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11.3 Coronary artery disease
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Published:July 2018
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This version:November 2019
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Abstract
In the work-up of suspected or known coronary artery disease (CAD), cardiovascular magnetic resonance (CMR) is an established technique and it is recommended by most recent guidelines. Stress dobutamine and stress perfusion CMR yield sensitivities and specificities to detect anatomically defined CAD (>50% coronary stenoses) ranging from 83% to 91% and from 83% to 86%, respectively, with areas under the receiver operating characteristic curve (AUCs) of 0.80–0.93. Multicentre trials report AUCs of 0.75–0.91 to detect CAD and showed superiority over scintigraphic techniques. Increasing evidence in thousands of patients demonstrates the high predictive value of CMR. Exclusion of ischaemia by CMR goes along with excellent event-free survival rates of 0.5–0.9%/year. Cost analyses in large data sets (e.g. in the European CMR registry), suggest considerable cost savings for CMR over first-line invasive strategies in suspected CAD. Tissue characterization by CMR to detect scar, necrosis, oedema, microvascular obstruction, or haemorrhage is of particular importance in the setting of acute coronary syndromes and this application is emerging as the number of centres offering CMR increases.
Update:
The large multicentre United States registry (SPINS trial) confirms high performance of perfusion cardiovascular magnetic resonance (CMR) to ...More
Update:
The large multicentre United States registry (SPINS trial) confirms high performance of perfusion cardiovascular magnetic resonance (CMR) to detect coronary artery disease (CAD), to guide CAD management, and to reduce costs. Large prospective multicentre trials confirm the high diagnostic performance of perfusion CMR to detect CAD in patients with suspected disease (GadaCAD 1 and 2) and the safe management of CAD patients by CMR in comparison to invasive fractional flow reserve-guided management (MR-INFORM trial).
CMR is recommended by European Society of Cardiology guidelines to evaluate patients with myocardial infarction with non-obstructive coronary arteries (MINOCA).
While not yet in clinical routine, further dedicated pulse sequences and additional evidence accumulates on quantitative myocardial perfusion by CMR.
First-in-man application of hyperpolarized contrast media to measure myocardial perfusion and metabolism by CMR in patients has been reported.
There is accumulating evidence that post-ischaemic scar as detected by CMR predicts arrhythmias and sudden cardiac death in post-myocardial infarction patients.
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