Abstract
Ischemic heart disease is one of the most diffuse diseases and while the therapeutic possibilities have become progressively more sophisticated, it is still one of the leading causes of death in Western countries. Besides the other imaging techniques, the role of CMR is becoming increasingly relevant. This is due to the flexibility of CMR which has made it possible to target a broad spectrum of pathologic findings which are ranging from inducible ischemia and postischemic viability to a fine morphologic assessment of myocardial tissue changes occurring at any stage of the disease. Concepts such as infarct size, gross microvascular damage, and myocardial salvage are now easily assessable by CMR and they can be routinely used for both clinical and research purposes. The use of CMR to evaluate regional and global function and to assess the presence, location, and extension of myocardial scar is already part of the cultural background of the modern cardiologist.
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3.1 Electronic Supplementary Material
SSFP cine images in short-axis view of the left ventricle. Segmental akinesia is evident at the level of the apical anterior segment (AVI 79055 kb)
SSFP cine images in horizontal long-axis view of the left ventricle. Segmental akinesia is evident at the level of the apical septal segment (AVI 117614 kb)
SSFP cine images in vertical long-axis view of the left ventricle. A large area of akinesia is detectable in the territory of LAD (AVI 117614 kb)
SSFP cine images in three-chamber view. Evidence of apical dyskinesia, thinning of the myocardial wall, and akinesia of inferior segments (AVI 6243 kb)
SSFP cine images in vertical long axis. Evidence of akinesia of inferior segments. Thinning of apical segments (AVI 6243 kb)
SPSS cine images in three-chamber view. Evidence of large akinetic area involving the middle and apical anterior segments of the left ventricle (AVI 117614 kb)
SPSS cine images in short-axis view of the heart. Evidence of regional functional impairment at the level of the anteroseptal segment of the left ventricle. Furthermore, also the diaphragmatic segment of the right ventricle appears akinetic (AVI 117614 kb)
SSFP cine images in horizontal long axis. Evidence of apical aki-dyskinesia where the myocardium appears thinned (AVI 79055 kb)
SSFP cine images in short-axis view of the left ventricle. The inferior and the anteroseptal segments are akinetc while the inferoseptal segment shows a residual reduced function (AVI 79055 kb)
SSFP cine images in vertical long-axis view with evidence of severely depressed global function because of global hypokinesia and akinesia at the level of the inferior mid-apical segments (AVI 117614 kb)
SSFP cine images in vertical long-axis view of the left ventricle. Presence of a large apical aneurism, partially filled by thrombotic material (AVI 79055 kb)
SSFP cine images in short-axis view of the heart. Impairment of global function and presence of akinesia at the level of the inferior segments and hypokinesia at the level of the lateral segments. Presence of a large, round-shaped inhomogeneous para-cardiac mass (AVI 1123 kb)
SSFP cine images in three-chamber view of the left ventricle. Impairment of global function and presence of akinesia at the level of the inferior. Presence of a large, bilobar, inhomogeneous para-cardiac mass (AVI 1250 kb)
SSFP cine images in three-chamber view. Evidence of a large pseudo-aneurism communicating with the left-ventricle cavity (AVI 1179 kb)
SSFP cine images in horizontal long axis. Evidence of a large pseudo-aneurism communicating with the left-ventricle cavity (AVI 1190 kb)
SSFP cine images in midventricle short axis. Evidence of a large pseudo-aneurism communicating with the left-ventricle cavity (AVI 1367 kb)
Stack of SSFP cine images in short axis covering the whole heart. Normal global function and no regional wall motion abnormalities (AVI 12029 kb)
Perfusion images (IR-GRE) obtained during the first pass through the heart of a bolus of contrast agent i.v. injected. Evidence of a transmural hypoperfused area at the level of the inferolateral and inferior wall in the midventricle and in the distal slice (AVI 20838 kb)
Perfusion images obtained under adenosine infusion (upper panels) (140 μg/kg/min/6 min) and at baseline (lower panels) during the first pass of a bolus of contrast agent (0.075 mmol (kg)) (AVI 47346 kb)
SSFP cine images. Vertical long axis of the left ventricle with evidence of a large area of akinesia at the level of the inferior segments (AVI 6243 kb)
SSFP cine images. Stack of short-axis view covering the whole left ventricle. Evidence of a large area of akinesia at the level of the inferior, inferoseptal, and inferolateral segments (AVI 22407 kb)
Perfusion images. Three parallel slices (left: proximal, right: apical). The arrows show the transmural perfusion defects at the level of inferior, inferoseptal, and inferolateral walls. Lower panels: perfusion images acquired in baseline conditions showing no underperfused segments (AVI 26051 kb)
Perfusion sequence. First-pass technique. Upper panel: images obtained during adenosine stress. Evidence of a large area of hypoperfusion involving the inferior, inferoseptal, and inferolateral segment. Lower panel: images obtained in baseline condition with no evidence of hypoperfused areas (AVI 24941 kb)
SSFP cine images in horizontal long axis. Evidence of regional impairment of function of the anterolateral wall at midventricle level (AVI 6243 kb)
Stack of eight parallel planes of SSFP cine images obtained in baseline conditions. A questionable impairment of regional function at the level of anterolateral wall at midventricle might be recognized (AVI 7539 kb)
Stack of eight parallel planes of SSFP cine images obtained during the infusion of dobutamine 30 gamma/kg + 5 min. Evidence of worsening of regional function at the level of anterolateral wall at midventricle level (AVI 7617 kb)
Perfusion images obtained during the first pass of a bolus of contrast agent e.v. injected (0.075Â mmol/kg). The three upper planes obtained at the top of dobutamine infusion. The three lower level obtained at baseline conditions. Evidence of large area of inducible ischemia at the level of the anterior and anterolateral segments in midventricle and apical planes (middle and right upper panels). Evidence of a further area of ischemia at the midventricle inferior level (middle panel) (AVI 26018 kb)
Stack of eight parallel planes of SSFP cine images at baseline. Akinesia of midventricle and apical inferolateral segments (AVI 6549 kb)
Stack of eight parallel planes of SSFP cine images during dobutamine infusion (40 gamma/kg). No new functional abnormalities nor worsening of preexisting ones. Test to be considered negative for inducible ischemia (AVI 6526 kb)
Perfusion (first-pass technique) study. Area of hypoperfusion is detectable only in correspondence of necrotic scar. Test to be considered negative for inducible ischemia (AVI 41006 kb)
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Rustamova, Y., Lombardi, M. (2020). Ischemic Heart Disease. In: Cardiac Magnetic Resonance Atlas. Springer, Cham. https://doi.org/10.1007/978-3-030-41830-4_3
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DOI: https://doi.org/10.1007/978-3-030-41830-4_3
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