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Updated: Sep 27, 2026

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Impaired myocardial oxygen metabolism and energy efficiency in patients with dilated cardiomyopathy
Liya Dai1, Jinhan Qiao2, Keyan Wang2
1Zhejiang Key Laboratory of Imaging and Interventional Medicine, Zhejiang Engineering Research Center of Interventional Medicine Engineering and Biotechnology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China; Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA.
Background:
Myocardial oxygen metabolism and mechano-energetic efficiency are key determinants of cardiac function and clinical outcomes, but their status in dilated cardiomyopathy (DCM) remains incompletely understood. This study applied a non-contrast cardiovascular magnetic resonance (CMR) technique to assess myocardial oxygenation, cardiac work, and energy efficiency in DCM.
Methods:
We enrolled 49 DCM patients and 23 age- and sex- matched controls. All subjects underwent cine CMR imaging for left ventricular ejection fraction (LVEF) and global longitudinal strain (LVGLS), pre- and post-contrast T1 mapping for extracellular volume (ECV), and first-pass perfusion imaging for semi-quantification of myocardial blood flow (MBF). A non-contrast CMR technique was applied to quantify myocardial oxygen extraction fraction (mOEF). Semi-quantitative myocardial oxygen consumption (MVO₂), external work (EW), and myocardial external efficiency (MEE) were derived for analysis.
Results:
Compared with controls, DCM patients exhibited significantly lower mOEF (50.3 [47.9, 53.9] % vs. 57.6 [56.2, 60.4] %, p < 0.001), MVO2 per gram tissue (0.07 ± 0.01 vs. 0.08 ± 0.01, p = 0.027), EW (248.38 ± 97.87 vs. 341.88 ± 86.98mmHg×mL/min×103, p < 0.001), and MEE (22.88 ± 10.62% vs. 45.95 ± 10.53%, p < 0.001), but higher total MVO₂ (7.99 ± 2.58 vs. 5.30 ± 1.48, p < 0.001). Resting mOEF showed no significant association with LVEF and LVGLS, whereas total MVO₂ and MEE correlated significantly with both LVEF and LVGLS. Female DCM patients exhibited higher LVEF (31.30 ± 10.18% vs. 22.47 ± 9.74%, p = 0.006), absolute LVGLS (9.81 ± 3.55% vs. 7.24 ± 2.86%, p = 0.011) and MEE (27.29 ± 11.87% vs. 20.74 ± 9.43%, p = 0.049) compared with males.
Conclusion:
This feasibility study demonstrates the potential of this non-contrast CMR technique for noninvasive assessment of myocardial oxygen metabolism and mechano-energetic coupling in DCM. Patients with DCM showed impaired resting myocardial oxygen metabolism and reduced energy efficiency.
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