> 85% age predicted maximum heart rate ), having being used to assess healthy subjects and patients with surgically repaired ventricular septal defects (VSD) [55,61]. Recently, ungated real time biventricular volume and aortic and pulmonary flows were performed during exercise to moderate exercise intensity in healthy subjects and patients with pulmonary arterial hypertension, the flow volumes acquired were similar to stroke volumes acquired from biventricular volumes [100].…”

Section: Flow Acquisitionmentioning

confidence: 99%

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Exercise cardiovascular magnetic resonance: development, current utility and future applications

Craven

Tsao

Gerche

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has developed over the past 25 years to combine the superior image qualities of CMR with the preferred method of exercise stress. Presently, numerous exercise methods exist, from performing stress on an adjacent CMR compatible treadmill to in-scanner exercise, most commonly on a supine cycle ergometer. Cardiac conditions studied by Ex-CMR are broad, commonly investigating ischaemic heart disease and congenital heart disease but extending to pulmonary hypertension and diabetic heart disease. This review presents an in-depth assessment of the various Ex-CMR stress methods and the varied pulse sequence approaches, including those specially designed for Ex-CMR. Current and future developments in image acquisition are highlighted, and will likely lead to a much greater clinical use of Ex-CMR across a range of cardiovascular conditions.

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Section: Exercise Cmr – Methodology and Developmentmentioning

confidence: 99%

Section: Flow Acquisitionmentioning

confidence: 99%

Exercise cardiovascular magnetic resonance: development, current utility and future applications

Craven

Tsao

Gerche

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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show abstract

“…2). Aortic PCMR sequences used a − 3 mm gap (thus the centre of the slices are spaced 5 mm apart) and the pulmonary flows had − 5 mm gap (thus the centre of the slices are spaced 3 mm apart).The increased overlap of the pulmonary PCMR sequences was to accommodate for the short length of the main pulmonary artery prior to bifurcation, which has led to difficulty performing pulmonary PCMR in previous Ex-CMR studies [24].…”

Section: Cmr Imaging Parametersmentioning

confidence: 99%

Exercise cardiovascular magnetic resonance: feasibility and development of biventricular function and great vessel flow assessment, during continuous exercise accelerated by Compressed SENSE: preliminary results in healthy volunteers

Craven

Jex

Chew

et al. 2020

Int J Cardiovasc Imaging

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Purpose Exercise cardiovascular magnetic resonance (Ex-CMR) typically requires complex post-processing or transient exercise cessation, decreasing clinical utility. We aimed to demonstrate the feasibility of assessing biventricular volumes and great vessel flow during continuous in-scanner Ex-CMR, using vendor provided Compressed SENSE (C-SENSE) sequences and commercial analysis software (Cvi42). Methods 12 healthy volunteers (8-male, age: 35 ± 9 years) underwent continuous supine cycle ergometer (Lode-BV) Ex-CMR (1.5T Philips, Ingenia). Free-breathing, respiratory navigated C-SENSE short-axis cines and aortic/pulmonary phase contrast magnetic resonance (PCMR) sequences were validated against clinical sequences at rest and used during low and moderate intensity Ex-CMR. Optimal PCMR C-SENSE acceleration, C-SENSE-3 (CS3) vs C-SENSE-6 (CS6), was further investigated by image quality scoring. Intra-and inter-operator reproducibility of biventricular and flow indices was performed. Results All CS3 PCMR image quality scores were superior (p < 0.05) to CS6 sequences, except pulmonary PCMR at moderate exercise. Resting stroke volumes from clinical PCMR sequences correlated stronger with CS3 than CS6 sequences. Resting biventricular volumes from CS3 and clinical sequences correlated very strongly (r > 0.93). During Ex-CMR, biventricular end-diastolic volumes (EDV) remained unchanged, except right-ventricular EDV decreasing at moderate exercise. Biventricular ejection-fractions increased at each stage. Exercise biventricular cine and PCMR stroke volumes correlated very strongly (r ≥ 0.9), demonstrating internal validity. Intra-observer reproducibility was excellent, co-efficient of variance (COV) < 10%. Inter-observer reproducibility was excellent, except for resting right-ventricular, and exercise bi-ventricular end-systolic volumes which were good (COV 10–20%). Conclusion Biventricular function, aortic and pulmonary flow assessment during continuous Ex-CMR using CS3 sequences is feasible, reproducible and analysable using commercially available software.

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“…However, phasecontrast quantification is very dependent upon maintaining a stationary imaging plane and the respiratory translation and whole body movement during exercise can result in considerable error. Nevertheless, some groups have shown that this technique is feasible (118)(119)(120)(121), and have demonstrated high correlations for exercise SV (R = 0.988) measured using realtime phase-contrast quantification and real-time assessment LV volumes (122).…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview

Foulkes

Claessen

Howden

et al. 2020

Front. Cardiovasc. Med.

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Dynamic bicycle exercise to assess cardiac output at multiple exercise levels during magnetic resonance imaging

Cited by 16 publications

References 25 publications

Exercise cardiovascular magnetic resonance: development, current utility and future applications

Exercise cardiovascular magnetic resonance: development, current utility and future applications

Exercise cardiovascular magnetic resonance: feasibility and development of biventricular function and great vessel flow assessment, during continuous exercise accelerated by Compressed SENSE: preliminary results in healthy volunteers

The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview

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