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.
Similar content being viewed by others
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
References
Balady GJ, Arena R, Sietsema K et al (2010) Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 122:191–225
Pennell DJ, Underwood SR, Manzara CC et al (1992) Magnetic resonance imaging during dobutamine stress in coronary artery disease. Am J Cardiol 70:34–40
Pedersen EM, Kozerke S, Ringgaard S, Scheidegger MB, Boesiger P (1999) Quantitative abdominal aortic flow measurements at controlled levels of ergometer exercise. Magn Reson Imaging 17:489–494
Lurz P, Muthurangu V, Schuler PK et al (2012) Impact of reduction in right ventricular pressure and/or volume overload by percutaneous pulmonary valve implantation on biventricular response to exercise: an exercise stress real-time CMR study. Eur Heart J 33:2434–2441
Pedersen LM, Pedersen TA, Pedersen EM, Hojmyr H, Emmertsen K, Hjortdal VE (2010) Blood flow measured by magnetic resonance imaging at rest and exercise after surgical bypass of aortic arch obstruction. Eur J Cardiothorac Surg 37:658–661
Price TB, Kennan RP, Gore JC (1998) Isometric and dynamic exercise studied with echo planar magnetic resonance imaging (MRI). Med Sci Sports Exerc 30:1374–1380
Laird WP, Fixler DE, Huffines FD (1979) Cardiovascular response to isometric exercise in normal adolescents. Circulation 59:651–654
Osranek M, Eisenach JH, Khandheria BK, Chandrasekaran K, Seward JB, Belohlavek M (2008) Arterioventricular coupling and ventricular efficiency after antihypertensive therapy: a noninvasive prospective study. Hypertension 51:275–281
Betim Paes Leme AM, Salemi VM, Weiss RG et al (2013) Exercise-induced decrease in myocardial high-energy phosphate metabolites in patients with Chagas heart disease. J Card Fail 19:454–460
Gonzalez M, de Champlain J, Lebeau R, Giorgi C, Nadeau R (1989) Sympatho-adrenal and cardiovascular responses during hand-grip in human hypertension. Clin Invest Med 12:115–120
von Knobelsdorff-Brenkenhoff F, Dieringer MA, Fuchs K, Hezel F, Niendorf T, Schulz-Menger J (2013) Isometric handgrip exercise during cardiovascular magnetic resonance imaging: set-up and cardiovascular effects. J Magn Reson Imaging 37:1342–1350
Hays AG, Hirsch GA, Kelle S, Gerstenblith G, Weiss RG, Stuber M (2010) Noninvasive visualization of coronary artery endothelial function in healthy subjects and in patients with coronary artery disease. J Am Coll Cardiol 56:1657–1665
Hays AG, Stuber M, Hirsch GA et al (2013) Non-invasive detection of coronary endothelial response to sequential handgrip exercise in coronary artery disease patients and healthy adults. PLoS One 8(3):e58047
Steeden JA, Atkinson D, Taylor AM, Muthurangu V (2010) Assessing vascular response to exercise using a combination of real-time spiral phase contrast MR and noninvasive blood pressure measurements. J Magn Reson Imaging 31:997–1003
Lurz P, Muthurangu V, Schievano S et al (2009) Feasibility and reproducibility of biventricular volumetric assessment of cardiac function during exercise using real-time radial k-t SENSE magnetic resonance imaging. J Magn Reson Imaging 29:1062–1070
Muthurangu V, Lurz P, Critchely JD, Deanfield JE, Taylor AM, Hansen MS (2008) Real-time assessment of right and left ventricular volumes and function in patients with congenital heart disease by using high spatiotemporal resolution radial k-t SENSE. Radiology 248:782–791
Steinier J, Termonia Y, Deltour J (1972) Smoothing and differentiation of data by simplified least square procedure. Anal Chem 44:1906–1909
Jones A, Steeden JA, Pruessner JC, Deanfield JE, Taylor AM, Muthurangu V (2011) Detailed assessment of the hemodynamic response to psychosocial stress using real-time MRI. J Magn Reson Imaging 33:448–454
Chirinos JA, Segers P, Raina A et al (2010) Arterial pulsatile hemodynamic load induced by isometric exercise strongly predicts left ventricular mass in hypertension. Am J Physiol Heart Circ Physiol 298:H320–H330
Ciampi Q, Betocchi S, Violante A et al (2003) Hemodynamic effects of isometric exercise in hypertrophic cardiomyopathy: comparison with normal subjects. J Nucl Cardiol 10:154–160
Fisman EZ, Embon P, Pines A et al (1997) Comparison of left ventricular function using isometric exercise Doppler echocardiography in competitive runners and weightlifters versus sedentary individuals. Am J Cardiol 79:355–359
Savin WM, Alderman EL, Haskell WL et al (1980) Left ventricular response to isometric exercise in patients with denervated and innervated hearts. Circulation 61:897–901
Muller MD, Gao Z, Mast JL et al (2012) Aging attenuates the coronary blood flow response to cold air breathing and isometric handgrip in healthy humans. Am J Physiol Heart Circ Physiol 302:H1737–H1746
Lind AR, McNicol GW (1967) Muscular factors which determine the cardiovascular responses to sustained and rhythmic exercise. Can Med Assoc J 96:706–715
Becklake MR, Frank H, Dagenais GR, Ostiguy GL, Guzman CA (1965) Influence of age and sex on exercise cardiac output. J Appl Physiol 20:938–947
Jones A, McMillan MR, Jones RW et al (2012) Adiposity is associated with blunted cardiovascular, neuroendocrine and cognitive responses to acute mental stress. PLoS One 7(6):e39143
Valensi P, Bich Ngoc PT, Idriss S et al (1999) Haemodynamic response to an isometric exercise test in obese patients: influence of autonomic dysfunction. Int J Obes Relat Metab Disord 23:543–549
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
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-015-3920-z