Cardiac MRI: evaluation of phonocardiogram-gated cine imaging for the assessment of global und regional left ventricular function in clinical routine.

Objectives: To validate a phonocardiogram (PCG)-gated cine imaging approach for the assessment of left ventricular (LV) function.

Methods: In this prospective study, cine MR imaging of the LV was performed twice in 79 patients by using retrospectively PCG- and retrospectively ECG-gated cine SSFP sequences at 1.5 T. End-diastolic volumes (EDV), end-systolic volumes (ESV), stroke volumes (SV), ejection fraction (EF), muscle mass (MM), as well as regional wall motion were assessed. Subgroup analyses were performed for patients with valvular defects and for patients with dysrhythmia.

Results: PCG-gated imaging was feasible in 75 (95%) patients, ECG-gating in all patients. Excellent correlations were observed for all volumetric parameters (r > 0.98 for all variables analysed). No significant differences were observed for EDV (-0.24 ± 3.14 mL, P = 0.5133), ESV (-0.04 ± 2.36 mL, P = 0.8951), SV (-0.20 ± 3.41 mL, P = 0.6083), EF (-0.16 ± 1.98%, P = 0.4910), or MM (0.31 ± 4.2 g, P = 0.7067) for the entire study cohort, nor for either of the subgroups. PCG- and ECG-gated cine imaging revealed similar results for regional wall motion analyses (115 vs. 119 segments with wall motion abnormalities, P = 0.3652).

Conclusion: The present study demonstrates that PCG-gated cine imaging enables accurate assessment of global and regional LV function in the vast majority of patients in clinical routine.

Key Points: Phonocardiogram-gating is an alternative to electrocardiographic-gating in cardiac MR. Phonocardiogram-gated imaging allows reliable assessment of global and regional left-ventricular function. Phonocardiogram-gating is feasible in patients with valvular lesions or cardiac dysrhythmia. Because phonocardiogram-gating is insensitive to magneto-hydrodynamic effects, it is suitable for ultra-high field.