Standard breath-hold versus free-breathing real-time cine cardiac MRI—a prospective randomized comparison in patients with known or suspected cardiac disease

Aims: Cardiovascular magnetic resonance (CMR) is established as the reference standard for cardiac volumetric assessment. Despite the accuracy and robustness of steady-state free precession (SSFP) cine imaging, its use may prove challenging in patients with arrhythmia and in those who cannot perform repeated breath holds. An alternative solution may be a free-breathing electrocardiogram (ECG)-triggered, retro-gated, real-time cine sequence. This study sought to compare left ventricular volumetric, wall motion, and thickness assessment with both techniques. Methods and results: Consecutive patients with known or suspected cardiac disease referred for clinical CMR were studied at 3-Tesla. Participants underwent short-axis standard SSFP and real-time cine imaging in a randomized order within the same scan. Between sequence agreement and mean difference were compared for end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume, ejection fraction (EF), left ventricular mass (LVM), maximal wall thickness (MWT), and wall motion score index (WMSi). Two hundred and two patients (mean age 61 ± 14 years, 51% male and 14% irregular rhythm) were studied. All left ventricular indices showed good-excellent agreement between the two methods intraclass correlation coefficient (95% confidence interval), EDV 0.96 (0.95-0.97), ESV 0.96 (0.94-0.97), EF 0.85 (0.81-0.88), LVM 0.93 (0.91-0.95), MWT 0.80 (0.75-0.85), and WMSi 0.93 (0.91-0.95). Conclusion: In patients with known or suspected cardiac disease, real-time cine imaging demonstrates good-excellent reproducibility of LV volumetric, wall thickness and resting wall motion assessment when compared with standard SSFP (Trial registration: NCT05221853).