title: Influence of the trigger technique on ventricular function measurements using 3-Tesla magnetic resonance imaging: comparison of ECG versus pulse wave triggering.
abstract: BACKGROUND
  Three Tesla cardiovascular magnetic resonance imaging (3T-CMR) is increasingly used in clinical practice. Despite many advantages one drawback is that ECG signal disturbances and artifacts increase with higher magnetic field strength resulting in trigger problems and false gating. This particularly affects cardiac imaging because most pulse sequences require ECG triggering. Pulse wave (PW) triggering is robust and might have advantages over ECG triggering.
  
  
  OBJECTIVE
  To evaluate differences in left ventricular (LV) function as an integral part of most CMR studies between ECG- and PW-triggered short-axis imaging using 3T-CMR.
  
  
  METHODS
  Forty-three patients underwent multiple short-axis cine imaging for LV-function assessment with ECG and PW triggering using standard multibreath hold steady-state free precession. LV-volumes (EDV, ESV), ejection fraction (EF), and mass were determined by slice summation. LV-wall motion was assessed by using a 4-point scoring scale. Bland Altman statistics for inter-observer variability were performed.
  
  
  RESULTS
  ECG triggering failed in 15 patients (34.8%). Thus, analysis was performed in 28 patients (13 with impaired LV function). Difference in volumes (EDV 0.13 ± 1.8 mL, ESV 0.59 ± 1.1 mL), EF (-0.32 ± 0.6%) and mass (0.01 ± 1.1 g) between ECG and PW triggering were very small and significant only for ESV and EF (p ≤ 0.011). In patients with impaired LV function (n = 19) differences were not significant (p ≥ 0.128). Wall motion scores did not differ between ECG and PW triggering (p ≥ 0.295). Inter-observer variability for function measurements was low.
  
  
  CONCLUSIONS
  Short-axis cine imaging for LV-function assessment can accurately be performed using PW triggering on 3T magnets, and may be used in clinical practice when ECG triggering is disturbed.
authors.affiliation: Division of Cardiology, Pulmology and Vascular Medicine, University Hospital, Duesseldorf, Germany. burkhard.sievers@mailbox.tu-dresden.de
authors.forename: Burkhard
authors.initials: B
authors.lastname: Sievers
authors.forename: Marco
authors.initials: M
authors.lastname: Wiesner
authors.forename: Nino
authors.initials: N
authors.lastname: Kiria
authors.forename: Uwe
authors.initials: U
authors.lastname: Speiser
authors.forename: Steffen
authors.initials: S
authors.lastname: Schoen
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Strasser
mesh_terms: D000328:Adult; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D013318:Stroke Volume; D016277:Ventricular Function, Left