Use of Cardiovascular Magnetic Resonance Imaging in Acute Coronary Syndromes

Abstract

The clinical role of cardiovascular magnetic resonance (CMR) continues to expand,1 supported by ongoing technological advances that have shortened acquisition times while maintaining and often improving image quality. New applications of CMR in cardiovascular imaging continue to emerge, and results from larger clinical trials are beginning to define the role of CMR in a range of clinical scenarios. Currently accepted indications for CMR include the assessment of congenital heart disease, the great vessels, acquired myocardial and pericardial disease, and chronic coronary artery disease (CAD).1 The role of CMR in the assessment of acute coronary syndromes (ACS) is less well established. However, evidence is accumulating that CMR provides often unique information in chest pain syndromes that can aid in the detection and differential diagnosis of ACS, guide clinical decision making, and improve risk stratification after an event. After reviewing the relevant CMR methodology, the present article puts forward the current evidence for CMR in ACS and gives an outlook of future developments. The following CMR methods are most commonly used to assess ACS (Figure 1) and can be incorporated into a clinical protocol that can be performed within an hour. Figure 1. A, CMR methods for assessment of ACS. Short-axis views (of different patients) illustrate the different imaging techniques used (rows 1 and 2), their morphological correlates (row 3), and main clinical application (row 4). B, These methods can be integrated into a CMR protocol in the sequence indicated to provide a comprehensive assessment of ACS patients. Such a study can be performed in less than 1 hour. Gd indicates gadolinium. ### Cine Imaging The assessment of global and regional left ventricular (LV) and right ventricular (RV) function by CMR is typically based on a cine data set aligned in the true LV short axis that covers the heart in 10 to …