Role of cardiovascular magnetic resonance in acute and chronic ischemic heart disease

A Baritussio,C Bucciarelli-Ducci,A Scatteia

doi:10.1007/s10554-017-1116-0

Abstract

Cardiovascular magnetic resonance (CMR) is a multi-parametric, multi-planar, non-invasive imaging technique, which allows accurate determination of biventricular function and precise myocardial tissue characterization in a one-stop-shop technique, free from the use of ionizing radiations. Though CMR has been increasingly applied over the last two decades in every-day clinical practice, its widest application has been in the assessment of ischemic cardiomyopathy.

Highlights

Coronary artery disease (CAD) is the leading cause of death worldwide [1]
The linear correlation between myocardial water content and T2 transverse relaxation time in acute myocardial infarction was first described in the early 80s; T2-weighted sequences were subsequently developed and implemented in clinical practice to assess the presence of myocardial oedema, which appears as an area of increased signal intensity
Not all patients in the non-ST elevation myocardial infarction (NSTEMI)-acute coronary syndrome (ACS) population have evidence of CAD requiring revascularization; Raman et al [13] showed that the presence of myocardium at risk on T2-weighted Cardiovascular magnetic resonance (CMR) sequences allows the identification of patients who will benefit from an early invasive management

Summary

Limitations

Though CMR is increasingly used, its availability is still limited in certain centres. CMR can definitely be performed safely in the acute setting, but the patient needs to be haemodinamically stable. Patients with non-MR conditional devices (intracranial clips, neuro-stimulator, metallic objects in the eye) should not be offered a CMR; recent advances in technology do provide MR-conditional cardiac devices (pace-maker and ICD), that allow CMR scanning, though under strict medical monitoring. Claustrophobia has long been thought to be an absolute contraindication to CMR; performing CMR with the patient lying prone, providing an angulated mirror in the CMR bore to allow the patients to look outside the scanner and inviting a relative to sit at the end of scanner should help reduce these cases to a negligible percentage

Conclusion

Findings

Compliance with ethical standards