Current perspective the expanding role of cardiovascular magnetic resonance in the identification of myocardial viability.

Abstract

Cardiovascular magnetic resonance (CMR) is becoming a widespread diagnostic tool available to cardiologists to image different cardiovascular diseases. Among the main applications CMR has proven to be useful in the evaluation of patients with coronary artery disease. Particularly important seems the evaluation of coronary artery disease patients with left ventricular dysfunction. As a matter of fact CMR can identify myocardial viability by using different methods. CMR can accurately measure diastolic wall thickness and demonstrate a contractile reserve in segments with wall motion abnormalities when coupled to low-dose dobutamine infusion. In both applications CMR has proven to be superior to other diagnostic tools that use the same target of viability. By using gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) administration it has recently been shown that CMR can accurately detect myocardial viability. In fact, irreversibly damaged myocardial segments show a delayed hyperenhancement compared to normal segments. Due to its excellent spatial resolution one of the most important information that CMR offers in this application is the transmural extent of necrosis/viability that no other method can offer. The available data suggest that Gd-DTPA CMR could be superior to any other currently used methods in the identification of both stunning and hibernation.