Singapore, 27 August 2025 – The National Heart Centre Singapore (NHCS) introduces Exercise Cardiac Magnetic Resonance (ExCMR) imaging, the first of its kind in Asia. This novel stress magnetic resonance imaging (MRI) test represents a breakthrough that allows doctors to accurately distinguish between normal changes in the heart from exercise¹ and potentially life-threatening or serious heart conditions in just one session, transforming how heart conditions are diagnosed in active individuals. 

ExCMR combines advanced MRI with real-time exercise using a specially designed stationary bicycle attached to the MRI scanner. During the test, patients pedal at set intervals while doctors observe how the heart performs during real exercise – capturing detailed images of the heart's structure, function, and blood flow. 

Unlike conventional tests that often require weeks or even months of several separate assessments, ExCMR provides fast and accurate results in a single visit. Research has shown that ExCMR significantly reduces the need for patients to undergo multiple tests by nearly 90% (from 56.8% to just 6.5%²). This not only ensures timely diagnosis and earlier treatment for patients but also translates into significant cost savings for patients and healthcare systems in the long run. 

Patient Story: From Uncertainty To Clarity 

In September 2024, 28-year-old national footballer Adam Swandi experienced dizziness and chest tightness during a match. After cardiac tests suggested he had cardiomyopathy, a form of heart muscle disease, he was referred to NHCS for ExCMR. 

"The ExCMR helped my doctors and me gain a clearer picture of my condition. The detailed indicators pointed to the most effective next steps in my treatment journey," recalls Adam. The test confirmed his cardiomyopathy diagnosis and revealed that he was at high risk of a fatal cardiac event if he continued competitive football. Armed with this clarity, Adam was referred for appropriate and timely treatment, avoiding further risks to his health. 

Revolutionary Technology For Proven, Precise Diagnosis 

“ExCMR is a game-changer. It has transformed our ability to detect heart conditions at an earlier stage, particularly in active individuals where conventional tests may be inconclusive. By providing a definitive diagnosis in a single session, doctors can initiate appropriate interventions sooner, potentially preventing adverse cardiac events,” said Associate Professor Calvin Chin, Senior Consultant and Clinician Scientist, Department of Cardiology, NHCS. Assoc Prof Chin is also Director, Cardiac Magnetic Resonance Imaging, and Deputy Director, National Heart Research Institute Singapore, NHCS. 

Previously, patients with abnormal electrocardiogram or inconclusive imaging results often had to undergo a cascade of tests, including treadmill stress tests, cardiopulmonary exercise tests, stress echocardiography or even detraining for weeks to reveal hidden disease. ExCMR now allows them to proceed directly to a single, comprehensive test that shortens the diagnostic pathway and removes much of the uncertainty for both patients and doctors. 

From Research to Clinical Care 

NHCS introduced ExCMR as a research project in 2017, funded by the National Medical Research Council. For each test session, a specialised stationary bicycle is set up inside the MRI scanner. Patients first undergo a standard resting MRI scan before cycling in the scanner to capture exercise images. After the session, the bicycle is removed, and the scanner resumes its normal use. Over 600 participants were studied to refine and validate the test, including comparisons with cardiopulmonary exercise testing – the gold standard non-invasive assessment of exercise capacity³. 

In 2020, the ExCMR was progressively rolled out as an alternative stress MRI to the conventional adenosine-administered method. To date, about 400 patients have benefited. Active individuals can get referred to the ExCMR test through their cardiologist from both public and private healthcare institutions. 

"The ExCMR test is a culmination of rigorous research efforts with contributions from radiographers, health economists, researchers and cardiologists, bringing precision to diagnosis. With more accurate assessments, active individuals can continue sports safely where appropriate, while those at risk are identified more quickly to receive timely intervention," said Assistant Professor Le Thu Thao, Junior Principal Investigator, National Heart Research Institute Singapore, NHCS, who leads the ExCMR research programme. "Beyond clinical care, NHCS is leading international efforts to set global standards, drive adoption, and develop alternative solutions to benefit more patients across the region." 

Future Developments 

NHCS aims to expand its ExCMR capacity to 100 patients annually. Initially applied to distinguish between athlete’s heart and dilated cardiomyopathy, ExCMR is now being extended to patients with suspected coronary artery disease and other heart conditions. While the current modality requires specialised exercise equipment sourced from overseas, NHCS is developing more practical and affordable solutions that can be seamlessly integrated into existing MRI scanners. This innovation will make ExCMR more accessible, keeping Singapore at the forefront of healthcare advancement while benefiting patients regionally and globally. 

“We are proud to be the pioneer centre in Asia and among a few worldwide offering this advanced test. As we strive for a healthier nation, advanced imaging technologies such as ExCMR are vital in enabling clearer diagnosis. Importantly it also shows how research has translated to clinical care directly benefiting Singaporeans,” said Professor Yeo Khung Keong, Chief Executive Officer, NHCS.

References

1. Le, TT., Bryant, J.A., Ang, B.W.Y. et al. The application of exercise stress cardiovascular magnetic resonance in patients with suspected dilated cardiomyopathy. J Cardiovasc Magn Reson 22, 10 (2020). https://doi.org/10.1186/s12968-020-0598-4 
2. Senanayake S, Lieo SWX, Latib AB, et al. Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience. J Cardiovasc Magn Reson. 2025;27(2):101924. https://doi.org/10.1016/j.jocmr.2025.101924 
3. Le TT, Bryant JA, Ting AE, Ho PY, Su B, Teo RC, Gan JS, Chung YC, O'Regan DP, Cook SA, Chin CW. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2017 Jan 23;19(1):7. doi: 10.1186/s12968-017-0322-1.