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Reliability and reproducibility of cardiac MRI quantification of peak exercise function with long-axis views
Amy A Kirkham1, Michelle V Goonasekera1, Brenna C Mattiello2
1Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada.
Plos One
|February 4, 2021
Summary
Real-time, free-breathing cardiac magnetic resonance (CMR) using long-axis imaging reliably assesses exercise left ventricular function. This method is reproducible and enables evaluation of global longitudinal strain reserve.
Area of Science:
- Cardiovascular Imaging
- Magnetic Resonance Imaging
- Exercise Physiology
Background:
- Conventional cardiac magnetic resonance (CMR) for assessing exercise left ventricular (LV) function faces technical and logistical challenges.
- Breath-holding and electrocardiography-gating in standard short-axis (SAX) acquisitions limit dynamic functional assessments.
- Free-breathing, real-time CMR offers a potential solution for overcoming these limitations.
Purpose of the Study:
- To evaluate the reliability of a free-breathing, long-axis (LAX) CMR approach compared to standard SAX methods for assessing LV function.
- To assess the reproducibility of the free-breathing LAX technique at rest and during peak exercise.
- To compare global longitudinal strain (GLS) exercise reserve between women with cardiovascular risk factors and healthy controls.
Main Methods:
- 3T CMR cine images (SAX and LAX) were acquired in 32 women with cardiovascular risk factors under four conditions: resting breath-hold, resting free-breathing, test-retest free-breathing, and peak exercise free-breathing.
- Reliability and agreement were assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots.
- GLS reserve was also measured in 12 young, healthy controls.
Main Results:
- Free-breathing LAX CMR demonstrated good-to-excellent reliability (ICC = 0.80-0.96) for LV volumes and function at rest compared to SAX.
- Excellent reliability (ICC = 0.92-0.96) was observed between peak exercise free-breathing LAX and SAX evaluations.
- Reproducibility of free-breathing LAX was good-to-excellent (ICC = 0.74-0.99) at rest and peak exercise; however, higher heart rates slightly reduced cardiac output reliability (ICC = 0.67-0.79).
Conclusions:
- Real-time, free-breathing CMR with LAX imaging is a reliable and reproducible method for assessing cardiac function at rest and during peak exercise.
- This approach enables the assessment of global longitudinal strain (GLS) reserve, revealing impaired GLS in women with cardiovascular risk factors.
- Free-breathing LAX CMR overcomes limitations of conventional breath-hold techniques, offering a valuable tool for cardiovascular assessment.
