Role of Advanced Cardiac MR Imaging Techniques in the Evaluation of Coronary Artery Disease

Abstract

Myocardial infarction (MI) is myocardial cell death as a result of prolonged ischemia that results in an inadequate supply of oxygenated blood to an area of the myocardium, particularly when ischemia exceeds a critical threshold that overwhelms cellular repair mechanisms. MI is typically caused by luminal thrombosis superimposed on coronary atherosclerosis; occasionally, it can be caused by coronary spasm, coronary embolism, or thrombosis in nonatherosclerotic vessels. Arteritis, dissection, congenital abnormalities, hypercoagulable states, and cocaine use are uncommon causes. Over the past decades cardiac magnetic resonance imaging (MRI) has emerged as an accurate diagnostic technique for the evaluation of patients with ischemic heart disease (IHD). In the acute setting of IHD, i.e. acute myocardial infarction (MI), comprehensive cardiac MRI study enables to precisely characterize the ischemic myocardial injury by differentiating the reversible from irreversible damaged tissue along with the depiction of microvascular injury. In the post-infarction phase, regional and global left ventricular (LV) post-infarction remodeling along with viability assessment by cardiac MRI provide crucial information for patients management and risk stratification. MR tagging–derived strains provide useful objective quantitative indexes that are superior to the simple visual assessment of LV motion abnormalities and improve the diagnostic performance of a dobutamine stress test for the detection of coronary heart disease in patients with complaints of chest pain.