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Cardiovascular magnetic resonance in the evaluation of heart failure
  1. Ravi G Assomull,
  2. Dudley J Pennell,
  3. Sanjay K Prasad
  1. Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
  1. Correspondence to:
    Dr Sanjay K Prasad
    Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; s.prasad{at}rbht.nhs.uk

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Heart failure is a common disorder that is associated with significant morbidity, mortality and financial burden to healthcare services. In the UK, around 900 000 people have been diagnosed with heart failure and the prevalence of the condition increases as the population ages.w1 Population-based studies suggest that heart failure carries a worse prognosis than breast and colon cancer, with estimates suggesting a 1 year mortality of 40% from the time of diagnosis. Heart failure currently accounts for a total of one million inpatient bed days and admissions are projected to rise by 50% over the next 25 years. Heart failure treatment currently absorbs 1.8% of the total National Health Service budget, of which 70% is spent on hospitalisation.

Accurate diagnosis, assessment and risk stratification of such patients by imaging modalities is important, particularly with the advent of effective but expensive implantable devices. In the last 5 years, there have been tremendous advances in the ability of cardiovascular magnetic resonance (CMR) to fulfil many of these needs and provide a comprehensive assessment.1 A combination of hardware and software developments means that a modern CMR scanner is able to yield information on myocardial anatomy, function, tissue characterisation, viability, perfusion and flow within a single 45–60 min study.

HOW DOES CMR WORK AND WHAT INFORMATION CAN IT PROVIDE?

Basic principles

Understanding the way in which CMR works provides a basis for appreciating its role in evaluating patients with heart failure. CMR yields high contrast and high resolution images of the heart by mapping radio wave signals absorbed and emitted by hydrogen nuclei (protons) in a powerful magnetic field. Most cardiovascular pathologies manifest with an increase in water content which is rich in protons so that CMR is a sensitive guide to early disease states. CMR is currently mainly performed at a magnetic field strength of 1.5 Tesla (T). The two main types of …

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