CMR in the diagnosis of ischemic heart disease
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CARDIAC RADIOLOGY
CMR in the diagnosis of ischemic heart disease Vitaliano Buffa1 · Paolo Di Renzi2 Received: 23 June 2020 / Accepted: 3 September 2020 © Italian Society of Medical Radiology 2020
Abstract Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae. Keywords Cardiac magnetic resonance · Ischemic heart disease · Stress perfusion cardiac magnetic resonance · Myocardial infarction
Introduction Despite the high incidence of acute myocardial Infarction in the world, new therapies and new imaging modality have increased survival and reduced cardiovascular events. In Italy, acute myocardial Infarction (AMI) entails an in hospital mortality of 4.12% and 1-year mortality of 10%. Cardiovascular magnetic resonance (CMR) has been always more often used in the last 10 years in evaluation of many end point due to its peculiar features that represent surrogate markers of end points itself [1, 2].
Definition of myocardial infarction Definition of myocardial infarction (MI) has been changed in the course of last 15 years. The fourth universal definition of myocardial infarction (FUDMI) published in 2018 underlines new concepts in order to differentiation between myocardial infarction and myocardial injury and, among others, * Vitaliano Buffa [email protected] Paolo Di Renzi [email protected] 1
Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
2
in order to highlight peri-procedural myocardial injury after cardiac and noncardiac procedures as discrete from myocardial infarction. In the new FUDMI, cardiovascular magnetic resonance (CMR) is now clearly considered in the assessment of myocardial injury [3]. Myocardial injury, defined by an elevated cardiac troponin (cTn) value above the 99th percentile upper reference limit (URL), is frequently encountered clinically and is associated with an adverse prognosis [4, 5]. Myocardial injury must to be considered as a prerequisite for the diagnosis of MI, but, on the other hand, it is to be considered a separate specific entity. Nonischemic myocardial injury may arise secondary to many cardiac conditions such as myocarditis, heart failure, or may be associated with noncardiac conditions such as renal failure [6] and in a patient with symptoms and increased cardiac troponin (cTn) values, it is mandatory to distinguish between nonischemic myocardial injury and one of the MI subtypes. Finally, in the cited FUDMI consensus document new sections have been added due to the clin
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