Exercise cardiovascular magnetic resonance: development, current utility and future applications
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(2020) 22:65
REVIEW
Open Access
Exercise cardiovascular magnetic resonance: development, current utility and future applications Thomas P. Craven1* , Connie W. Tsao2, Andre La Gerche3,4, Orlando P. Simonetti5 and John P. Greenwood1
Abstract Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has developed over the past 25 years to combine the superior image qualities of CMR with the preferred method of exercise stress. Presently, numerous exercise methods exist, from performing stress on an adjacent CMR compatible treadmill to in-scanner exercise, most commonly on a supine cycle ergometer. Cardiac conditions studied by Ex-CMR are broad, commonly investigating ischaemic heart disease and congenital heart disease but extending to pulmonary hypertension and diabetic heart disease. This review presents an in-depth assessment of the various Ex-CMR stress methods and the varied pulse sequence approaches, including those specially designed for Ex-CMR. Current and future developments in image acquisition are highlighted, and will likely lead to a much greater clinical use of Ex-CMR across a range of cardiovascular conditions. Keywords: Cardiovascular magnetic resonance, Exercise cardiovascular magnetic resonance, Stress cardiovascular magnetic resonance, Exercise stress, Treadmill cardiovascular magnetic resonance, Supine cycle ergometer
Background Stress testing can be a pivotal tool for the diagnostic and prognostic assessment of cardiovascular disease. Historically for coronary artery disease (CAD), treadmill electocardiography (ECG) was the reference standard [1, 2]. However, the use of stress cardiac imaging for exercise testing has significantly improved the diagnostic accuracy for CAD detection compared to exercise ECG alone [3–8]. Thus stress imaging is now the preferred investigation for CAD diagnosis in intermediate risk patients and a useful tool for prognostication and decision making [9, 10]. Cardiovascular magnetic resonance (CMR) has several well established benefits over alternative imaging modalities, allowing a non-invasive comprehensive * Correspondence: [email protected] 1 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK Full list of author information is available at the end of the article
multi-parametric assessment, with few limitations from body habitus, no ionizing radiation [11], and is the noninvasive gold standard for bi-ventricular volume and functional assessment [12, 13]. Pharmacological stress CMR has become widely utilised clinically, demonstrating superiority over myocardial perfusion scintigraphy by single photon emission computed tomography (MPSSPECT) in the diagnosis [14, 15] and prognosis of CAD [16] and recently, a lower incidence of revascularization and non-inferiority in major adverse cardiac events compared to CAD management guided
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