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Table 1 Characteristics and benefits of the varying exercise modalities used in exercise CMR

From: Exercise cardiovascular magnetic resonance: development, current utility and future applications

Exercise type

Treadmill

Upright cycle ergometer

Supine Cycle ergometer

Supine stepper ergometer

Prone exercise

Isometric Handgrip

Outside MR scanner

Inside MR scanner

Dynamic

Dynamic

Dynamic

Dynamic

Dynamic

Static

Common applications

Ischaemia testing

(Regional wall motion & perfusion)

Aortic/Pulmonary Flow

Ventricular volumes

Aortic/pulmonary flow

Ventricular volumes

Aortic/pulmonary flow

Spectroscopy

Spectroscopy

Coronary endothelial function

Max exercise intensitya

Maximal

Light

Maximal

Submaximal/ Vigorous

Light-Moderate

Very-light

Benefits

-Patients more readily achieve maximal intensity exercise

-Diagnostic 12 lead ECG performed during exercise

-Treadmill test provides separate prognostic data

- Maximal oxygen uptake during exercise on CMR adjacent treadmill feasible

-Most natural and tolerated form of exercise

Allows imaging during exercise

Allows imaging at multpile exercise levels

-Only modality with upright in-scanner exercise

-Less claustrophobia in open magnet scanner

-Can be performed to maximal exercise intensity in MR bore.

-Less leg restriction than cycle ergometer

 

-Stable stress heart rate

-Minimal movement

-No magnet bore restriction

Weaknesses

- Post stress imaging allows heart rate recovery before imaging

- Logistically difficult to image at multiple exercise intensities

Unable to perform 12 lead ECG or accurate ST segment monitoring during in-scanner exercise

-Uses open magnet scanner – low field strength (low SNR), limited availability, CMR feasible but non-standard.

-Only published in minimal studies to light intensity exercise.

-Cycling can be restricted by magnet bore diameter

- Lower intensity exercise than cycle ergometer

- Uncomfortable form of exercise

- Modest exercise feasible

- Logistically difficult to increase resistance

-Atypical form of exercise

- Limited increase in heart rate

  1. aHighest exercise intensity achieved in published research, with intensities defined by American College of sports medicines guidelines [32]. SNR = signal-to-noise ratio