Cardiac magnetic resonance in ischemic cardiomyopathy: present role and future directions

Abstract

Ischemic cardiomyopathy is a significant cause of mortality and morbidity, with peculiar needs for accurate diagnostic and prognostic characterization. Cardiac magnetic resonance (CMR) can help to satisfy these requirements by allowing a comprehensive evaluation of myocardial function, perfusion and tissue composition, with a demonstrated utility in guiding clinical management of patients with known or suspected ischemic cardiomyopathy. When compared with alternative non-invasive imaging modalities, such as stress echocardiography and nuclear techniques, CMR is able to provide accurate (function and perfusion) or peculiar (tissue characterization) information on cardiac pathophysiology, while avoiding exposition to ionizing radiations and overcoming limitations related to the quality of the imaging window. In particular, stress perfusion CMR showed to be accurate, safe, cost-effective, and clinically valuable as a non-invasive test for detecting severity and distribution of myocardial ischemia. In many circumstances, however, local availability of the technique, together with procedural costs, and scanning and post-processing time duration still limit the use of CMR in clinical routine. In the current review, we focused on clinical applications of CMR in ischemic cardiomyopathy. The consolidated role of the technique is described by illustrating both standard and advanced sequences that constitute the current body of a dedicated CMR examination. Ongoing developments and potential future diagnostic and prognostic applications of CMR when assessing ischemic cardiomyopathy are also discussed, with a focus on artificial intelligence-based implementations proposed for refining the efficiency of CMR analysis and reporting.

Cardiac arrest in seronegative idiopathic inflammatory myopathy: a case report

“…Mid-myocardial LGE, along with sub-epicardial LGE, is commonly seen in myocarditis, whereas ischaemic cardiomyopathy most often presents with sub-endocardial LGE with variable degrees of transmurality usually following a coronary distribution. 13 , 14 In actuality, endomyocardial biopsy is the gold standard for establishing the diagnosis of myocarditis and the underlying aetiology. 15 Endomyocardial biopsy was discussed in our patient case, but given the lack of increased T2 signal in the cMRI to indicate active inflammation, the utility of biopsy was thought to be low.…”

Guia prático de avaliação fisioterapêutica para cardiopatas

“…Resultados obtidos por meio de RMC podem descrever com precisão as consequências funcionais e estruturais de insultos isquêmicos recentes e antigos no músculo cardíaco tanto em termos de extensão da lesão quanto de viabilidade de tecido miocárdico fornecendo informações quantitativas e qualitativas no coração em repouso e ou estresse. 25,38 Tal exame é capaz de identificar diferentes densidades no tecido como deposição de gordura, edema e inflamação do miocárdio. É possível se obter quantitativamente o teor de água dos tecidos edemaciados que aparecem logo após insulto isquêmico levando a um sinal mais brilhante nas imagens (Figura 3.15).…”

“…Algumas limitações podem ser observadas no exame de RMC: quando pretende-se observar o tecido miocárdico imagens de baixa qualidade podem dificultar a identificação de lesões em pacientes com frequência cardíaca muito elevada ou irregular e capacidade limitada do operador. 25,38 Figura 3.15: Abordagem da Ressonância Magnética Cardíaca para caracterização da cardiomiopatia isquêmica. Primeiro, avaliação funcional, em sequência, caracterização de viabilidade de tecido miocárdico (é possível se observar infiltração de tecido gorduroso, edema miocárdico e necrose de tecido) e por último, avaliação de perfusão miocárdica.…”

Silent Myocardial Ischemia: From Pathophysiology to Diagnosis and Treatment

“…Following intravenous administration, these agents highlight regions of the myocardium with compromised blood flow during stress and rest conditions. Perfusion abnormalities, manifested as subendocardial hypoenhancements, become apparent on the images, allowing for the identification of ischemic territories [46]. Additionally, cine MRI sequences enable the assessment of myocardial function by providing dynamic images of the cardiac chambers and myocardial wall motion.…”