Abstract
Noninvasive imaging modalities are changing the management of cardiovascular disease. Cardiovascular magnetic resonance (CMR) has matured as a clinical tool, having passed through validation, standardization, and clinical roll-out phases.1–5 CMR now aids the prediction of clinical outcomes with a growing prognostic evidence base, systematically reviewed here with a summary of 32 CMR outcome studies with 8855 patients (range, n=25 to 1299). Ongoing trials on the clinicaltrials.gov website are also highlighted. The methodologies of systematic review were used with a search of electronic databases (PubMed, Medline) for studies published from 1998 to 2008 using key words in combination as both MeSH terms and text words. Major article references and the 2008 American Heart Association, American College of Cardiology, European Society of Cardiology (ESC), and Society for Cardiovascular Magnetic Resonance (SCMR) abstracts were also reviewed. In total, 32 CMR studies with outcome data (8855 patients, 22 253 patient-years) were included. In addition, more than 380 CMR trials registered on clinicaltrials.gov were reviewed for the presence of prognostic primary/secondary end points to indicate future research directions. ### CMR in Ischemic Heart Disease The assessment of ischemic heart disease (IHD) benefits from the multiplicity of techniques available within a single CMR study. Rest function is typically combined with the use of gadolinium chelate contrast agents in 3 postcontrast temporal phases: Perfusion (first pass) for microvascular obstruction (MVO, the tissue equivalent of no-reflow) and for ischemia, either at rest or during stress; early for MVO and thrombus detection; and late for focal interstitial expansion—the late gadolinium enhancement (LGE) technique for myocardial infarction (MI) and focal myocardial damage. The spatial resolution (up to 60-fold greater than single-photon emission computed tomography [SPECT]) and excellent image contrast of CMR makes it ideal for detecting these effects in a variety of clinical settings, as discussed below.6 #### Acute Coronary Syndromes In acute chest pain, the ECG and …
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