IMR Press / RCM / Volume 24 / Issue 9 / DOI: 10.31083/j.rcm2409261
Open Access Systematic Review
Measuring Cardiac Dyssynchrony with DENSE (Displacement Encoding with Stimulated Echoes)—A Systematic Review
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1 Institute of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
2 Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
3 A.I. Virtanen Institute, University of Eastern Finland, 70210 Kuopio, Finland
4 Heart Center, Kuopio University Hospital, 70029 Kuopio, Finland
*Correspondence: (Saara Sillanmäki)
Rev. Cardiovasc. Med. 2023, 24(9), 261;
Submitted: 7 May 2023 | Revised: 18 June 2023 | Accepted: 26 June 2023 | Published: 18 September 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: In this review, we introduce the displacement encoding with stimulated echoes (DENSE) method for measuring myocardial dyssynchrony using cardiovascular magnetic resonance (CMR) imaging. We provide an overview of research findings related to DENSE from the past two decades and discuss other techniques used for dyssynchrony evaluation. Additionally, the review discusses the potential uses of DENSE in clinical practice. Methods: A search was conducted to identify relevant articles published from January 2000 through January 2023 using the Scopus, Web of Science, PubMed and Cochrane databases. The following search term was used: (DENSE OR ‘displacement encoding with stimulated echoes’ OR CURE) AND (dyssynchrony* OR asynchron* OR synchron*) AND (MRI OR ‘magnetic resonance’ OR CMR). Results: After removing duplicates, researchers screened a total of 174 papers. Papers that were not related to the topic, reviews, general overview articles and case reports were excluded, leaving 35 articles for further analysis. Of these, 14 studies focused on cardiac dyssynchrony estimation with DENSE, while the remaining 21 studies served as background material. The studies used various methods for presenting synchronicity, such as circumferential uniformity ratio estimate (CURE), CURE-singular value decomposition (SVD), radial uniformity ratio estimate (RURE), longitudinal uniformity ratio estimate (LURE), time to onset of shortening (TOS) and dyssynchrony index (DI). Most of the dyssynchrony studies concentrated on human heart failure, but congenital heart diseases and obesity were also evaluated. The researchers found that DENSE demonstrated high reproducibility and was found useful for detecting cardiac resynchronisation therapy (CRT) responders, optimising CRT device settings and assessing right ventricle synchronicity. In addition, studies showed a correlation between cardiac fibrosis and mechanical dyssynchrony in humans, as well as a decrease in the synchrony of contraction in the left ventricle in obese mice. Conclusions: DENSE shows promise as a tool for quantifying myocardial function and dyssynchrony, with advantages over other cardiac dyssynchrony evaluation methods. However, there remain challenges related to DENSE due to the relatively time-consuming imaging and analysis process. Improvements in imaging and analysing technology, as well as possible artificial intelligence solutions, may help overcome these challenges and lead to more widespread clinical use of DENSE.

displacement encoding with stimulated echoes
cardiovascular magnetic resonance imaging
systematic review
Emil Aaltonen Foundation
5063584/Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding
5063586/Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding
Fig. 1.
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