CMR for myocardial characterization in ischemic heart disease: state-of-the-art and future developments

Abstract

Ischemic heart disease and its sequelae are one of the major contributors to morbidity and mortality worldwide. Over the last decades, technological developments have strengthened the role of noninvasive imaging for detection, risk stratification, and management of patients with ischemic heart disease. Cardiac magnetic resonance (CMR) imaging incorporates both functional and morphological characterization of the heart to determine presence, acuteness, and severity of ischemic heart disease by evaluating myocardial wall motion and function, the presence and extent of myocardial edema, ischemia, and scarring. Currently established clinical protocols have already demonstrated their diagnostic and prognostic value. Nevertheless, there are emerging imaging technologies that provide additional information based on advanced quantification of imaging biomarkers and improved diagnostic accuracy, therefore potentially allowing reduction or avoidance of contrast and/or stressor agents. The aim of this review is to summarize the current state of the art of CMR imaging for ischemic heart disease and to provide insights into promising future developments.

Visualization of Concurrent Epicardial and Microvascular Coronary Artery Disease in a Patient with Systemic Lupus Erythematosus by Magnetic Resonance Imaging

“…6 The diagnosis of ischemic heart disease by CMR has been well established. 7 CMR has the ability to discriminate between transient and permanent manifestations of myocardial injury as a result of ischemia. 5 Based on the specific CMR findings (akinesia, edema, rest perfusion defect, and transmural late gadolinium enhancement with central unenhanced area of microvascular obstruction; Suppl.…”

30-minute CMR for common clinical indications: a Society for Cardiovascular Magnetic Resonance white paper

“…CMR LGE imaging is the reference standard for visualization of infarct scar [ 46 ]. The absence of myocardial scar is not only indicative of myocardial viability but also associates with better patient prognosis.…”

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

“…Furthermore, despite atrio-ventricular coupling and dependence on ventricular capacity, the proven independent Importantly, CMR technique offers unique capabilities beyond deformation analyses in patients suffering ICM by enabling profound myocardial tissue analyses. These myocardial characterisations include visualization of edema, infarct, microvascular obstruction, late gadolinium enhancement (LGE) for scar quantification well as myocardial ischemia and viability testing based on dobutamine administration [52,53]. In addition, CMR imaging can be used for the detection of several complications of AMI like spotting septal rupture, differentiation between an aneurysm or pseudo-aneurysm and identification of thrombi [54] highlighting the broad applicability of CMR imaging and CMR-derived deformation quantification for a wide, multiparametric cardiac assessment and for improved risk stratification in these patients.…”