2025 Stress MR III In DC: A Hands-On Workshop-Day 1 - Part III: Part III: Alternative Approaches and Special Populations Moderator: Jennifer Jordan

Video Transcription

Video Summary

The session covered alternative stress CMR approaches and emerging techniques. Sebastian Kellett reviewed dobutamine stress MRI, emphasizing proper patient selection based on pretest probability and guideline indications, especially when vasodilator perfusion testing is less suitable (e.g., prior CABG, older patients, contraindications to contrast). He explained dobutamine’s beta-1 stimulation, patient preparation, monitoring, contraindications, and a standardized protocol for wall motion analysis, including dose escalation and atropine use. Dobutamine stress MRI was presented as safe, cost-effective, and valuable for diagnosing ischemia, viability, and prognostication, including in patients who cannot receive gadolinium.<br /><br />Corey Trankle then discussed exercise CMR, arguing that reproducing real-world symptoms can improve diagnostic relevance. He reviewed treadmill, upright and supine ergometers, and isometric exercise options, along with practical limitations like ferromagnetic equipment and staffing. Exercise CMR can assess wall motion, perfusion, volumes, and even be combined with invasive hemodynamics or cardiopulmonary exercise testing. He highlighted clinical use in coronary disease, heart failure with preserved EF, congenital heart disease, and nonischemic cardiomyopathies.<br /><br />Amit Patel introduced quantitative BOLD imaging, explaining the physics behind blood oxygen level–dependent signal changes and how stress can reveal ischemia without contrast. He also discussed breath-hold/hyperventilation approaches as potential non-pharmacologic stressors and noted promising but still early evidence for detecting obstructive CAD and microvascular dysfunction.<br /><br />Finally, emerging techniques such as stress T1 mapping and strain imaging were reviewed as promising quantitative tools, but currently limited by small studies and need for further validation. The session ended with illustrative dobutamine and exercise CMR cases showing how these methods can detect ischemia, uncover alternative diagnoses, and guide management.

Keywords

dobutamine stress MRI

exercise CMR

quantitative BOLD imaging

stress T1 mapping

strain imaging

ischemia detection

myocardial viability

coronary artery disease

microvascular dysfunction

wall motion analysis

patient selection

atropine use

cardiopulmonary exercise testing

emerging CMR techniques