Computed Tomography and Cardiac Magnetic Resonance in Ischemic Heart Disease

Abstract

Ischemic heart disease is a complex disease process caused by the development of coronary atherosclerosis, with downstream effects on the left ventricular myocardium. It is characterized by a long preclinical phase, abrupt development of myocardial infarction, and more chronic disease states such as stable angina and ischemic cardiomyopathy. Recent advances in computed tomography (CT) and cardiac magnetic resonance (CMR) now allow detailed imaging of each of these different phases of the disease, potentially allowing ischemic heart disease to be tracked during a patient’s lifetime. In particular, CT has emerged as the noninvasive modality of choice for imaging the coronary arteries, whereas CMR offers detailed assessments of myocardial perfusion, viability, and function. The clinical utility of these techniques is increasingly being supported by robust randomized controlled trial data, although the widespread adoption of cardiac CT and CMR will require further evidence of clinical efficacy and cost effectiveness.

Magnetic resonance imaging in heart failure, including coronary imaging: numbers, facts, and challenges

“…While atherosclerotic lesions with a low-risk of rupture are linked to a thick fibrotic cap and a high proportion of fibrotic tissue, plaques that rupture often show a thin fibrous cap, a necrotic core, positive remodelling, inflammation, angiogenesis, and plaque haemorrhage. 15 The identification of such vulnerable plaques can help in identifying patients with an active state of disease who are at an increased risk of acute cardiovascular events. 29 Due to its superior soft-tissue contrast, CMR has the potential to provide detailed imaging of the coronary vessel wall.…”

“…43 Challenges CMR of coronary arteries has several advantages over CT, showing a superior soft-tissue contrast for the visualization of plaque morphology, not being affected by calcium blooming, and most importantly not involving ionizing radiation, which add to its attractiveness as a screening tool. 15 However, there are still technical challenges regarding cardiac motion and spatial resolution, as the heart shows a rapid movement with the cardiac and breathing cycle. With its relatively long scanning and acquisition times, these requirements are especially challenging for CMR.…”

“…CMR plays a central role in the diagnosis of HF such as in the assessment of ventricular global and regional dysfunction, the visualization of injured myocardium and its transmural extent,13 or the evaluation of the underlying aetiology, and provides insights into disease progression 14. CMR techniques might not only enhance our understanding of the pathophysiology of coronary plaque formation and of the aetiology of dysfunction in HF, but also improve individual risk assessment, and they guide therapeutic interventions in individuals at highest risk for acute cardiovascular events and chronic HF 15, 16…”

“…14 CMR techniques might not only enhance our understanding of the pathophysiology of coronary plaque formation and of the aetiology of dysfunction in HF, but also improve individual risk assessment, and they guide therapeutic interventions in individuals at highest risk for acute cardiovascular events and chronic HF. 15,16 This editorial focuses on the current knowledge, challenges, and future prospects for CMR in imaging HF and coronary atherosclerosis.…”

Application effect of high-quality nursing on patients with coronary heart disease

“…It is associated with high morbidity rates among the elderly [1]. CHD morbidity rates have continuously increased with the aging population.…”