Abstract
The utility of cardiac magnetic resonance imaging (CMR) as a diagnostic technique is well established. CMR enables tissue characterization, distinction between myocardial scar tissue and viable tissue, and evaluation of myocardial perfusion and contractile function. To date, CMR has been mostly applied in the assessment of stable disease; however, a role for CMR in the acute setting is also emerging. An accurate appraisal of the myocardium with CMR in the first hours after the onset of chest pain could provide supporting information to standard diagnostic tools, such as electrocardiography and measurement of blood biomarkers, which could help guide the selection of appropriate treatment. The aims of this integrated approach include positive identification of an ischemic syndrome, estimation of downstream areas at risk of damage, evaluation of epicardial artery patency and small vessel integrity, quantification of infarct size, and determination of myocardial function. This Review critically evaluates both established and emerging CMR techniques, and relates the imaging findings to the underlying pathophysiological processes in acute coronary syndromes. A more thorough understanding of CMR techniques will clarify their potential clinical applications and limitations, and assess the practicality of CMR in the setting of acute coronary syndromes, where early intervention is crucial to save myocardium at risk of irreversible injury.
Key Points
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Cardiac magnetic resonance imaging (CMR) is widely used for diagnosis of coronary artery disease and to assess myocardial viability and function
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Efficient treatment needs to be in place early for patients with acute coronary syndromes (ACS) to improve long-term prognosis
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Currently available diagnostic tools in the emergency department are often not sufficient to inform appropriate treatment in the setting of ACS
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New CMR techniques are emerging that provide useful information to further characterize the myocardium and provide a more thorough understanding of pathophysiological processes
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Further investigations are needed to prove that CMR assessment of the myocardium in ACS may be useful to manage or change treatment and, more importantly, improve prognosis
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R. P. Choudhury receives funding from the Wellcome Trust and The British Heart Foundation. E. Dall'Armellina is supported by the NIHR Oxford Comprehensive Biomedical Research Centre funding scheme.
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E. Dall'Armellina and R. P. Choudhury contributed to discussion of content for the article, researched data to include in the manuscript, wrote the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments. T. D. Karamitsos and S. Neubauer contributed to discussion of content for the article, and reviewed and edited the manuscript before submission.
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Dall'Armellina, E., Karamitsos, T., Neubauer, S. et al. CMR for characterization of the myocardium in acute coronary syndromes. Nat Rev Cardiol 7, 624–636 (2010). https://doi.org/10.1038/nrcardio.2010.140
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DOI: https://doi.org/10.1038/nrcardio.2010.140
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