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Published on: July 19, 2013
Assessment of myocardial viability by cardiac MRI
Basil Al-Sabeq1, Faisal Nabi, Dipan J Shah
1Division of Cardiovascular Imaging, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
Insights
Cardiac magnetic resonance (CMR) is a powerful tool for assessing myocardial viability in patients with coronary artery disease. This review highlights CMR
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Coronary artery disease frequently causes left ventricular systolic dysfunction.
- Determining which patients benefit from revascularization is challenging.
- Myocardial viability testing aids in guiding revascularization decisions.
Purpose of the Study:
- To review the role of cardiac magnetic resonance (CMR) in myocardial viability assessment.
- To emphasize CMR's unique strengths compared to other imaging modalities.
Main Methods:
- Review of existing literature on cardiac magnetic resonance for viability testing.
- Focus on late gadolinium enhancement imaging techniques.
- Discussion of ST-elevation myocardial infarction patient data.
Main Results:
- Transmural extent of hyperenhancement in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention can regress over time.
- CMR is a powerful and well-tolerated imaging modality for viability assessment.
- Observational data suggest a prognostic role for viability, but randomized studies are needed.
Conclusions:
- Cardiac magnetic resonance is a valuable tool for myocardial viability assessment when it influences patient management.
- Further randomized studies are required to confirm the prognostic role of viability testing.
- CMR's unique strengths make it a key imaging modality in this field.
Purpose Of Review:
Left ventricular systolic dysfunction because of coronary artery disease is common, and ascertaining which patients will benefit from revascularization can be challenging. Viability testing is an accepted means by which to base this decision, with multiple noninvasive imaging modalities available for this purpose. This review aims to highlight the key role of cardiac magnetic resonance in myocardial viability assessment, with a focus on its unique strengths over other imaging modalities.
Recent Findings:
Transmural extent of hyperenhancement with late gadolinium imaging has been shown to be greater acutely in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and regress at follow-up studies. An explanation for this reported phenomenon and an argument against redefining CMR viability criteria in the acute setting will be offered.
Summary:
Although not universally available, cardiac magnetic resonance is an exceptionally powerful and well tolerated imaging modality that should be considered when viability testing will influence patient management. Although observational outcomes data suggest a promising prognostic role for viability, randomized studies in this area are needed.
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