Role of Cardiac Magnetic Resonance Imaging in Myocardial Infarction

Carità, Patrizia; Rabbat, Mark; Guglielmo, Marco; Baggiano, Andrea; Muscogiuri, Giuseppe; Guaricci, Andrea Igoren

doi:10.1007/s11886-017-0907-1

Cited by 14 publications

(13 citation statements)

References 74 publications

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“…If recent strong evidences [ 16 , 17 ] have favoured in Europe a relevant spin-off of CCTA in the field of CCS against functional imaging [ 18 , 19 ], numerous data have underlined the excellent sensibility and specificity of S-CMR in CAD diagnosis and patient risk classification with a long-standing scientific evidence [ 20 , 21 ].…”

Section: Clinical Applications and Technical Approachmentioning

confidence: 99%

Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role

Baessato

Guglielmo

Muscogiuri

et al. 2021

BioMed Research International

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The recently published 2019 guidelines on chronic coronary syndromes (CCS) focus on the need for noninvasive imaging modalities to accurately establish the diagnosis of coronary artery disease (CAD) and assess the risk of clinical scenario occurrence. Appropriate patient management should rely on controlling symptoms, improving prognosis, and guiding each therapeutic strategy as well as monitoring disease progress. Among the noninvasive imaging modalities, cardiovascular magnetic resonance (CMR) has gained broad acceptance in past years due to its unique features in providing a complete assessment of CAD through data on cardiac anatomy and function and myocardial viability, with high spatial and temporal resolution and without ionizing radiation. In detail, evaluation of the presence and extent of myocardial ischemia through stress CMR (S-CMR) has shown a high rule-in power in detecting functionally significant coronary artery stenosis in patients suspected of CCS. Moreover, S-CMR technique may add significant prognostic value, as demonstrated by different studies which have progressively evidenced the valuable power of this multiparametric imaging modality in predicting adverse cardiac events. The latest scientific progress supports a greater expansion of S-CMR with improvement of quantitative myocardial perfusion analysis, myocardial strain, and native mapping within the same examination. Although further study is warranted, these techniques, which are currently mostly restricted to the research field, are likely to become increasingly prevalent in the clinical setting with the scope of increasing accuracy in the selection of patients to be sent to invasive revascularization. This review investigates the diagnostic and prognostic role of S-CMR in the context of CAD, by analysing a strong, long-standing, scientific evidence together with an appraisal of new advanced techniques which may potentially enrich CAD management in the next future.

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Section: Clinical Applications and Technical Approachmentioning

confidence: 99%

Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role

Baessato

Guglielmo

Muscogiuri

et al. 2021

BioMed Research International

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“…Cine SSFP sequences provide high temporal and spatial resolution with marked tissue contrast and the use of electrocardiographically gated breathhold acquisitions in any desired plane. They can also show valvular disfunction, thrombosis, and pericardial effusion (7)(8)(9). Phase-contrast imaging may be used to quantify the amount and severity of ischemic mitral regurgitation.…”

Section: State-of-the-art Protocolmentioning

confidence: 99%

“…The area at risk refers to the ischemic myocardium corresponding to the jeopardized perfusion territory of the culprit coronary artery, which is potentially irreversibly damaged if reperfusion does not occur (ie, viable and nonviable myocardium). In comparison, the infarcted zone is defined as the necrotic irreversible area of scarring (9). As a result, the MSI is obtained by subtracting the infarct size from the area at risk (Fig 1) (9).…”

Section: Cardiac Mri and Acute MI Basic Conceptsmentioning

confidence: 99%

“…In comparison, the infarcted zone is defined as the necrotic irreversible area of scarring (9). As a result, the MSI is obtained by subtracting the infarct size from the area at risk (Fig 1) (9). The amount of myocardium that is salvaged by reperfusion therapy is identified with the MSI (eg, 0% for no salvage, 100% for complete salvage), which gives information on the effects of treatment.…”

Section: Cardiac Mri and Acute MI Basic Conceptsmentioning

confidence: 99%

“…The presence of elevated cardiac biomarker levels and acute chest pain is not specific for acute MI because there are other cardiac diseases that could manifest in a similar manner, namely myocarditis, MI with nonobstructive coronary arteries (MINOCA), and Takotsubo cardiomyopathy (Table 3). Distinguishing among these entities early in the course of the disease is important because treatment and prognosis are substantially different from those for acute MI secondary to coronary artery disease (7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

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Cardiac MRI in Patients with Acute Chest Pain

Broncano

Bhalla

Caro³

et al. 2021

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Acute chest pain is a common reason for visits to the emergency department. It is important to distinguish among the various causes of acute chest pain, because treatment and prognosis are substantially different among the various conditions. It is critical to exclude acute coronary syndrome (ACS), which is a major cause of hospitalization, death, and health care costs worldwide. Myocardial ischemia is defined as potential myocyte death secondary to an imbalance between oxygen supply and demand due to obstruction of an epicardial coronary artery. Unobstructed coronary artery disease can have cardiac causes (eg, myocarditis, myocardial infarction with nonobstructed coronary arteries, and Takotsubo cardiomyopathy), and noncardiac diseases can manifest with acute chest pain and increased serum cardiac biomarker levels. In the emergency department, cardiac MRI may aid in the identification of patients with non-STsegment elevation myocardial infarction or unstable angina or ACS with unobstructed coronary artery disease, if the patient's clinical history is known to be atypical. Also, cardiac MRI is excellent for risk stratification of patients for adverse left ventricular remodeling or major adverse cardiac events. Cardiac MRI should be performed early in the course of the disease (<2 weeks after onset of symptoms). Steady-state free-precession T2-weighted MRI with late gadolinium enhancement is the mainstay of the cardiac MRI protocol. Further sequences can be used to analyze the different pathophysiologic subjacent mechanisms of the disease, such as microvascular obstruction or intramyocardial hemorrhage. Finally, cardiac MRI may provide several prognostic biomarkers that help in follow-up of these patients.

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Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Falcão‐Pires,

Ferreira,

Trindade

et al. 2024

European J of Heart Fail

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Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD‐induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin–angiotensin–aldosterone system inhibitors, beta‐blockers, diuretics and sodium–glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end‐diastolic/end‐systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre‐clinical evaluation.

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Role of Cardiac Magnetic Resonance Imaging in Myocardial Infarction

Cited by 14 publications

References 74 publications

Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role

Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role

Cardiac MRI in Patients with Acute Chest Pain

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

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