{
  "abstract": "Introduction Cardiopulmonary exercise testing (CPET) is the clinical gold standard for assessing exercise capacity but cannot distinguish whether reduced oxygen uptake (VO 2) reflects impaired cardiac output or peripheral oxygen extraction. Advances in real-time cardiovascular magnetic resonance (CMR) acquisition and MR-compatible ergometry have raised the possibility of simultaneous CMR and cardiopulmonary exercise testing (CMR-CPET); the feasibility, methodological consistency, and data quality of this technique have not been systematically evaluated.Methods We performed a systematic review of human studies integrating supine, within-bore CPET with CMR. Searches were conducted across MEDLINE, Embase, Cochrane CENTRAL, and conference proceedings to 2020 and screened was completed by two independent reviewers. Eligible studies screened included any age group and disease population provided supine, within-bore CPET was performed with concurrent CMR. Data were synthesised descriptively, focusing on technical approaches and primary outcomes including peak VO 2, exercise cardiac output, stroke volume responses, peripheral oxygen extraction (a-vO2 or SvO2), and feasibility metrics such as completion rate and image quality. Risk of bias was assessed using an adapted observational framework.Results Seven studies comprising 249 participants were included ( figure 1, table 1), spanning healthy controls (HC) and patient cohorts, MR-compatible ergometers and real-time, free-breathing MRI acquisitions. Completion rates were high (approximately 90–100%), image acquisition was successful, and no serious adverse events were reported. Across studies, image quality was assessed using pragmatic feasibility criteria, including successful acquisition and segmentation of flow and ventricular volume data during exercise, with formal reproducibility metrics reported in studies specifically designed to assess repeatability. Multiple studies reported significant between-group differences in peak VO2, cardiac index, and a-vO2 compared with healthy controls, alongside strong correlations or agreement between MRI-derived and conventional physiological measures, supporting physiological validity. Across healthy control cohorts, expected rest-to-peak increases in VO2, cardiac output, and oxygen extraction were observed, providing an internal physiological reference. In contrast, peak VO2 during supine, in-magnet CPET was reduced in patient cohorts, with CMR-CPET distinguishing impaired cardiac output or stroke volume augmentation from attenuated peripheral oxygen extraction (table 2).Conclusions CMR-CPET is a feasible and technically robust method for integrated assessment of exercise physiology. Consistent methodology and reproducible physiological responses suggest progression beyond proof-of-concept.References Barber NJ, Ako EO, Kowalik GT, et al. MR augmented cardiopulmonary exercise testing—a novel approach to assessing cardiovascular function. Physiol Meas. 2015;36(5):N85–N98. doi:10.1088/0967-3334/36/5/N85 Barber NJ, Ako EO, Kowalik GT, et al. Magnetic resonance–augmented cardiopulmonary exercise testing comprehensively assessing exercise intolerance in children with cardiovascular disease. Circ Cardiovasc Imaging. 2016;9(10):e005282. doi:10.1161/CIRCIMAGING.116.005282 Brown AJ, Ranjit A, Shafiq A, et al. Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance–augmented cardiopulmonary exercise study. J Cardiovasc Magn Reson. 2021;23:81. doi:10.1186/s12968-021-00817-1 Brown AJ, Ranjit A, Shafiq A, et al. Ongoing exercise intolerance following COVID-19: a magnetic resonance–augmented cardiopulmonary exercise test study. J Am Heart Assoc. 2022;11(3):e024207. doi:10.1161/JAHA.121.024207 Canada JM, Trankle CR, Buckley LF, et al. Simultaneous exercise stress cardiac magnetic resonance and cardiopulmonary exercise testing to elucidate the Fick components of aerobic exercise capacity: a feasibility and reproducibility study and pilot study in hematologic cancer survivors. Cardio-Oncology. 2023;9:10. doi:10.1186/s40959-023-00182-1 Brown AJ, Ranjit A, Shafiq A, et al. Prognostic utility of exercise cardiovascular magnetic resonance in patients with systemic sclerosis–associated pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging. 2024;20(12):1712–1723. doi:10.1093/ehjci/jeae177 Skow RJ, Hodges GJ, Tarnopolsky MA, et al. Validation of magnetic resonance imaging–derived venous oxygen saturation and oxygen consumption measurements during exercise. Am J Physiol Heart Circ Physiol. 2020;328(2):H345–H357. doi:10.1152/ajpheart.00567.2024 Abstract 180 Table 1Study characteristics. Abbreviations: HC= Healthy Controls; PAH = pulmonary arterial hypertension; ToF = Tetralogy of Fallot; SSc = systemic sclerosis; IPAH = idiopathic pulmonary arterial hypertension; CTEPH = chronic thromboembolic pulmonary hypertension; COVID-reduced = individuals with self-reported reduced exercise capacity following SARS-CoV-2 infection; COVID-normal = individuals with preserved exercise capacity following SARS-CoV-2 infectionAuthor Country Sample Size Sex (F/M) Ergometer Exercise Protocol MRI Population Barber et al. 20151 UK1717/12CycleStep1.5 THCBarber et al. 20162UK3017/13CycleStep1.5 THCl, PAH, ToFBrown et al. 20213UK6045/15CycleStep1.5 TSSc–PAH, non–SSc IPAH, CTEPH, HCBrown et al. 20224UK6034/26CycleStep1.5 TCOVID-reduced, COVID-normal, HCCanada et al. 20235USA167/16CycleStep3 THC, haematological cancer survivorsBrown et al. 20246UK5048/2CycleStep1.5 TSSc–PAHSkow et al. 20207Canada2019/15StepperRamp3 THCAbstract 180 Table 2Resting and peak exercise physiological responses measured during simultaneous cardiovascular magnetic resonance and cardiopulmonary exercise testing (CMR-CPET) across patient cohorts. Values are reported as mean ± SD or median (interquartile range) as presented in the original publications. Unless otherwise stated, oxygen uptake (VO2) is normalised to body mass (mL•kg−1•min−1), cardiac output is reported as cardiac index (L•min−1•m−2), and arteriovenous oxygen difference (a-vO2) is expressed as mL O2 per 100 mL of blood. Where studies reported alternative units, these are indicated in the table footnotes. Abbreviations: VO2 = oxygen uptake; CO = cardiac output; CI = cardiac index; a-vO2 = arteriovenous oxygen difference; PAH = pulmonary arterial hypertension; ToF = tetralogy of fallot; SSc = systemic sclerosis; IPAH = idiopathic pulmonary arterial hypertension; CTEPH = chronic thromboembolic pulmonary hypertension Population Rest VO2 Peak VO2 Rest CO or CI Peak CO or CI Rest a-vO2 Peak a-vO2 Barber et al. 20162Paediatric PAH4.32 ± 1.1812.6 ± 1.314.5 ± 1.15.9 ± 1.13.0 ± 0.346.9 ± 1.3 Paediatric ToF4.24 ± 1.1713.5 ± 1.293.0 ± 1.25.3 ± 1.24.7 ± 1.28.7 ± 1.5Brown et al. 20213SSc-associated PAH3.3 (2.6–4.7)14.2 (7.6–26.2)3.1 ± 0.75.5 ±1.24.3 (2.3–6.7)10.3 (4.6–11.8) non–SSc IPAH3.4 (2.9–5.0)9.2 (5.2–15.7)3.0 ±0.84.2 ± 14.3 (3.3–9.2)7.7 (6.1–12.9) CTEPH3.1 (1.7–5.3)10.8 (6.9–19.9)3.0 ±0.74.3 ±1.14.4 (3.0–6.6)10.9 (6.9–17.5)Brown et al. 20224COVID-reduced3.1 ± 0.814.9 (13.1–16.2)2.5 (2.3–3.0)4.7 ± 1.24.8 ± 1.213.5 ± 3.4 COVID-normal3.6 ± 0.719.1 (15.4–23.7)2.9 (2.4–3.2)5.7 ± 1.55.1 ± 0.913.8 ± 2.8Canada et al. 20235†Cancer survivors0.156 (0.136–0.204)1.07 (0.74–1.20)3.09 (2.8-3.29)5.0 (4.7-6.3)4.9 (4.7–6.8)14.4 (11.8–16.9)Brown et al. 20246SSc-PAH3.4 (3.0-4.0)9.7 +/- 1.83.1 +/- 0.84.1 +/- 1.14.2 (3.9-5.0)8.7 (7.5-10.9)† Canada et al. report VO2 in L·min−1·m−2 and a-vO2 in mL O2·dL−1.Abstract 180 Figure 1PRISMA flow diagram demonstrating study selection and exclusion",
  "authors": [
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom"
      ],
      "name": "Jhiamluka Solano"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom"
      ],
      "name": "Jordan J McGing"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom"
      ],
      "name": "Aaron Henry"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom"
      ],
      "name": "Jennifer J Rayner"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom",
        "Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia"
      ],
      "name": "Ladislav Valkovič"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom"
      ],
      "name": "Oliver J Rider"
    }
  ],
  "title": "180 Feasibility and physiological scope of simultaneous cardiac MRI and cardiopulmonary exercise testing: a systematic review",
  "uid": "405b3285-e970-5bd0-b58b-13d6de3d4829"
}