Key result
Free-breathing real-time cine imaging shows excellent agreement with standard SSFP for left ventricular indices.
Why the study?
Standard SSFP CMR cine imaging is challenging in patients with arrhythmia or inability to perform repeated breath holds, suggesting free-breathing real-time cine as a potential alternative.
Does free-breathing real-time cine MRI provide comparable left ventricular assessment to standard breath-hold SSFP cine MRI in patients with known or suspected cardiac disease?
RCT (n=202)
Randomized order
Does free-breathing real-time cine MRI provide comparable left ventricular assessment to standard breath-hold SSFP cine MRI in patients with known or suspected cardiac disease?
Free-breathing real-time cine MRI provides comparable left ventricular volumetric and functional assessment to standard breath-hold SSFP, offering a robust alternative for patients with arrhythmias or breath-holding difficulties.
Supports free-breathing real-time cine as alternative in breath-hold intolerant patients; extends RCT validation of real-time sequences for LV assessment.
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).
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Elshibly et al. (2025) conducted an RCT in Known or suspected cardiac disease (n=202). Free-breathing real-time cine imaging vs. Standard breath-hold SSFP cine imaging was evaluated on Between sequence agreement for left ventricular volumetric, wall motion, and thickness assessment (ICC 0.96 for EDV, 95% CI 0.95-0.97). Free-breathing real-time cine imaging demonstrated good-to-excellent agreement with standard SSFP for left ventricular indices, including EDV (ICC 0.96; 95% CI 0.95-0.97) and EF (ICC 0.85).
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