Methodist DeBakey Heart and Vascular Center and The Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas 77030, USA.
Curr Opin Cardiol. 2011 Sep;26(5):385-91. doi: 10.1097/HCO.0b013e3283490373.
Coronary artery disease (CAD) is associated with significant morbidity and mortality. Several noninvasive imaging techniques such as stress echocardiography, stress nuclear studies, computed tomography coronary angiography, and, most recently, stress cardiovascular magnetic resonance (CMR) have enhanced the accuracy and efficiency of evaluation of patients.
The diagnostic capabilities of CMR have increased substantially over the past 20 years due to hardware and software advances. Today, CMR has a number of unique advantages over other imaging modalities - primarily because it provides a view of the entire heart without limitations from inadequate imaging windows or body habitus. Furthermore, along with stress imaging for inducible wall motion or perfusion abnormalities, CMR provides a comprehensive examination with concurrent evaluation of the ejection fraction, aorta, pericardium, and valves all without the inherent risks of radiation administration or contrast exposure.
The purpose of this article is to review the current state of stress CMR for both detection of significant disease and the prognostication of future cardiac events. Clinical data will demonstrate that stress CMR is accurate, with detection in a broad population of patients similar to or better than reported using other noninvasive stress imaging techniques. Moreover, patients with a normal adenosine stress CMR scan have an excellent prognosis on follow-up with no adverse cardiovascular outcomes. Thus, CMR perfusion stress testing has been deemed appropriate for the evaluation of chest pain syndromes in patients with intermediate probability of coronary artery disease (CAD) and for ascertaining the physiologic significance of indeterminate coronary artery lesions.
冠心病（CAD）与较高的发病率和死亡率相关。多种非侵入性影像学技术，如负荷超声心动图、负荷核素研究、计算机断层冠状动脉造影，以及最近的负荷心血管磁共振（CMR），提高了对患者评估的准确性和效率。
过去 20 年，由于硬件和软件的进步，CMR 的诊断能力有了实质性的提高。如今，CMR 相较于其他影像学模式具有一些独特的优势——主要是因为它可以提供整个心脏的视图，不受成像窗不足或体型的限制。此外，与用于检测节段性室壁运动或灌注异常的负荷成像相结合，CMR 可进行全面的检查，同时评估射血分数、主动脉、心包和瓣膜，而不存在辐射暴露或造影剂暴露的固有风险。
本文旨在综述负荷 CMR 的现状，包括对重大疾病的检测和未来心脏事件的预测。临床数据表明，负荷 CMR 具有较高的准确性，在广泛的患者群体中的检出率与其他非侵入性负荷成像技术相似或更高。此外，腺苷负荷 CMR 扫描正常的患者在随访期间预后良好，无不良心血管结局。因此，CMR 灌注负荷试验适用于评估具有中等 CAD 概率的胸痛综合征，并确定不确定冠状动脉病变的生理意义。
