Purpose of review
Coronary artery disease (CAD) is associated with significant morbidity and mortality. Several noninvasive imaging techniques such as stress echocardiography, stress nuclear studies, computed tomography coronary angiography, and, most recently, stress cardiovascular magnetic resonance (CMR) have enhanced the accuracy and efficiency of evaluation of patients.
The diagnostic capabilities of CMR have increased substantially over the past 20 years due to hardware and software advances. Today, CMR has a number of unique advantages over other imaging modalities – primarily because it provides a view of the entire heart without limitations from inadequate imaging windows or body habitus. Furthermore, along with stress imaging for inducible wall motion or perfusion abnormalities, CMR provides a comprehensive examination with concurrent evaluation of the ejection fraction, aorta, pericardium, and valves all without the inherent risks of radiation administration or contrast exposure.
The purpose of this article is to review the current state of stress CMR for both detection of significant disease and the prognostication of future cardiac events. Clinical data will demonstrate that stress CMR is accurate, with detection in a broad population of patients similar to or better than reported using other noninvasive stress imaging techniques. Moreover, patients with a normal adenosine stress CMR scan have an excellent prognosis on follow-up with no adverse cardiovascular outcomes. Thus, CMR perfusion stress testing has been deemed appropriate for the evaluation of chest pain syndromes in patients with intermediate probability of coronary artery disease (CAD) and for ascertaining the physiologic significance of indeterminate coronary artery lesions.