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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
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.
Steady State Free Precession …
Footnotes
Contributors CBD conceived and designed the work. AGD and JCLR drafted the manuscript, AB revised it, and all authors reviewed the current published literature and critically revised it for important intellectual content and approved the final version to be submitted. CBD is the guarantor of the paper, taking responsibility for the integrity of the work as a whole.
Disclaimer The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health Research, or Department of Health.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.