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Isometric stress in cardiovascular magnetic resonance—a simple and easily replicable method of assessing cardiovascular differences not apparent at rest

Abstract

Introduction

Isometric exercise may unmask cardiovascular disease not evident at rest, and cardiovascular magnetic resonance (CMR) imaging is proven for comprehensive resting assessment. This study devised a simple isometric exercise CMR methodology and assessed the hemodynamic response evoked by isometric exercise.

Methods

A biceps isometric exercise technique was devised for CMR, and 75 healthy volunteers were assessed at rest, after 3-minute biceps exercise, and 5-minute of recovery using: 1) blood pressure (BP) and 2) CMR measured aortic flow and left ventricular function. Total peripheral resistance (SVR) and arterial compliance (TAC), cardiac output (CO), left ventricular volumes and function (ejection fraction, stroke volume, power output), blood pressure (BP), heart rate (HR), and rate pressure product were assessed at all time points.

Results

Image quality was preserved during stress. During exercise there were increases in CO (+14.9 %), HR (+17.0 %), SVR (+9.8 %), systolic BP (+22.4 %), diastolic BP (+25.4 %) and mean BP (+23.2 %). In addition, there were decreases in TAC (-22.0 %) and left ventricular ejection fraction (-6.3 %). Age and body mass index modified the evoked response, even when resting measures were similar.

Conclusions

Isometric exercise technique evokes a significant cardiovascular response in CMR, unmasking physiological differences that are not apparent at rest.

Key points

Isometric exercise unmasks cardiovascular differences not evident at rest.

CMR is the reference standard for non-invasive cardiovascular assessment at rest.

A new easily replicable method combines isometric exercise with CMR.

Significant haemodynamic changes occur and differences are unmasked.

The physiological, isometric CMR stressor can be easily replicated.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

LV:

Left ventricular

LVEDV:

Left ventricular end-diastolic volume

LVESV:

Left ventricular end-systolic volume

LVSV:

Left ventricular stroke volumes

CO:

Cardiac output

TPR:

Total peripheral resistance

TAC:

Total arterial compliance

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

MBP:

Mean blood pressure

PP:

Pulse pressure

RPP:

Rate pressure product

LVPO:

Left ventricular power output

BMI:

Body mass index

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Acknowledgments

We would like to thank Rod Jones, Wendy Norman and Anne Layther for their help with recruitment and imaging.

The scientific guarantor of this publication is Dr Vivek Muthurangu. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the British Heart Foundation. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects in this study.

Methodology: prospective, observational, performed at one institution.

Author information

Correspondence to Kristian H. Mortensen.

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Mortensen, K.H., Jones, A., Steeden, J.A. et al. Isometric stress in cardiovascular magnetic resonance—a simple and easily replicable method of assessing cardiovascular differences not apparent at rest. Eur Radiol 26, 1009–1017 (2016). https://doi.org/10.1007/s00330-015-3920-z

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Keywords

  • Magnetic resonance imaging
  • Cardiovascular physiological processes
  • Cardiac imaging technique
  • Isometric exercise
  • Exercise test