Kardiale Magnetresonanztomografie bei koronarer Herzerkrankung

Abstract

The accurate noninvasive diagnosis and functional evaluation of patients with suspected or known coronary artery disease represents the cornerstone in clinical decision making to enable appropriate selection of therapeutic strategies. Over the past decade, a plethora of evidence has been gathered demonstrating the importance of cardiac magnetic resonance (CMR) imaging in the diagnostic workup of patients with chronic coronary artery disease and acute coronary syndromes. CMR techniques have become mature for determining myocardial ischemia, viability and scar and are widely employed in clinical routine. Comprehensive CMR imaging is mainly based on the versatility of the imaging modality and supplies the clinician with a broad range of useful morphological and functional information regarding cardiovascular diseases.

Kernaussagen

• Der klinische Nutzen und die Wertigkeit der CMR zur Abbildung myokardialer Ischämiereaktionen und zur Infarktnarbendarstellung ist gut validiert. Die CMR ist daher inzwischen ein fester Bestandteil der klinischen Routinediagnostik und Verlaufsbeurteilung von Patienten mit bekannter oder vermuteter KHK.

• Die CMR bietet die einzigartige Möglichkeit einer umfassenden nicht invasiven Beurteilung von myokardialer Viabilität, Ischämie und Infarktnarbe durch die Kombination von regionaler Wandbewegungs- und Perfusionsanalyse in Ruhe und unter pharmakologischer Belastung zusammen mit Spätaufnahmen („delayed enhancement”).

• Die CMR kann zur Diagnostik eines akuten Koronarsyndroms hinzugezogen werden und bietet vor allem den Vorteil einer breiten differenzialdiagnostischen Abklärung von Patienten mit Thoraxschmerzen.

• Die CMR leistet einen wichtigen Beitrag zur Risikoeinschätzung kardiovaskulärer Patienten. Bei negativem Stress-CMR-Befund ist die Rate kardialer Ereignisse in den folgenden 2 Jahren gering (< 1 %).

• Die Darstellung und Charakterisierung der koronararteriellen Gefäßwand könnte die kardiovaskuläre Risikoeinschätzung optimieren. In diesem Bereich kann man künftig aufgrund der technischen Weiterentwicklung eine weitere Verbesserung entsprechender CMR-Bildgebungsansätze erwarten.

Literatur

• 1 Hendel R C, Patel M R, Kramer C M et al. ACCF, ACR, SCCT, SCMR, ASNC, NASCI, SCAI, SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging.  J Am Coll Cardiol. 2006;  48 1475-1497
• 2 Hundley W G, Bluemke D A, Finn J P et al. ACCF, ACR, AHA, NASCI, SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents.  Circulation. 2010;  121 2462-2508
• 3 Pennell D J, Sechtem U P, Higgins C B et al. Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report.  Eur Heart J. 2004;  25 1940-1965
• 4 Kern M J, Lerman A, Bech J W et al. Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology.  Circulation. 2006;  114 1321-1341
• 5 Kern M J, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory.  J Am Coll Cardiol. 2010;  55 173-185
• 6 Wilson R F. Assessing the severity of coronary-artery stenoses.  N Engl J Med. 1996;  334 1735-1737
• 7 Nesto R W, Kowalchuk G J. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia.  Am J Cardiol. 1987;  59 23C-30C
• 8 Leong-Poi H, Rim S J, Le D E et al. Perfusion versus function: the ischemic cascade in demand ischemia: implications of single-vessel versus multivessel stenosis.  Circulation. 2002;  105 987-992
• 9 Gebker R, Jahnke C, Manka R et al. Additional value of myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of coronary artery disease.  Circ Cardiovasc Imaging. 2008;  1 122-130
• 10 Hundley W G, Hamilton C A, Thomas M S et al. Utility of fast cine magnetic resonance imaging and display for the detection of myocardial ischemia in patients not well suited for second harmonic stress echocardiography.  Circulation. 1999;  100 1697-1702
• 11 Nagel E, Lehmkuhl H B, Bocksch W et al. Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography.  Circulation. 1999;  99 763-770
• 12 Jerosch-Herold M, Muehling O. Stress perfusion magnetic resonance imaging of the heart.  Top Magn Reson Imaging. 2008;  19 33-42
• 13 Panting J R, Gatehouse P D, Yang G Z et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging.  N Engl J Med. 2002;  346 1948-1953
• 14 Petersen S E, Jerosch-Herold M, Hudsmith L E et al. Evidence for microvascular dysfunction in hypertrophic cardiomyopathy: new insights from multiparametric magnetic resonance imaging.  Circulation. 2007;  115 2418-2425
• 15 Schwitter J, Wacker C M, van Rossum A C et al. MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial.  Eur Heart J. 2008;  29 480-489
• 16 Plein S, Kozerke S, Suerder D et al. High spatial resolution myocardial perfusion cardiac magnetic resonance for the detection of coronary artery disease.  Eur Heart J. 2008;  29 2148-2155
• 17 Manka R, Jahnke C, Kozerke S et al. Dynamic Three-Dimensional Stress Cardiac Magnetic Resonance Perfusion Imaging: Detection of Coronary Artery Disease and Volumetry of Myocardial Hypoenhancement Before and After Coronary Stenting.  J Am Coll Cardiol. 2010;  in press
• 18 Jahnke C, Gebker R, Manka R et al. Navigator-gated 3D blood oxygen level-dependent CMR at 3,0-T for detection of stress-induced myocardial ischemic reactions.  JACC Cardiovasc Imaging. 2010;  3 375-384
• 19 Karamitsos T D, Leccisotti L, Arnold J R et al. Relationship between regional myocardial oxygenation and perfusion in patients with coronary artery disease: insights from cardiovascular magnetic resonance and positron emission tomography.  Circ Cardiovasc Imaging. 2010;  3 32-40
• 20 Wahl A, Paetsch I, Gollesch A et al. Safety and feasibility of high-dose dobutamine-atropine stress cardiovascular magnetic resonance for diagnosis of myocardial ischaemia: experience in 1000 consecutive cases.  Eur Heart J. 2004;  25 1230-1236
• 21 Paetsch I, Jahnke C, Wahl A et al. Comparison of dobutamine stress magnetic resonance, adenosine stress magnetic resonance, and adenosine stress magnetic resonance perfusion.  Circulation. 2004;  110 835-842
• 22 Wahl A, Paetsch I, Roethemeyer S et al. High-dose dobutamine-atropine stress cardiovascular MR imaging after coronary revascularization in patients with wall motion abnormalities at rest.  Radiology. 2004;  233 210-216
• 23 Nandalur K R, Dwamena B A, Choudhri A F et al. Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis.  J Am Coll Cardiol. 2007;  50 1343-1353
• 24 Meijboom W B, Van Mieghem C A, van Pelt N et al. Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina.  J Am Coll Cardiol. 2008;  52 636-643
• 25 Gould K L. Does coronary flow trump coronary anatomy?.  JACC Cardiovasc Imaging. 2009;  2 1009-1023
• 26 Watkins S, McGeoch R, Lyne J et al. Validation of magnetic resonance myocardial perfusion imaging with fractional flow reserve for the detection of significant coronary heart disease.  Circulation. 2009;  120 2207-2213
• 27 Wagner A, Mahrholdt H, Holly T A et al. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study.  Lancet. 2003;  361 374-379
• 28 Mahrholdt H, Wagner A, Holly T A et al. Reproducibility of chronic infarct size measurement by contrast-enhanced magnetic resonance imaging.  Circulation. 2002;  106 2322-2327
• 29 Kim R J, Wu E, Rafael A, Chen E L et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.  N Engl J Med. 2000;  343 1445-1453
• 30 Wellnhofer E, Olariu A, Klein C et al. Magnetic resonance low-dose dobutamine test is superior to SCAR quantification for the prediction of functional recovery.  Circulation. 2004;  109 2172-2174
• 31 Wu K C, Zerhouni E A, Judd R M et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction.  Circulation. 1998;  97 765-772
• 32 Cury R C, Shash K, Nagurney J T et al. Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department.  Circulation. 2008;  118 837-844
• 33 Friedrich M G, Abdel-Aty H, Taylor A et al. The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance.  J Am Coll Cardiol. 2008;  51 1581-1587
• 34 Aletras A H, Tilak G S, Natanzon A et al. Retrospective determination of the area at risk for reperfused acute myocardial infarction with T2-weighted cardiac magnetic resonance imaging: histopathological and displacement encoding with stimulated echoes (DENSE) functional validations.  Circulation. 2006;  113 1865-1870
• 35 Carlsson M, Ubachs J F, Hedstrom E et al. Myocardium at risk after acute infarction in humans on cardiac magnetic resonance: quantitative assessment during follow-up and validation with single-photon emission computed tomography.  JACC Cardiovasc Imaging. 2009;  2 569-576
• 36 O’Regan D P, Ahmed R, Karunanithy N et al. Reperfusion hemorrhage following acute myocardial infarction: assessment with T2* mapping and effect on measuring the area at risk.  Radiology. 2009;  250 916-922
• 37 Jahnke C, Nagel E, Gebker R et al. Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging.  Circulation. 2007;  115 1769-1776
• 38 Pilz G, Jeske A, Klos M et al. Prognostic value of normal adenosine-stress cardiac magnetic resonance imaging.  Am J Cardiol.. 2008;  101 1408-1412
• 39 Kwong R Y, Chan A K, Brown K A et al. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease.  Circulation. 2006;  113 2733-2743
• 40 Bingham S, Hachamovitch R. Abstract 4185: Does Combined Stress, Delayed Enhancement, and Functional Cardiac Magnetic Resonance Imaging Yield Incremental Prognostic Value and Risk Stratification?.  Circulation. 2008;  118 S838
• 41 Kwong R Y, Schussheim A E, Rekhraj S et al. Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging.  Circulation. 2003;  107 531-537
• 42 Ingkanisorn W P, Kwong R Y, Bohme N S et al. Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain.  J Am Coll Cardiol. 2006;  47 1427-1432
• 43 Assomull R G, Lyne J C, Keenan N et al. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries.  Eur Heart J. 2007;  28 1242-1249
• 44 Eitel I, Behrendt F, Schindler K et al. Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging.  Eur Heart J. 2008;  29 2651-2659
• 45 Jahnke C, Paetsch I, Nehrke K et al. Rapid and complete coronary arterial tree visualization with magnetic resonance imaging: feasibility and diagnostic performance.  Eur Heart J. 2005;  26 2313-2319
• 46 Greil G F, Seeger A, Miller S et al. Coronary magnetic resonance angiography and vessel wall imaging in children with Kawasaki disease.  Pediatr Radiol. 2007;  37 666-673
• 47 Maintz D, Ozgun M, Hoffmeier A et al. Selective coronary artery plaque visualization and differentiation by contrast-enhanced inversion prepared MRI.  Eur Heart J. 2006;  27 1732-1736