Feasibility of Continuous Ventricular Volumetric Quantification in Arrhythmias using Real-Time 3D CMR-MOTUS
Conventional cardiovascular magnetic resonance (CMR) cine imaging combines data across multiple heartbeats, an assumption that can fail in arrhythmia because beat-to-beat variation causes motion artifacts and obscures functional heterogeneity. Although 2D real-time cine resolves individual beats, stacked slices are suboptimal for capturing complex 3D cardiac dynamics. We investigated continuous beat-to-beat volumetric quantification in patients with premature ventricular contractions (PVCs) using free-running 3D real-time CMR. CMR-MOTUS was extended to jointly reconstruct time-resolved 3D motion fields and a motion-corrected reference image from continuously acquired data without breath-holding or ECG gating. Data were acquired with a variable-density Cartesian trajectory and either 3D spoiled gradient-echo or balanced steady-state free-precession imaging. Ventricular volumes were obtained by propagating one manual reference-image segmentation through all reconstructed frames. The method was evaluated in a cardiac motion phantom with static ground-truth acquisitions, 10 healthy volunteers, and 10 patients with PVCs; all in vivo scans were performed after contrast administration. Phantom ejection fraction (EF) agreed closely with ground truth (17.86% versus 17.27%). Healthy volunteers showed narrow beat-to-beat EF distributions, whereas patients with PVCs showed broader and sometimes bimodal distributions. Simultaneous ECG recordings supported the temporal correspondence between volume irregularities and PVC episodes. Free-running joint 3D motion-field and image reconstruction enables continuous beat-to-beat volumetric assessment and can reveal functional heterogeneity obscured by gated or heartbeat-averaged methods. Larger studies are required to establish clinical validity and determine its role alongside standard 2D cine analysis.