Despite advances in the diagnosis and management of coronary artery disease (CAD) in developed countries, a significant proportion of CAD patients develop heart failure, which is associated with a tremendous economic and societal burden.1,2 With increasing industrialisation, changes in diet and a rapidly ageing population, there has been an enormous increase in the prevalence of heart failure due to CAD in South Asia and China. This has led to huge healthcare expenditure each year in these developing countries.3 It is well-known that heart failure progresses through different stages, and optimal medical therapy in the early stage of disease can slow its progression.4 Furthermore, early diagnosis and recognition of reversible elements that lead to heart failure can further improve long-term outcome. Cardiac magnetic resonance imaging (cMRI) is unique in that it has an unlimited imaging window, free from radiation exposure, little inter- and intra-observer variability and excellent tissue characterisation. This article reviews the current role of cMRI in the diagnosis and management of ischaemic cardiomyopathy.
Previous clinical studies have shown that assessment of left ventricular (LV) function provides important information and is a powerful independent prognostic index for patients with heart failure.5 Currently, transthoraic echocardiography is the most widely used technique for measuring LV chamber dimension and function as it is easily available. Nevertheless, it is limited by several technical problems, including poor echo windows, unclear endocardial definition and unusual chamber geometry in some patients, which causes significant inter- and intra-observer variability. In contrast, cMRI provides highly reproducible LV volumetric measurements due to unlimited imaging windows and the high tissue contrast between the endocardial border and the blood pool.6 Furthemore, cMRI acquires chamber volumes in a 3D fashion. The endocardial contours at the end-systolic and end-diastolic phase of each contiguous LV short-axis level of the whole heart are traced manually. The chamber volumes are obtained simply by adding the volume of all of the slice levels. As a result, unlike echocardiography, no geometry assumption is required. Since cMRI is more sensitive in detecting the temporal changes in myocardial size, mass and function, it has been increasingly used in clinical practice and trials for the assessment of disease progression as well as the response to therapy. In addition, by using semi-quantitative methods (American College of Cardiologists [ACC]/American Heart Association [AHA] 17 Segments Guideline), the functional recovery regarding regional wall contractility can be compared in patients with CAD before and after revascularisation.7
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