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

Abstract

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.

Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging

“…Cardiovascular magnetic resonance (CMR), thanks to excellent spatial, temporal and contrast resolution, represents one of the most effective non-invasive functional tests for the assessment of functionally relevant CAD [47][48][49][50], with a solid role from both diagnostic and prognostic perspectives [51][52][53]. In the MR-INFORM (Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease) trial, Nagel et al showed that a non-invasive imaging approach with stress perfusion CMR was not inferior to invasive assessment with fractional flow reserve (FFR) in planning appropriate invasive procedures with respect to future cardiac events [48].…”

The Applications of Artificial Intelligence in Cardiovascular Magnetic Resonance—A Comprehensive Review

“…Cardiac magnetic resonance has demonstrated the ability to prognosticate various cardiovascular conditions [ 6 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ]. Cheng et al showed that greater heterogenicity of LGE in patients with HCM and systolic dysfunction was associated with adverse events [ 99 ].…”

Artificial Intelligence Based Multimodality Imaging: A New Frontier in Coronary Artery Disease Management

“…S-CMR is a powerful diagnostic tool that allows a comprehensive evaluation of known or suspected CAD patients. Different from other techniques, S-CMR combines the evaluation of global cardiac function with an accurate and reproducible definition of regional myocardial viability by combining information on cardiac muscle function, tissue characterization, persistent and inducible ischemia (34).…”