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Chronic Coronary Syndromes

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Case-based Atlas of Cardiovascular Magnetic Resonance

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Abstract

Cardiac magnetic resonance (CMR) imaging has emerged as new mainstream technique for functional evaluation of myocardial ischemia and assessment of myocardial infarction providing unique information to support clinical decision-making. Accurate assessment of ischemic burden and myocardial scarring is essential for diagnosing chest pain syndromes, guiding myocardial revascularization procedures, and improving cardiovascular risk stratification and prognosis. Evaluation of inducible myocardial ischemia by assessment of perfusion reserve or regional wall motion abnormalities is a key element in the diagnostic work-up of patients with chronic coronary syndromes (CCS) and an intermediate-to-high pre-test probability of coronary artery disease. The 2022 recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography for the use of non-invasive imaging in coronary syndromes endorse the use of stress CMR to detect ischemia and guide clinical decision-making in patients with high intermediate pre-test clinical likelihood of CCS. Consistently, the 2021 American College of Cardiology and American Heart Association guidelines for the evaluation and diagnosis of chest pain delivered Class I recommendation for stress CMR as a first-line functional investigation for evaluation of chronic chest pain in intermediate-risk patients with known or suspected coronary artery disease. Through its ability to assess myocardial ischemia, presence of myocardial scar, and global and regional biventricular function, stress CMR perfusion imaging can accurately detect anatomically and functionally significant coronary artery disease, assess microvascular function, predict myocardial viability, guide revascularization strategies, deliver robust cardiac prognostication, and provide clinical risk stratification safely and effectively in CCS patients. Stress CMR is more commonly performed with vasodilators using adenosine, regadenoson, or dipyridamole to induce myocardial hyperemia. Quantitative stress CMR perfusion enables high-resolution, pixel-wise, absolute myocardial blood flow quantification and has been found analogous to rubidium positron emission tomography. Quantitative myocardial perfusion can further improve the diagnostic accuracy of stress CMR to better differentiate between single- and multi-vessel disease than visual analysis and assess both epicardial disease and coronary microvascular dysfunction.

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Author information

Authors and Affiliations

  1. Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio University” of Chieti-Pescara, Chieti, Italy

    Fabrizio Ricci

  2. Fondazione Villaserena per la Ricerca, Città Sant’Angelo, Italy

    Fabrizio Ricci

  3. Cardiothoracovascular Department, Careggi Hospital, Florence, Italy

    Nazario Carrabba

  4. Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Amedeo Chiribiri

  5. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy

    Pasquale Perrone Filardi

Authors
  1. Fabrizio Ricci
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  2. Nazario Carrabba
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  3. Amedeo Chiribiri
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  4. Pasquale Perrone Filardi
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Corresponding author

Correspondence to Fabrizio Ricci .

Editor information

Editors and Affiliations

  1. Cardiology & Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Andrea Barison

  2. Advanced Cardiovascular Imaging Unit, Ospedale Accreditato Villa dei Fiori, Acerra (Naples), Italy

    Santo Dellegrottaglie

  3. Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Milano, Italy

    Gianluca Pontone

  4. Division of Cardiology, Department of medical and surgical sciences, Magna Grecia University of Catanzaro, Catanzaro, Italy

    Ciro Indolfi

Electronic Supplementary Material

Cine bSSFP: Left ventricular short-axis stack (MOV 1228 kb)

Cine bSSFP: 4-chamber view (MP4 163 kb)

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Ricci, F., Carrabba, N., Chiribiri, A., Perrone Filardi, P. (2023). Chronic Coronary Syndromes. In: Barison, A., Dellegrottaglie, S., Pontone, G., Indolfi, C. (eds) Case-based Atlas of Cardiovascular Magnetic Resonance. Springer, Cham. https://doi.org/10.1007/978-3-031-32593-9_4

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  • DOI: https://doi.org/10.1007/978-3-031-32593-9_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-32592-2

  • Online ISBN: 978-3-031-32593-9

  • eBook Packages: MedicineMedicine (R0)

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