Department of Cardiology, Brigham and Women's Hospital, Boston, MA 02215, USA.
Prog Cardiovasc Dis. 2011 Nov-Dec;54(3):191-203. doi: 10.1016/j.pcad.2011.09.004.
Assessment of myocardial ischemia in symptomatic patients remains a common and challenging clinical situation faced by physicians. Risk stratification by presence of ischemia provides important utility for both prognostic assessment and management. Unfortunately, current noninvasive modalities possess numerous limitations and have limited prognostic capacity. More recently, ischemia assessment by cardiovascular magnetic resonance (CMR) has been shown to be a safe, available, and potentially cost-effective alternative with both high diagnostic and prognostic accuracy. Cardiovascular magnetic resonance has numerous advantages over other noninvasive methods, including high temporal and spatial resolution, relatively few contraindications, and absence of ionizing radiation. Furthermore, studies assessing the clinical utility and cost effectiveness of CMR in the short-term setting for patients without evidence of an acute myocardial infarction have also demonstrated favorable results. This review will cover techniques of ischemia assessment with CMR by both stress-induced wall motion abnormalities as well as myocardial perfusion imaging. The diagnostic and prognostic performance studies will also be reviewed, and the use of CMR for ischemia assessment will be compared with other commonly used noninvasive modalities.
评估有症状患者的心肌缺血仍然是医生面临的常见且具有挑战性的临床情况。通过存在缺血来进行风险分层，为预后评估和管理提供了重要的作用。不幸的是，目前的非侵入性方法存在许多局限性，并且预后能力有限。最近，心血管磁共振（CMR）评估缺血已被证明是一种安全、可用且具有潜在成本效益的替代方法，具有较高的诊断和预后准确性。心血管磁共振相对于其他非侵入性方法具有许多优势，包括高时间和空间分辨率、相对较少的禁忌症以及没有电离辐射。此外，在没有急性心肌梗死证据的患者中，评估 CMR 在短期设置中的临床实用性和成本效益的研究也取得了有利的结果。这篇综述将涵盖 CMR 通过应激诱导的壁运动异常和心肌灌注成像评估缺血的技术。还将回顾诊断和预后性能研究，并将 CMR 用于缺血评估与其他常用的非侵入性方法进行比较。
