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STATE-OF-THE-ART PAPER

Cardiovascular Magnetic Resonance in Patients With Myocardial Infarction

Current and Emerging Applications

Han W. Kim, MD^_*,, Afshin Farzaneh-Far, MD, PhD^_*, and Raymond J. Kim, MD^_*,,,_*

^_* Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Department of Radiology, Duke University Medical Center, Durham, North Carolina

Manuscript received March 9, 2009; revised manuscript received May 26, 2009, accepted June 18, 2009.

^_* Reprint requests and correspondence: Dr. Raymond J. Kim, Duke Cardiovascular MRI Center, DUMC 3934, Durham, North Carolina 27710 (Email: raymond.kim{at}duke.edu).

In patients with known or suspected myocardial infarction (MI), cardiovascular magnetic resonance (CMR) provides a comprehensive, multifaceted view of the heart. The data, including that from a recent multicenter clinical trial, indicate that delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) is a well-validated, robust technique that can be easily implemented on scanners that are commonly available worldwide, with an effectiveness that clearly rivals the best available imaging techniques for the detection and assessment of acute and chronic MI. When patients present outside the diagnostic window of cardiac troponins, DE-CMR may be especially useful. Moreover, because DE-CMR can uniquely differentiate between ischemic and various nonischemic forms of myocardial injury, it may be helpful in cases of diagnostic uncertainty, such as in patients with classical features of MI in whom coronary angiography does not show a culprit lesion. Even after the diagnosis of MI has been made, CMR provides clinically relevant information by identifying residual viability, microvascular damage, stunning, and right ventricular infarction. In addition, post-MI sequelae, including left ventricular thrombus and pericarditis, are easily identified. Given that quantification of infarct size by DE-CMR is highly reproducible, this technique may provide a useful surrogate end point for clinical trials with appreciable reductions in sample size compared with alternative methods.

Key Words: myocardial • infarction • magnetic resonance imaging

Abbreviations and Acronyms   ACS = acute coronary syndrome   CAD = coronary artery disease   CMR = cardiovascular magnetic resonance   DE = delayed enhancement   ECG = electrocardiogram   FWHM = full-width at half-maximum   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   MI = myocardial infarction   SPECT = single-photon emission computed tomography   STEMI = ST-segment elevation myocardial infarction

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