MRI-specific anxiety, patient experience, beta-blocker therapy, and image quality during cardiac magnetic resonance imaging

Introduction Cardiac magnetic resonance (CMR) is performed in a confined scanner environment and requires patient cooperation during repeated breath-holds, factors that may contribute to distress. This mixed-methods study examined how patient experiences, emotional states, and perceived distress influence breath-hold performance and image quality during CMR, and whether these relationships differ by previous magnetic resonance imaging (MRI) experience, sex or beta-blocker therapy.Methods Fifty-three patients undergoing early post-infarction CMR were included. State anxiety was assessed before and after CMR, and MRI-specific anxiety post-scan. Breath-hold effort, duration and heart rate were recorded across predefined sequences. Image quality was rated using a predefined scale. Sixteen semi-structured interviews were analysed using reflexive thematic analysis.Results State anxiety decreased modestly after CMR (p = 0.01), with no differences related to previous MRI experience or beta-blocker therapy. MRI-specific anxiety was significantly higher among patients not receiving beta-blocker therapy, consistent with qualitative reports of bodily stress and claustrophobic sensations. Patients receiving beta-blockers described calmer emotional states. Perceived breath-hold effort was light to moderate and comparable across subgroups. Overall image quality was high, with respiratory ghosting in Grid-tagging short axis (SAX) and blurring and mis-triggering in Cine and late gadolinium enhancement SAX sequences.Conclusion Beta-blocker therapy was associated with lower MRI-specific anxiety but not general state anxiety, suggesting modulation of scanner-related physiological arousal. Procedural and emotional factors shaped cooperation during CMR.Implications for practice Patients not receiving beta-blockers may benefit from enhanced preparatory information and reassurance. Clear communication, breath-hold guidance and protocol flexibility may support comfort, cooperation and diagnostic image quality.