Stukalova O.V.1,2, Beliaevskaia A.A.3, Ternovoy S.K.1,3


1 – E.I. Chazov National Medical Research Centre of Cardiology

2 – Russian Medical Academy of Continuing Professional Education

3 – I.M. Sechenov First Moscow State Medical University (Sechenov University).


urpose. To evaluate the diagnostic capabilities of the different techniques for studying the function of the left ventricle of the heart using a cine-MRI without breath-holding and ECG synchronization, as well as using a standard cine-MRI with repeated breath delays performed after administration of a contrast agent.

Materials and methods. The study included 43 patients with various diseases; the examination was performed on a 1.5 T MRI scanner. All patients underwent full examination according to the diagnosis and cine-MRI using standard methods before and after administration of a contrast agent and cine-MRI in “real-time” mode without ECG synchronization and holding the breath. For contrast enhancement, gadolinium-containing contrast agent was used (0.15 mmol/kg of patient weight). The quality of images and the number of artifacts in all three series of images were assessed using Bland-Altman plotting. The agreement between measurements was quantified using Lin's concordance correlation coefficient.

Results. Evaluation of image quality and artifacts showed statistically insignificant differences. When comparing the ejection fraction determined by obtaining images using cine-MRI with repeated breath-holds before and after the administration of a contrast agent, as well as without breath-holding and ECG synchronization, no significant differences were obtained between the indicators. When constructing Bland-Altman plots, it was revealed that the average difference in determining the left ventricular ejection fraction using cine-MRI before and after administration of a contrast agent was 0.68% (of the parameter value), the standard error of measurement was 0.24%. Lean's consistency correlation coefficient in this case was 0.95 (95% CI 0.91, 0.97).

When determining ejection fraction using cine-MRI with multiple breath-holds and without breath-holds and ECG synchronization, the average difference in determination was 0.7149, which is 0.13% of the parameter value, the standard measurement error was 0.42%. Lin's consistency correlation coefficient in this case was 0.80 (95% CI 0.65, 0.89).

Discussion. The assessment of image quality according to visual criteria in points using a special pulse sequence that does not require breath-holding and ECG synchronization, and a standard cine sequence with multiple breath-holds immediately after the administration of a contrast agent, was lower than the standard approach. However, quantitative analysis did not reveal significant differences in determining the main indicator of left ventricular performance - ejection fraction.

Conclusion. The use of scanning without holding breath and ECG synchronization to accelerate the study is applicable to heart research in clinical settings, allows obtaining data for an accurate quantitative assessment of LV function. Performing cine MRI to assess LV function not before, but after the administration of a contrast agent (in the pause required to obtain postcontrast images in the delayed phase) reduces the visual assessment of image quality, but does not significantly change the main indicator of LV function – the ejection fraction.



Keywords: cardiac magnetic resonance imaging, cine MRI, ejection fraction, acceleration of the study.


Corresponding author: Stukalova O.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript


For citation: Stukalova O.V., Beliaevskaia A.A., Ternovoy S.K. Assessment of left ventricular ejection fraction using cine-MRI without breath-holding and synchronization with ECG. REJR 2024; 14(1):89-97. DOI: 10.21569/2222-7415-2024-14-1-89-97.

Received:        20.12.23 Accepted:       12.02.24