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In the previous article in this series, we discussed the cardiovascular magnetic resonance (CMR) techniques used in the assessment of ischaemic heart disease and their clinical application in patients with acute myocardial infarction. In this article we address the use of CMR in the chronic phase of infarction, focusing on the assessment of function and viability in patients with ischaemic cardiomyopathy or (suspected) prior infarction.
General considerations
A basic imaging protocol in patients with ischaemic cardiomyopathy or (suspected) old myocardial infarction includes cine imaging for the assessment of ventricular and valvular function, and delayed contrast enhanced (DE) imaging for the assessment of regional scar and viability. Total (maximum) examination time for the assessment of ventricular function and viability will be 30 min, which can be reduced to around 20 min if contrast is given before the examination. If the presence and distribution of scar is the only clinical concern, DE imaging may provide the answer within 5 min. Low dose dobutamine stress cine is a good alternative method for assessing viability in patients with (relative) contraindications to gadolinium based contrast agents—for example, in advanced renal failure. Depending on the clinical situation, adenosine first-pass imaging or high dose dobutamine stress cine can be added to detect ischaemia related perfusion defects or wall motion abnormalities, respectively. An extensive description of these techniques is beyond the scope of this article.
Function
Global ventricular function
Global left ventricular function strongly influences prognosis and management and its assessment is an essential part of the work-up in a patient with prior myocardial infarction. As in acute infarction, the selection of candidates for implantable cardioverter defibrillator (ICD) or cardiac resynchronisation devices relies heavily on left ventricular ejection fraction (LVEF). Cine imaging ensures the quantification of global function with the highest …
Footnotes
Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. The authors have no competing interests.
Provenance and peer review Commissioned; not externally peer reviewed.