Functional MRI in ischemic heart disease based on detection of contractionabnormalities

Even though several non-invasive techniques are available for the assessmen t of coronary artery disease and the detection of myocardial ischemia, many coronary angiograms yield negative results, thus, warranting higher accura cy for non-invasive tests. The detection of obstructive coronary artery dis ease is only possible during physical or pharmacological stress, Currently, the assessment of wall motion abnormalities by echocardiography is clinica lly the most widely used method. However, a significant number of patients yield suboptimal or non-diagnostic images despite improvements with harmoni c imaging. Cardiovascular magnetic resonance (CMR) imaging allows a non-invasive visua lization of the heart with high spatial and temporal resolution. Gradient e cho CMR images permit an exact and reproducible determination of global and regional left ventricular function, wall thickness and wall thickening and identical pharmacological stress protocols, as currently used for dobutami ne stress echocardiography, can be implemented for CMR imaging. A review of the literature on dobutamine stress CMR for the detection of st ress induced wall motion abnormalities is presented and the safety of CMR s tress examinations is discussed. The results show, that especially in those patients with suboptimal echocardiographic image quality dobutamine stress CMR is superior in comparison with dobutamine stress echocardiography and may replace echocardiography in these patients. Further possibilities by th e use of myocardial tagging or intravascular contrast agents are outlined, (C) 1999 Wiley-Liss, Inc.