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Education in Heart
NON-INVASIVE IMAGING
Advances in cardiovascular magnetic resonance in ischaemic heart disease and non-ischaemic cardiomyopathies Manish Motwani, Ananth Kidambi, John P Greenwood, Sven Plein ▸ Additional references are published online. To view please visit the journal (http:// dx.doi.org/10.1136/heartjnl2013-304680). Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK Correspondence to Professor S Plein, Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK; [email protected] Published Online First 2 April 2014
In 2008, Heart published an overview of advances in cardiovascular magnetic resonance (CMR) and their clinical application.1 Since then, the evidence for the use of CMR both as a clinical and cardiovascular research tool has increased further. In 2010, the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American College of Radiology, and the Society for Cardiovascular Magnetic Resonance (SCMR) produced an expert consensus document that provided an up-to-date perspective on the current state of CMR and its clinical applications.2 Data from the large EuroCMR registry continue to demonstrate the impact of the clinical information gained by CMR on patient management, and more data regarding the prognostic impact of CMR have emerged across a spectrum of cardiovascular diseases.3 w1–4 Reflecting this growing body of evidence, recent European and North American practice guidelines have endorsed the use of CMR in several clinical scenarios, including chest pain and heart failure.4–7 w5 Standardisation of CMR training, protocols and reporting has progressed with several recommendation papers published over the past 5 years reflecting the increasing maturity of this imaging modality.w6–10 Finally, further technical advances and innovations have refined CMR methods and provided novel techniques. This article focuses on advances in CMR in ischaemic heart disease (IHD) and non-ischaemic cardiomyopathies, as well as touching on potential future applications.
ADVANCES IN CMR ASSESSMENT OF IHD CMR produces high resolution images which can be acquired in any plane and allow the assessment of global and regional cardiac function, myocardial perfusion, myocardial viability, tissue characterisation, and proximal coronary anatomy. Here we summarise recent clinical evidence for the role of CMR in the assessment of IHD and further technical advances.
Clinical validation of stress perfusion CMR
To cite: Motwani M, Kidambi A, Greenwood JP, et al. Heart 2014;100:1722–1733. 1722
The use of stress perfusion CMR as a first line diagnostic tool in patients with IHD has been the subject of several recent clinical studies and meta-analyses.8 9 w11 w12 The most recent meta-analysis of 37 studies of CMR demonstrated a pooled sensitivity of 89% (95% CI 88% to 91%) and pooled specificity of 76% (95% CI 73% to 78%) for the detection of angiographically defined IHD.w12 In the large single centre CE-MARC study (n=752), CMR had higher
sensitivity (87% vs 67%, p50% QCA>50% QCA>50% QCA ≥50% FFR
Education in Heart
NON-INVASIVE IMAGING
Advances in cardiovascular magnetic resonance in ischaemic heart disease and non-ischaemic cardiomyopathies Manish Motwani, Ananth Kidambi, John P Greenwood, Sven Plein ▸ Additional references are published online. To view please visit the journal (http:// dx.doi.org/10.1136/heartjnl2013-304680). Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK Correspondence to Professor S Plein, Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK; [email protected] Published Online First 2 April 2014
In 2008, Heart published an overview of advances in cardiovascular magnetic resonance (CMR) and their clinical application.1 Since then, the evidence for the use of CMR both as a clinical and cardiovascular research tool has increased further. In 2010, the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American College of Radiology, and the Society for Cardiovascular Magnetic Resonance (SCMR) produced an expert consensus document that provided an up-to-date perspective on the current state of CMR and its clinical applications.2 Data from the large EuroCMR registry continue to demonstrate the impact of the clinical information gained by CMR on patient management, and more data regarding the prognostic impact of CMR have emerged across a spectrum of cardiovascular diseases.3 w1–4 Reflecting this growing body of evidence, recent European and North American practice guidelines have endorsed the use of CMR in several clinical scenarios, including chest pain and heart failure.4–7 w5 Standardisation of CMR training, protocols and reporting has progressed with several recommendation papers published over the past 5 years reflecting the increasing maturity of this imaging modality.w6–10 Finally, further technical advances and innovations have refined CMR methods and provided novel techniques. This article focuses on advances in CMR in ischaemic heart disease (IHD) and non-ischaemic cardiomyopathies, as well as touching on potential future applications.
ADVANCES IN CMR ASSESSMENT OF IHD CMR produces high resolution images which can be acquired in any plane and allow the assessment of global and regional cardiac function, myocardial perfusion, myocardial viability, tissue characterisation, and proximal coronary anatomy. Here we summarise recent clinical evidence for the role of CMR in the assessment of IHD and further technical advances.
Clinical validation of stress perfusion CMR
To cite: Motwani M, Kidambi A, Greenwood JP, et al. Heart 2014;100:1722–1733. 1722
The use of stress perfusion CMR as a first line diagnostic tool in patients with IHD has been the subject of several recent clinical studies and meta-analyses.8 9 w11 w12 The most recent meta-analysis of 37 studies of CMR demonstrated a pooled sensitivity of 89% (95% CI 88% to 91%) and pooled specificity of 76% (95% CI 73% to 78%) for the detection of angiographically defined IHD.w12 In the large single centre CE-MARC study (n=752), CMR had higher
sensitivity (87% vs 67%, p50% QCA>50% QCA>50% QCA ≥50% FFR
