The Role of Magnetic Resonance Imaging in the Detection of Coronary Artery Disease

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Citation
US Cardiology - Volume 5 Issue 1;2008:5(1):31-33

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Cardiovascular magnetic resonance imaging (MRI) has moved from niche applications to the center of cardiovascular decision-making. Today, cardiovascular MRI offers several options for detecting ischemia in patients with known or suspected coronary artery disease (CAD). Over the last few years, much evidence has been accumulated of the diagnosis of CAD and heart failure with cardiovascular MRI.1–3

Safety and Feasibility

MRI is contraindicated in patients with non-compatible biometallic implants, pacemakers, and implanted cardioverter–defibrillators (ICDs), and in patients with claustrophobia.4 Coronary stents, sternal wires, and the majority of prosthetic valve types do not represent a contraindication for cardiovascular MRI. Ischemia can be detected by stress imaging techniques such as dobutamine stress MR (DSMR) or myocardial perfusion imaging; the patient’s heart rate and blood pressure and rhythm need to be monitored throughout the duration of the process.5

Detection of Ischemia and Coronary Artery Stenoses

Two fundamentally different strategies for assessing the presence of significant coronary artery lesions are available. The first is the direct visualization of the coronary arteries, which provides identical information to invasive angiography, such as the location and degree of coronary artery stenosis. The second is the assessment of physiological information by DSMR or first-pass perfusion imaging to induce and visualize myocardial ischemia.
The assessment of hemodynamics rather than the degree of stenosis has several advantages as luminal narrowing is only mildly related to a reduction of blood flow. Therefore, positive perfusion studies with normal epicardial coronary arteries may occur in specific situations, e.g. syndrome X (microvascular dysfunction), diabetes mellitus, or LV hypertrophy. Similarly, negative stress studies can be found in patients with higher-grade luminal stenosis, e.g. if they have sufficient collateralization. However, symptoms and prognosis of patients are closely related to the existence and severity of myocardial ischemia.

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References
  1. Pennell DJ, Pennell DJ, Sechtem UP, et al., J Cardiovasc Magn Reson, 2004;6(4):727–65.
    Crossref | PubMed
  2. Pennell DJ, Sechtem UP, Higgins CB, et al., Eur Heart J, 2004;25(21):1940–65.
    Crossref | PubMed
  3. Hendel RC, Patel MR, Kramer CM, et al., J Am Coll Cardiol, 2006;48(7):1475–97.
    Crossref | PubMed
  4. Faris OP, Shein M, Circulation, 2006;114(12): 1232–3.
    Crossref | PubMed
  5. Wahl A, Paetsch I, Gollesch A, et al., Eur Heart J, 2004;25(14):1230–36.
    Crossref | PubMed
  6. Nagel E, Lorenz C, Baer F, et al., J Cardiovasc Magn Reson, 2001;3(3):267–81.
    Crossref | PubMed
  7. Nagel E, Bornstedt A, Hug J, et al., Circulation, 1999;99(6):763–70.
    Crossref | PubMed
  8. Wahl A, Paetsch I, Roethemeyer S, et al., Radiology, 2004;233(1):210–16.
    Crossref | PubMed
  9. Hundley WG, Hamilton CA, Thomas MS, et al., Circulation, 1999;100(16): 1697–1702.
    Crossref | PubMed
  10. Paetsch I, Jahnke C, Ferrari VA, et al., Eur Heart J, 2006;27(12):1459–64.
    Crossref | PubMed
  11. Mandapaka S, Hundley WG, J Magn Reson Imaging, 2006;24(3):499–512.
    Crossref | PubMed
  12. Wellnhofer E, Olariu A, Klein C, et al., Circulation, 2004;109(18): 2172–4.
    Crossref | PubMed
  13. Hundley WG, Morgan TM, Neagle CM, et al.,Circulation, 2002; 106 (18):2328–33.
    Crossref | PubMed
  14. Jahnke C, Nagel E, Gebker R, et al., Circulation, 2007; 115(13):1769–76.
    Crossref | PubMed
  15. Giang TH, Nanz D, Coulden R, et al., Eur Heart J, 2004;25(18):1657–65.
    Crossref | PubMed
  16. Wolff SD, Schwitter J, Coulden R, et al., Circulation, 2004;110(6):732–7.
    Crossref | PubMed
  17. Bucciarelli-Ducci C,Wu E, Lee DC, et al., Curr Probl Cardiol, 2006;31(2):128–68.
    Crossref | PubMed
  18. Klem I, Heitner JF, Shah DJ, et al.,J Am Coll Cardiol, 2006;47(8):1630–38.
    Crossref | PubMed
  19. Schwitter J, Nanz D, Kneifel S, et al., Circulation, 2001;103(18):2230–35.
    Crossref | PubMed
  20. Al-Saadi N, Nagel E, Gross M, et al., Circulation, 2000;101(12): 1379–83.
    Crossref | PubMed
  21. Ibrahim T, Nekolla SG, Schreiber K, et al., J Am Coll Cardiol, 2002;39(5):864–70.
    Crossref | PubMed
  22. Nagel E, Klein C, Paetsch I, et al., Circulation, 2003;108(4):432–7.
    Crossref | PubMed
  23. Ingkanisorn WP, Kwong RY, Bohme NS, et al., J Am Coll Cardiol, 2006;47(7):1427–32.
    Crossref | PubMed
  24. Kim RJ, Shah DJ, Judd RM, J Cardiovasc Magn Reson, 2003;5(3): 505–14.
    Crossref | PubMed
  25. Arheden H, Saeed M, Higgins CB, et al., Radiology, 1999; 211(3):698–708.
    Crossref | PubMed
  26. Sakuma H, J Magn Reson Imaging, 2007;26(1):3–13. .
    Crossref | PubMed
  27. Abdel-Aty H, Zagrosek A, Schulz-Menger J, et al., Circulation, 2004;109(20):2411–16.
    Crossref | PubMed
  28. Kim RJ,Wu E, Rafael A, et al., N Engl J Med, 2000;343(20):1445–53.
    Crossref | PubMed
  29. Choi KM, Kim RJ, Gubernikoff G, et al., Circulation, 2001;104(10):1101–7.
    Crossref | PubMed
  30. Roes SD, Kelle S, Kaandorp TA, et al., Am J Cardiol, 2007;100(6):930–36.
    Crossref | PubMed
  31. Yan AT, Shayne AJ, Brown KA, et al., Circulation, 2006;114(1):32–9.
    Crossref | PubMed
  32. Pedersen M, J Magn Reson Imaging, 2007;25(5):881–3.
    Crossref | PubMed
  33. Murphy KP, Szopinski KT, Cohan RH, et al., Acad Radiol, 1999;6:656–64.
    Crossref | PubMed
  34. US FDA (CDER), www.fda.gov/cder/drug/advisory/ gadolinium_agents_ 20061222.htm
  35. Joffe P, Henrik ST, Monika M, Acad Radiol, 1998;5(7):491–502.
    Crossref | PubMed