Myocardial Wall Motion Imaging with Cardiac Magnetic Resonance Imaging

Wall motion imaging with cardiac magnetic resonance imaging (CMR) provides important functional information about global and regional myocardial function. This review will give an overview of the current state of myocardial wall motion imaging, especially focusing on the clinical role of dobutamine stress CMR in ischaemic heart disease. Dobutamine stress CMR provides functional information on the myocardium under conditions of pharmacologically induced stress. High-dose dobutamine is used for wall motion analysis of the left ventricle. Wall motion abnormalities are indicative of myocardial ischaemia and occur in the ischaemic cascade before the onset of chest pain and ECG abnormalities. As a result of technological advances, dobutamine stress CMR has evolved towards a very accurate cardiac stress test. The current state of dobutamine stress CMR allows us to obtain cine MR images with high spatial and temporal resolution in rest and during stress. The use of myocardial tagging has improved the diagnostic accuracy even further. The addition of first-pass perfusion imaging at peak dose dobutamine might enhance accuracy even more. Besides being able to detect myocardial ischaemia, low-dose dobutamine can be used to assess myocardial viability. With these capabilities, viability, wall motion and myocardial perfusion can be assessed in a single examination. The safety and feasibility of dobutamine stress CMR has been proven. The technique and clinical implications are discussed.