Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques

Abstract

Coronary artery disease (CAD) is a leading cause of death and disability worldwide. Cardiovascular magnetic resonance (CMR) is established in clinical practice guidelines with a growing evidence base supporting its use to aid the diagnosis and management of patients with suspected or established CAD. CMR is a multi-parametric imaging modality that yields high spatial resolution images that can be acquired in any plane for the assessment of global and regional cardiac function, myocardial perfusion and viability, tissue characterisation and coronary artery anatomy, all within a single study protocol and without exposure to ionising radiation. Advances in technology and acquisition techniques continue to progress the utility of CMR across a wide spectrum of cardiovascular disease, and the publication of large scale clinical trials continues to strengthen the role of CMR in daily cardiology practice. This article aims to review current practice and explore the future directions of multi-parametric CMR imaging in the investigation of stable CAD.

Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art

“…Usually, 3 short -axis slices are acquired every heartbeat, and the whole first -pass perfusion scan is performed during one breath -hold (FIGURE 2). 7, 40,49,52,53 inversely with the viability of the myocardium (FIGURE 3). [69][70][71] It has been shown that infarct scars not exceeding 25% of the myocardial wall width are most likely to achieve functional recovery after revascularization, whereas segments with subendocardial hyperenhancement greater than 75% are unlikely to recover.…”

“…The key problems of higher field strength are susceptibility artefacts, greater field inhomogeneity, and higher local energy deposition, which might be a limitation for numerous magnetic resonance imaging-conditional implants and devices. 40,53,[60][61][62] Dobutamine -stress cardiac magnetic resonance imaging In contrast to first -pass perfusion imaging, where only differences in myocardial perfusion between the healthy and hypoperfused myocardium are visualized, dobutamine is an inotropic and chronotropic agent, which induces maximal vasodilation and therefore leads to true ischemia and LV wall motion abnormalities in patients with significant CAD. The protocol is similar to the one used in stress echocardiography with increasing doses of dobutamine and optional addition of atropine until the target heart rate is reached: 85% of the maximal predicted heart rate = ([220 -age] × 0.85 bpm).…”

“…Inotropic stress is an alternative to vasodilator stress perfusion CMR in patients with severely impaired renal function or other contraindications to vasodilator medication or gadolinium--based CM. 7, 49,53,63,64 If there are no contraindications to the use of CM, dobutamine -stress CMR can be combined with first -pass perfusion to increase sensitivity. 65,66 In general, a sensitivity of 83% and a specificity of 86% on a per -patient level for the detection of CAD defined by quantitative angiography (≥50% diameter stenosis) was reported.…”

“…The subendocardial pattern of LGE allows to distinguish infarct scar from other myocardial fibrosis of nonischemic origin. 7, 49,53,68 The transmurality of the infarct scar correlates Abbreviations: ACS, acute coronary syndrome; AF, atrial fibrillation; AFl, atrial flutter; AMI, acute myocardial infarction; approx., approximately; AV, atrioventricular; BP, blood pressure; CM, contrast media; CMR, cardiac magnetic resonance imaging; COPD, chronic obstructive pulmonary disease; HR, heart rate; IV, intravenous; LGE, late gadolinium enhancement; MRI, magnetic resonance imaging; SBP, systolic blood pressure; TIA, transient ischemic attack; UA, unstable angina; VT, ventricular tachycardia; others, see FIGURE 1 not undergo revascularization, have poorer survival. 7 3 It must be noted that the presence of infarct scar also predicts cardiovascular events in patients without a previous diagnosis of CAD and without LV regional wall motion abnormalities.…”

Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the U.S

“…Cardiac magnetic resonance imaging (CMR) overcomes many of the shortcomings of SPECT, offering improved diagnostic accuracy, clinical utility, and efficiency 15,[17][18][19][20][21][22][23][24][25] . In terms of diagnostic accuracy, meta-analyses have shown CMR to have a sensitivity of 0.90-0.91 and a specificity of 0.79-0.94 in perfusion analysis, showing substantial benefits over SPECT in terms of reducing the number of false negatives 15,26 .…”