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Myocardial viability: magnetic resonance assessment of functional reserve and tissue characterization
N Watzinger1, M Saeed, M F Wendland
1Department of Radiology, University of California, San Francisco, USA.
Insights
Determining myocardial viability is key for patients with left ventricular dysfunction. Magnetic resonance imaging (MRI) offers advanced techniques to assess viable myocardium, guiding revascularization decisions and improving patient outcomes.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Cardiac MRI
Background:
- Myocardial viability assessment is critical for patients with left ventricular dysfunction due to ischemia or coronary artery disease.
- Revascularization benefits viable myocardium; treating scar tissue offers no advantage and poses risks.
- Established methods include echocardiography and radionuclide imaging.
Purpose of the Study:
- To review advancements in Magnetic Resonance Imaging (MRI) techniques for assessing myocardial viability.
- To highlight the current and future role of MRI in evaluating viable myocardium.
Main Methods:
- MRI offers multiple approaches for assessing acute ischemic injury and hibernating myocardium.
- Contractile reserve can be evaluated using MRI, similar to echocardiography.
- Contrast-enhanced MRI characterizes ischemic injury and differentiates viable from nonviable myocardial zones.
Main Results:
- MRI provides comprehensive methods for myocardial viability assessment.
- New contrast agents enhance the characterization of myocardial ischemic injury.
- MRI's ability to discriminate viable from nonviable tissue is a significant advancement.
Conclusions:
- MRI is a powerful tool for determining myocardial viability.
- The review focuses on MR techniques for defining myocardial viability.
- MRI plays an increasingly important role in guiding patient management for coronary artery disease.
Abstract:
The determination of myocardial viability is crucial in patients with left ventricular dysfunction resulting from acute myocardial ischemia or chronic coronary artery disease. Viable myocardium will most likely benefit from revascularization procedures. However, the revascularization of scar tissue will not lead to improvement of ventricularfunction andfurthermore bears unnecessary riskfor the patient. Currently, echocardiographic and radionuclide techniques are the most established methods for the assessment of presence and extent of viable myocardium. Magnetic resonance imaging (MRI) also provides multiple approaches for determining viability of acute ischemically injured and hibernating myocardium. MRI can assess contractile reserve in a manner similar to echocardiography. Additionally, contrast-enhanced MRI can characterize myocardial ischemic injury, including the ability to discriminate viable from nonviable zones. Several new contrast media have been introduced for this purpose. This review addresses the progress toward the goal of defining myocardial viability based on MR techniques and focuses on the current and future role of MR in the assessment of viable myocardium.