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Acute coronary syndromes
MRI in the assessment of ischaemic heart disease
  1. Amardeep Ghosh Dastidar,
  2. Jonathan CL Rodrigues,
  3. Anna Baritussio,
  4. Chiara Bucciarelli-Ducci
  1. NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Bristol, UK
  1. Correspondence to Dr Chiara Bucciarelli-Ducci, NIHR Bristol Cardiovascular Biomedical Research Unit, CMR Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8HW, UK; c.bucciarelli-ducci{at}bristol.ac.uk

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Learning objectives

  • To understand the principles of using cardiac MRI (CMR) in patients with ischaemic heart disease (IHD).

  • To understand the various CMR techniques used in the assessment of IHD.

  • To review the current evidence and indications for the use of CMR in acute and chronic IHD.

Introduction

Ischaemic heart disease (IHD) is the leading cause of death worldwide. Over the last two decades, cardiac MRI (CMR) has emerged as a promising non-invasive modality in the assessment of patients with suspected and established IHD due to its good spatial resolution, high reproducibility and myocardial tissue characterisation capabilities, thereby aiding in the diagnosis, guiding clinical decision-making and improving risk stratification.

This article provides an overview of why, when and where CMR may fit into the routine clinical practice.

A) CMR imaging techniques

The cornerstone of CMR is its multiparametric nature, that is, its ability to assess multiple aspects of myocardial structure and function in a single examination with the aid of various imaging techniques. The combination of techniques used is tailored to the clinical question.

Cine imaging

CMR is the current non-invasive gold standard method to measure left and right ventricular (LV and RV) volumes and ejection fraction.1 ,2 For CMR volumetric assessment, the ventricles are sliced from base to apex and the endocardium and epicardium subsequently contoured (figure 1). Therefore, it is truly three-dimensional (3D) without relying on geometrical assumptions, unlike 2D echocardiography. However, the third axis information is limited compared with 3D echocardiography or 3D multislice CT. Both the CMR long-axis and short-axis views are similar to echocardiography, as well as the myocardial segmental nomenclature (except the 17th segment apical cap, usually omitted in echocardiography).3

Figure 1

Top panel shows the four-chamber and two-chamber cines. Lower panel (1–9) short-axis cine dataset covering the heart, obtained by cutting the heart from base to apex.

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