Assessment of myocardial ischemia with cardiovascular magnetic resonance |
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Authors: | Heydari Bobak Jerosch-Herold Michael Kwong Raymond Y |
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Affiliation: | aDepartment of Cardiology, Brigham and Women's Hospital, Boston, MA 02215 |
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Abstract: | Assessment of myocardial ischemia in symptomatic patients remains a common and challenging clinical situation faced by physicians. Risk stratification by presence of ischemia provides important utility for both prognostic assessment and management. Unfortunately, current noninvasive modalities possess numerous limitations and have limited prognostic capacity. More recently, ischemia assessment by cardiovascular magnetic resonance (CMR) has been shown to be a safe, available, and potentially cost-effective alternative with both high diagnostic and prognostic accuracy. Cardiovascular magnetic resonance has numerous advantages over other noninvasive methods, including high temporal and spatial resolution, relatively few contraindications, and absence of ionizing radiation. Furthermore, studies assessing the clinical utility and cost effectiveness of CMR in the short-term setting for patients without evidence of an acute myocardial infarction have also demonstrated favorable results. This review will cover techniques of ischemia assessment with CMR by both stress-induced wall motion abnormalities as well as myocardial perfusion imaging. The diagnostic and prognostic performance studies will also be reviewed, and the use of CMR for ischemia assessment will be compared with other commonly used noninvasive modalities. |
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Keywords: | Abbreviations and Acronyms: ACS, acute coronary syndrome AUC, area under the curve CAD, coronary artery disease CFR, coronary flow reserve CMR, cardiovascular magnetic resonance Ds-CMR, dobutamine stress cardiovascular magnetic resonance DSE, dobutamine stress echo ECG, electrocardiographic ED, emergency department FFR, fractional flow reserve GBCA, gadolinium-based contrast agent LGE, late gadolinium enhancement LVEF, left ventricular ejection fraction MACE, major adverse cardiovascular outcomes MI, myocardial infarction MPI, myocardial perfusion imaging MR-IMPACT, Comparison of Perfusion-cardiac Magnetic Resonance with Single-photon Emission Computed Tomography for the Detection of Coronary Artery Disease NSF, nephrogenic systemic fibrosis PET, positron emission tomography QCA, quantitative coronary angiography ROC, receiver operator characteristic SPECT, single-photon emission computed tomography SSFP, steady-state free precession |
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