Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance

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Title: Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance
Author(s): Le, T-T
Bryant, JA
Ting, AE
Ho, PY
Su, B
Teo, RCC
Gan, JS-J
Chung, Y-C
O'Regan, DP
Cook, SA
Chin, CW-L
Item Type: Journal Article
Abstract: Background Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes. Methods Free-breathing real-time CMR (1.5T Aera, Siemens) was performed in 11 athletes (5 males; median age 29 [IQR: 28–39] years) and 16 age- and sex-matched healthy volunteers (7 males; median age 26 [interquartile range (IQR): 25–33] years). All participants underwent an in-scanner exercise protocol on a CMR compatible cycle ergometer (Lode BV, the Netherlands), with an initial workload of 25W followed by 25W-increment every minute. In 20 individuals, exercise capacity was also evaluated by cardiopulmonary exercise test (CPET). Scan-rescan reproducibility was assessed in 10 individuals, at least 7 days apart. Results The exCMR protocol demonstrated excellent scan-rescan (cardiac index (CI): 0.2 ± 0.5L/min/m2) and inter-observer (ventricular volumes: 1.2 ± 5.3mL) reproducibility. CI derived from exCMR and CPET had excellent correlation (r = 0.83, p < 0.001) and agreement (1.7 ± 1.8L/min/m2). Despite similar values at rest (P = 0.87), athletes had increased exercise CI compared to healthy individuals (at peak exercise: 12.2 [IQR: 10.2–13.5] L/min/m2 versus 8.9 [IQR: 7.5–10.1] L/min/m2, respectively; P < 0.001). Peak exercise CI, where image acquisition lasted 13–17 s, outperformed that at rest (c-statistics = 0.95 [95% confidence interval: 0.87–1.00] versus 0.48 [95% confidence interval: 0.23–0.72], respectively; P < 0.0001 for comparison) in differentiating athletes from healthy volunteers; and had similar performance as VO2max (c-statistics = 0.84 [95% confidence interval = 0.62–1.00]; P = 0.29 for comparison). Conclusions We have developed a novel in-scanner exCMR protocol using real-time CMR that is highly reproducible. It may now be developed for clinical use for physiological studies of the heart and circulation.
Publication Date: 23-Jan-2017
Date of Acceptance: 6-Jan-2017
ISSN: 1532-429X
Publisher: BioMed Central
Journal / Book Title: Journal of Cardiovascular Magnetic Resonance
Volume: 19
Copyright Statement: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Radiology, Nuclear Medicine & Medical Imaging
Cardiovascular System & Cardiology
Cardiovascular magnetic resonance
Supine bike ergometer
Exercise physiology
Cardiopulmonary exercise test
Cardiopulmonary exercise test
Cardiovascular magnetic resonance
Exercise physiology
Supine bike ergometer
Nuclear Medicine & Medical Imaging
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Article Number: ARTN 7
Open Access location:
Appears in Collections:Clinical Sciences
Imaging Sciences
National Heart and Lung Institute

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