Magnetresonanztomografie des Herzens: ischämische Herzerkrankung

Zusammenfassung

Die kardiale MRT konnte in den letzten Jahren eine breite klinische Akzeptanz gewinnen und stellt inzwischen eine Standardreferenz der nicht invasiven Ischämiediagnostik dar. Da dieses Verfahren ohne Strahlenexposition auskommt und durch eine hohe diagnostische und prognostische Aussagekraft gekennzeichnet ist, stellt die kardiale MRT eine wertvolle Alternative zu anderen nicht invasiven Verfahren wie der Myokardszintigrafie und der Stressechokardiografie dar. Nach der aktuellen Datenlage profitieren insbesondere symptomatische Patienten mit einer mittleren Vortestwahrscheinlichkeit für eine stenosierende KHK von einer kardialen MRT-Ischämiediagnostik.

Abstract

Cardiac magnetic resonance (CMR) is a clinically well established modality for the detection of coronary artery disease (CAD) and risk stratification of patients with ischemic heart disease. Due to its non-invasive nature and its versatility to assess myocardial function, perfusion and viability if required all within the same examination and without radiation exposure for the patients, CMR is a valuable alternative to stress echocardiography and nuclear techniques. According to current guidelines and literature, CMR provides accurate detection of myocardial ischemia particularly in patients with intermediate pre-test probability for CAD.

Schlüsselwörter

koronare Herzerkrankung - Magnetresonanztomografie (MRT) - diagnostische Aussagekraft - Risikostratifikation

Key words

coronary artery disease - magnetic resonance imaging (MRI) - diagnostic accuracy - risk stratification

• Literatur

• 1 Roger VL, Go AS, Lloyd-Jones DM et al. Executive summary: heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation 2012; 125: 188-197
• 2 Gianrossi R, Detrano R, Mulvihill D et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation 1989; 80: 87-98
• 3 Hendel RC, Patel MR, Kramer CM et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006; 48: 1475-1497
• 4 Fox K, Garcia MA, Ardissino D et al. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006; 27: 1341-1381
• 5 Greenwood JP, Maredia N, Younger JF et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 2012; 379: 453-460
• 6 Wijns W, Kolh P, Danchin N et al. Guidelines on myocardial revascularization. Eur Heart J 2010; 31: 2501-2555
• 7 Cerqueira MD, Weissman NJ, Dilsizian V et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105: 539-542
• 8 Nagel E, Klein C, Paetsch I et al. Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease. Circulation 2003; 108: 432-437
• 9 Di Bella EV, Parker DL, Sinusas AJ. On the dark rim artifact in dynamic contrast-enhanced MRI myocardial perfusion studies. Magn Reson Med 2005; 54: 1295-1299
• 10 Gerber BL, Garot J, Bluemke DA et al. Accuracy of contrast-enhanced magnetic resonance imaging in predicting improvement of regional myocardial function in patients after acute myocardial infarction. Circulation 2002; 106: 1083-1089
• 11 Wahl A, Paetsch I, Gollesch A et al. Safety and feasibility of high-dose dobutamine-atropine stress cardiovascular magnetic resonance for diagnosis of myocardial ischaemia: experience in 1000 consecutive cases. Eur Heart J 2004; 25: 1230-1236
• 12 Cerqueira MD, Verani MS, Schwaiger M et al. Safety profile of adenosine stress perfusion imaging: results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol 1994; 23: 384-389
• 13 Nandalur KR, Dwamena BA, Choudhri AF et al. Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol 2007; 50: 1343-1353
• 14 Paetsch I, Jahnke C, Wahl A et al. Comparison of dobutamine stress magnetic resonance, adenosine stress magnetic resonance, and adenosine stress magnetic resonance perfusion. Circulation 2004; 110: 835-842
• 15 Paetsch I, Jahnke C, Ferrari VA et al. Determination of interobserver variability for identifying inducible left ventricular wall motion abnormalities during dobutamine stress magnetic resonance imaging. Eur Heart J 2006; 27: 1459-1464
• 16 Lubbers DD, Kuijpers D, Bodewes R et al. Inter-observer variability of visual analysis of “stress”-only adenosine first-pass myocardial perfusion imaging in relation to clinical experience and reading criteria. Int J Cardiovasc Imaging 2011; 27: 557-562
• 17 Paetsch I, Foll D, Kaluza A et al. Magnetic resonance stress tagging in ischemic heart disease. Am J Physiol Heart Circ Physiol 2005; 288: H2708-H2714
• 18 Kuijpers D, Ho KY, van Dijkman PR et al. Dobutamine cardiovascular magnetic resonance for the detection of myocardial ischemia with the use of myocardial tagging. Circulation 2003; 107: 1592-1597
• 19 Korosoglou G, Lossnitzer D, Schellberg D et al. Strain-encoded cardiac MRI as an adjunct for dobutamine stress testing: incremental value to conventional wall motion analysis. Circ Cardiovasc Imaging 2009; 2: 132-140
• 20 Korosoglou G, Lehrke S, Wochele A et al. Strain-encoded CMR for the detection of inducible ischemia during intermediate stress. JACC Cardiovasc Imaging 2010; 3: 361-371
• 21 Patel AR, Antkowiak PF, Nandalur KR et al. Assessment of advanced coronary artery disease: advantages of quantitative cardiac magnetic resonance perfusion analysis. J Am Coll Cardiol 2010; 56: 561-569
• 22 Tarroni G, Corsi C, Antkowiak PF et al. Myocardial Perfusion: Near-automated Evaluation from Contrast-enhanced MR Images Obtained at Rest and during Vasodilator Stress. Radiology 2012; 265: 576-583
• 23 Gebker R, Jahnke C, Manka R et al. Additional value of myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of coronary artery disease. Circ Cardiovasc Imaging 2008; 1: 122-130
• 24 Gebker R, Mirelis JG, Jahnke C et al. Influence of left ventricular hypertrophy and geometry on diagnostic accuracy of wall motion and perfusion magnetic resonance during dobutamine stress. Circ Cardiovasc Imaging 2010; 3: 507-514
• 25 Jahnke C, Nagel E, Gebker R et al. Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation 2007; 115: 1769-1776
• 26 Kelle S, Chiribiri A, Vierecke J et al. Long-term prognostic value of dobutamine stress CMR. JACC Cardiovasc Imaging 2011; 4: 161-172
• 27 Korosoglou G, Elhmidi Y, Steen H et al. Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1,493 consecutive patients: assessment of myocardial wall motion and perfusion. J Am Coll Cardiol 2010; 56: 1225-1234
• 28 Hundley WG, Morgan TM, Neagle CM et al. Magnetic resonance imaging determination of cardiac prognosis. Circulation 2002; 106: 2328-2333
• 29 Kuijpers D, van Dijkman PR, Janssen CH et al. Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia. Eur Radiol 2004; 14: 2046-2052
• 30 Jahnke C, Furundzija V, Gebker R et al. Gender-based prognostic value of pharmacological cardiac magnetic resonance stress testing: head-to-head comparison of adenosine perfusion and dobutamine wall motion imaging. Int J Cardiovasc Imaging 2012; 28: 1087-1098
• 31 Bodi V, Sanchis J, Lopez-Lereu MP et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol 2007; 50: 1174-1179
• 32 Steel K, Broderick R, Gandla V et al. Complementary prognostic values of stress myocardial perfusion and late gadolinium enhancement imaging by cardiac magnetic resonance in patients with known or suspected coronary artery disease. Circulation 2009; 120: 1390-1400
• 33 Bertaso AG, Richardson JD, Wong DT et al. Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population. Int J Cardiol 2012;
• 34 Bingham SE, Hachamovitch R. Incremental prognostic significance of combined cardiac magnetic resonance imaging, adenosine stress perfusion, delayed enhancement, and left ventricular function over preimaging information for the prediction of adverse events. Circulation 2011; 123: 1509-1518
• 35 Nagel E, Lehmkuhl HB, Bocksch W et al. Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 1999; 99: 763-770
• 36 Hendel RC, Verani MS, Miller DD et al. Diagnostic utility of tomographic myocardial perfusion imaging with technetium 99 m furifosmin (Q12) compared with thallium 201: results of a phase III multicenter trial. J Nucl Cardiol 1996; 3: 291-300
• 37 Klocke FJ, Baird MG, Lorell BH et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003; 108: 1404-1418
• 38 Meijboom WB, van Mieghem CA, Mollet NR et al. 64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol 2007; 50: 1469-1475
• 39 Motoyama S, Sarai M, Harigaya H et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 2009; 54: 49-57
• 40 Russo V, Zavalloni A, Bacchi Reggiani ML et al. Incremental prognostic value of coronary CT angiography in patients with suspected coronary artery disease. Circ Cardiovasc Imaging 2010; 3: 351-359
• 41 George RT, Arbab-Zadeh A, Miller JM et al. Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging 2012; 5: 333-340
• 42 Min JK, Leipsic J, Pencina MJ et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 2012; 308: 1237-1245
• 43 Jahnke C, Furundzija V, Gebker R et al. Gender-based prognostic value of pharmacological cardiac magnetic resonance stress testing: head-to-head comparison of adenosine perfusion and dobutamine wall motion imaging. Int J Cardiovasc Imaging 2012; 28: 1087-1098