The cardiac magnetic resonance (CMR) approach to assessing myocardial viability |
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Authors: | Andrew E Arai |
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Institution: | (1) Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA |
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Abstract: | Cardiac magnetic resonance (CMR) is a noninvasive imaging method that can determine myocardial anatomy, function, perfusion,
and viability in a relative short examination. In terms of viability assessment, CMR can determine viability in a non-contrast
enhanced scan using dobutamine stress following protocols comparable to those developed for dobutamine echocardiography. CMR
can also determine viability with late gadolinium enhancement (LGE) methods. The gadolinium-based contrast agents used for
LGE differentiate viable myocardium from scar on the basis of differences in cell membrane integrity for acute myocardial
infarction. In chronic myocardial infarction, the scarred tissue enhances much more than normal myocardium due to increases
in extracellular volume. LGE is well validated in pre-clinical and clinical studies that now span from almost a cellular level
in animals to human validations in a large international multicenter clinical trial. Beyond infarct size or infarct detection,
LGE is a strong predictor of mortality and adverse cardiac events. CMR can also image microvascular obstruction and intracardiac
thrombus. When combined with a measure of area at risk like T2-weighted images, CMR can determine infarct size, area at risk,
and thus estimate myocardial salvage 1-7 days after acute myocardial infarction. Thus, CMR is a well validated technique that
can assess viability by gadolinium-free dobutamine stress testing or late gadolinium enhancement. |
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