Abstract
Cardiovascular magnetic resonance (CMR) using T2-weighted sequences can visualize myocardial edema. When compared to previous protocols, newer pulse sequences with substantially improved image quality have increased its clinical utility. The assessment of myocardial edema provides useful incremental diagnostic and prognostic information in a variety of clinical settings associated with acute myocardial injury. In patients with acute chest pain, T2-weighted CMR is able to identify acute or recent myocardial ischemic injury and has been employed to distinguish acute coronary syndrome (ACS) from non-ACS as well as acute from chronic myocardial infarction.T2-weighted CMR can also be used to determine the area at risk in reperfused and non-reperfused infarction. When combined with contrast-enhanced imaging, the salvaged area and thus the success of early coronary revascularization can be quantified. Strong evidence for the prognostic value of myocardial salvage has enabled its use as a primary endpoint in clinical trials. The present article reviews the current evidence and clinical applications for T2-weighted CMR in acute cardiac disease and gives an outlook on future developments."The principle of all things is water"Thales of Miletus (624 BC - 546 BC)
Highlights
Cardiovascular magnetic resonance (CMR) is wellestablished and increasingly used in clinical practice for the diagnosis and management of cardiovascular disease [1,2,3].Importantly, recent technological advances of CMR have introduced its use for visualizing certain tissue changes in patients with acute myocardial diseases
This is of particular interest in patients with suspected ischemic disease, a broad and heterogeneous population that challenges the clinician in terms of: 1) accurately establishing the diagnosis; 2) risk stratification; 3) therapeutic decision making; and 4) monitoring response to therapy [4]
CMR has an unparalleled potential as the main diagnostic tool in acute cardiac disease by providing information on the stage, degree, and extent of reversible and irreversible myocardial injury [5,6]
Summary
Cardiovascular magnetic resonance (CMR) is wellestablished and increasingly used in clinical practice for the diagnosis and management of cardiovascular disease [1,2,3]. A recent study has demonstrated that the endocardial extent of infarction as assessed by LGE CMR underestimates the area at risk in comparison to T2-weighted imaging, especially in patients with early reperfusion and aborted myocardial infarction [85]. Another potential CMR method for area at risk measurement is to assess the dysfunctional myocardium in cine SSFP imaging [86]. In combination with scar imaging, T2-weighted CMR of myocardial edema differentiates reversible from irreversible injury and can quantify myocardial salvage after coronary revascularization, with important implications for patient management and prognosis It provides a very powerful, safe and cost-efficient endpoint for clinical trials on myocardial revascularization. Competing interests The authors declare that they have no competing interests
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