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Cardiac exercise imaging using a 3-tesla magnetic resonance-conditional pedal ergometer: Preliminary results in healthy volunteers and patients with known or suspected coronary artery disease
Affiliations- University Clinic of Radiology, Medical University of Innsbruck, Austria
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
- Rehabilitation and University Hospital Ulm, Department of Radiology and Neuroradiology, University Clinic of Ulm, Germany
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Abstract
Background: Cardiac magnetic resonance imaging (CMR) remains underutilized as an exercise
imaging modality, mostly because of the limited availability of MR-compatible exercise equipment. This
study prospectively evaluates the clinical feasibility of a newly developed MR-conditional pedal ergometer
for exercise CMR
Methods: Ten healthy volunteers (mean age 44 ± 16 years) and 11 patients (mean age 60 ± 9 years)
with known or suspected coronary artery disease (CAD) underwent rest and post-exercise cinematic 3T
CMR. Visual analysis of wall motion abnormalities (WMA) was rated by 2 experienced radiologists,
and volumes and ejection fractions (EF) were determined. Image quality was assessed by a 4-point
Likert scale for visibility of endocardial borders.
Results: Median subjective image quality of real-time cine at rest was 1 (interquartile range [IQR]
1–2) and 2 (IQR 2–2.5) for post-exercise real-time cine (p = 0.001). Exercise induced a significant increase
in heart rate (62 [62–73] to 111 [104–143] bpm, p < 0.0001). Stroke volume and cardiac index
increased from resting to post-exercise conditions (85 ± 21 to 101 ± 19 mL and 2.9 ± 0.7 to 6.6 ±
1.9 L/min/m2, respectively; both p < 0.0001), driven by a reduction in end-systolic volume (55 ± 20
to 42 ± 21 mL, p < 0.0001). Patients (2/11) with inducible regional WMA at high-resolution postexercise
cine imaging revealed significant coronary artery stenosis in subsequently performed invasive
coronary angiography.
Conclusions: Exercise-CMR using our newly developed 3T MR-conditional pedal ergometer is clinically
feasible. Imaging of both cardiac response and myocardial ischemia, triggered by dynamic stress,
is rapidly conducted while the patient is near their peak heart rate.
Abstract
Background: Cardiac magnetic resonance imaging (CMR) remains underutilized as an exercise
imaging modality, mostly because of the limited availability of MR-compatible exercise equipment. This
study prospectively evaluates the clinical feasibility of a newly developed MR-conditional pedal ergometer
for exercise CMR
Methods: Ten healthy volunteers (mean age 44 ± 16 years) and 11 patients (mean age 60 ± 9 years)
with known or suspected coronary artery disease (CAD) underwent rest and post-exercise cinematic 3T
CMR. Visual analysis of wall motion abnormalities (WMA) was rated by 2 experienced radiologists,
and volumes and ejection fractions (EF) were determined. Image quality was assessed by a 4-point
Likert scale for visibility of endocardial borders.
Results: Median subjective image quality of real-time cine at rest was 1 (interquartile range [IQR]
1–2) and 2 (IQR 2–2.5) for post-exercise real-time cine (p = 0.001). Exercise induced a significant increase
in heart rate (62 [62–73] to 111 [104–143] bpm, p < 0.0001). Stroke volume and cardiac index
increased from resting to post-exercise conditions (85 ± 21 to 101 ± 19 mL and 2.9 ± 0.7 to 6.6 ±
1.9 L/min/m2, respectively; both p < 0.0001), driven by a reduction in end-systolic volume (55 ± 20
to 42 ± 21 mL, p < 0.0001). Patients (2/11) with inducible regional WMA at high-resolution postexercise
cine imaging revealed significant coronary artery stenosis in subsequently performed invasive
coronary angiography.
Conclusions: Exercise-CMR using our newly developed 3T MR-conditional pedal ergometer is clinically
feasible. Imaging of both cardiac response and myocardial ischemia, triggered by dynamic stress,
is rapidly conducted while the patient is near their peak heart rate.
Keywords
feasibility study, cine magnetic resonance imaging, stroke volume, physiological stress, heart rate
About this articleTitle
Cardiac exercise imaging using a 3-tesla magnetic resonance-conditional pedal ergometer: Preliminary results in healthy volunteers and patients with known or suspected coronary artery disease
Journal
Issue
Article type
Original Article
Pages
276-285
Published online
2021-08-17
Page views
2791
Article views/downloads
660
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(2):276-285.
Keywords
feasibility study
cine magnetic resonance imaging
stroke volume
physiological stress
heart rate
Authors
Agnes Mayr
Gert Klug
Sebastian J. Reinstadler
Regina Esterhammer
Christian Kremser
Klemens Mairer
Bernhard Metzler
Michael F. Schocke
References (38)- Kwong RY, Ge Y, Steel K, et al. Cardiac magnetic resonance stress perfusion imaging for evaluation of patients with chest pain. J Am Coll Cardiol. 2019; 74(14): 1741–1755.
- Nagel E, Berry C, Nagel E, et al. MR-INFORM Investigators. Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease. N Engl J Med. 2019; 380(25): 2418–2428.
- Bourque JM, Beller GA. Value of exercise ECG for risk stratification in suspected or known CAD in the era of advanced imaging technologies. JACC Cardiovasc Imaging. 2015; 8(11): 1309–1321.
- Demir OM, Bashir A, Marshall K, et al. Comparison of clinical efficacy and cost of a cardiac imaging strategy versus a traditional exercise test strategy for the investigation of patients with suspected stable coronary artery disease. Am J Cardiol. 2015; 115(12): 1631–1635.
- Ferket BS, Genders TSS, Colkesen EB, et al. Systematic review of guidelines on imaging of asymptomatic coronary artery disease. J Am Coll Cardiol. 2011; 57(15): 1591–1600.
- Beaudry RI, Samuel TJ, Wang J, et al. Exercise cardiac magnetic resonance imaging: a feasibility study and meta-analysis. Am J Physiol Regul Integr Comp Physiol. 2018; 315(4): R638–R645.
- Foster EL, Arnold JW, Jekic M, et al. MR-compatible treadmill for exercise stress cardiac magnetic resonance imaging. Magn Reson Med. 2012; 67(3): 880–889.
- Jekic M, Foster EL, Ballinger MR, et al. Cardiac function and myocardial perfusion immediately following maximal treadmill exercise inside the MRI room. J Cardiovasc Magn Reson. 2008; 10: 3.
- Raman SV, Dickerson JA, Mazur W, et al. Diagnostic performance of treadmill exercise cardiac magnetic resonance: the prospective, multicenter exercise CMR's accuracy for cardiovascular stress testing (EXACT) trial. J Am Heart Assoc. 2016; 5(8).
- Sukpraphrute B, Drafts BC, Rerkpattanapipat P, et al. Prognostic utility of cardiovascular magnetic resonance upright maximal treadmill exercise testing. J Cardiovasc Magn Reson. 2015; 17: 103.
- Thavendiranathan P, Dickerson JA, Scandling D, et al. Comparison of treadmill exercise stress cardiac MRI to stress echocardiography in healthy volunteers for adequacy of left ventricular endocardial wall visualization: A pilot study. J Magn Reson Imaging. 2014; 39(5): 1146–1152.
- Lafountain RA, da Silveira JS, Varghese J, et al. Cardiopulmonary exercise testing in the MRI environment. Physiol Meas. 2016; 37(4): N11–N25.
- Gusso S, Salvador C, Hofman P, et al. Design and testing of an MRI-compatible cycle ergometer for non-invasive cardiac assessments during exercise. Biomed Eng Online. 2012; 11: 13.
- Heiberg J, Asschenfeldt B, Maagaard M, et al. Dynamic bicycle exercise to assess cardiac output at multiple exercise levels during magnetic resonance imaging. Clin Imaging. 2017; 46: 102–107.
- La Gerche A, Claessen G, Van de Bruaene A, et al. Cardiac MRI: a new gold standard for ventricular volume quantification during high-intensity exercise. Circ Cardiovasc Imaging. 2013; 6(2): 329–338.
- Le TT, Bryant JA, Ting AE, et al. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2017; 19(1): 7.
- Oosterhof T, Tulevski II, Roest AAW, et al. Disparity between dobutamine stress and physical exercise magnetic resonance imaging in patients with an intra-atrial correction for transposition of the great arteries. J Cardiovasc Magn Reson. 2005; 7(2): 383–389.
- Pflugi S, Roujol S, Akçakaya M, et al. Accelerated cardiac MR stress perfusion with radial sampling after physical exercise with an MR-compatible supine bicycle ergometer. Magn Reson Med. 2015; 74(2): 384–395.
- Steding-Ehrenborg K, Jablonowski R, Arvidsson PM, et al. Moderate intensity supine exercise causes decreased cardiac volumes and increased outer volume variations: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2013; 15: 96.
- Weber TF, von Tengg-Kobligk H, Kopp-Schneider A, et al. High-resolution phase-contrast MRI of aortic and pulmonary blood flow during rest and physical exercise using a MRI compatible bicycle ergometer. Eur J Radiol. 2011; 80(1): 103–108.
- Knuuti J, Wijns W, Saraste A, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407–477.
- Cheng ASH, Pegg TJ, Karamitsos TD, et al. Cardiovascular magnetic resonance perfusion imaging at 3-tesla for the detection of coronary artery disease: a comparison with 1.5-tesla. J Am Coll Cardiol. 2007; 49(25): 2440–2449.
- McGee KP, Debbins JP, Boskamp EdB, et al. Cardiac magnetic resonance parallel imaging at 3.0 Tesla: technical feasibility and advantages. J Magn Reson Imaging. 2004; 19(3): 291–297.
- Rajiah P, Bolen MA. Cardiovascular MR imaging at 3 T: opportunities, challenges, and solutions. Radiographics. 2014; 34(6): 1612–1635.
- Sievers B, Wiesner M, Kiria N, et al. Influence of the trigger technique on ventricular function measurements using 3-Tesla magnetic resonance imaging: comparison of ECG versus pulse wave triggering. Acta Radiol. 2011; 52(4): 385–392.
- Spicher N, Kukuk M, Maderwald S, et al. Initial evaluation of prospective cardiac triggering using photoplethysmography signals recorded with a video camera compared to pulse oximetry and electrocardiography at 7T MRI. Biomed Eng Online. 2016; 15(1): 126.
- Becker M, Frauenrath T, Hezel F, et al. Comparison of left ventricular function assessment using phonocardiogram- and electrocardiogram-triggered 2D SSFP CINE MR imaging at 1.5 T and 3.0 T. Eur Radiol. 2010; 20(6): 1344–1355.
- Frauenrath T, Hezel F, Renz W, et al. Acoustic cardiac triggering: a practical solution for synchronization and gating of cardiovascular magnetic resonance at 7 Tesla. J Cardiovasc Magn Reson. 2010; 12: 67.
- Kording F, Schoennagel B, Lund G, et al. Doppler ultrasound compared with electrocardiogram and pulse oximetry cardiac triggering: A pilot study. Magn Reson Med. 2015; 74(5): 1257–1265.
- Kording F, Yamamura J, Lund G, et al. Doppler ultrasound triggering for cardiovascular MRI at 3T in a healthy volunteer study. Magn Reson Med Sci. 2017; 16(2): 98–108.
- Zhang X, Xie G, Lu Na, et al. 3D self-gated cardiac cine imaging at 3 Tesla using stack-of-stars bSSFP with tiny golden angles and compressed sensing. Magn Reson Med. 2019; 81(5): 3234–3244.
- Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. 2007; 28(3): R1–39.
- Humphreys K, Ward T, Markham C. Noncontact simultaneous dual wavelength photoplethysmography: a further step toward noncontact pulse oximetry. Rev Sci Instrum. 2007; 78(4): 044304.
- Kamshilin AA, Nippolainen E, Sidorov IS, et al. A new look at the essence of the imaging photoplethysmography. Sci Rep. 2015; 5: 10494.
- Nelson RR, Gobel FL, Jorgensen CR, et al. Hemodynamic predictors of myocardial oxygen consumption during static and dynamic exercise. Circulation. 1974; 50(6): 1179–1189.
- Gusso S, Pinto T, Baldi JC, et al. Exercise training improves but does not normalize left ventricular systolic and diastolic function in adolescents with type 1 diabetes. Diabetes Care. 2017; 40(9): 1264–1272.
- Gusso S, Pinto TE, Baldi JC, et al. Diastolic function is reduced in adolescents with type 1 diabetes in response to exercise. Diabetes Care. 2012; 35(10): 2089–2094.
- Pinto TE, Gusso S, Hofman PL, et al. Systolic and diastolic abnormalities reduce the cardiac response to exercise in adolescents with type 2 diabetes. Diabetes Care. 2014; 37(5): 1439–1446.
