COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh VermaStress cardiac MRI in stable coronary artery diseaseGe, Yina; Deva, Djeven P.b; Connelly, Kim A.a; Yan, Andrew T.aAuthor Information aDivision of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada bDepartment of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, Canada Correspondence to Yin Ge, MD, St Michael's Hospital, Division of Cardiology, Department of Medicine, University of Toronto, 30 Bond St, Toronto, ON M5B 1X1. Tel: +416 864 5062; fax: +416 864 5416; e-mail: [email protected] Current Opinion in Cardiology: September 2020 - Volume 35 - Issue 5 - p 566-573 doi: 10.1097/HCO.0000000000000776 Buy Metrics Abstract Purpose of review Non-invasive testing is often the first step in the evaluation of stable coronary artery disease (CAD). Stress cardiac magnetic resonance imaging (CMR) is an established modality with high diagnostic accuracy and prognostic value. This review will focus on the recent advances in understanding how stress CMR can help guide patient care. Recent findings Diagnostic accuracy of stress CMR has been validated against coronary angiography with fractional flow reserve (FFR) in patients with stable CAD. Large registry data have shown stress CMR to have important prognostic importance and that its cost-effectiveness compares favorably to alternatives. In patients with stable CAD, guidance using a CMR based strategy led to equivalent outcomes when compared to coronary angiography with FFR. Summary In persons with stable CAD, Stress CMR is an accurate and cost-effective imaging modality that should be considered in patients at intermediate pre-test probability of CAD. Prognostic studies have shown it to have excellent negative predictive value and that it can safely serve as a “gatekeeper” for invasive angiography. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.