2025 Stress MR III In DC: A Hands-On Workshop-Day 2 - Part IV: Stress CMR

Video Transcription

Video Summary

The session opened with housekeeping announcements about CME sign-up, a travel grant photo, and an optional live stress perfusion case viewing.  <br /><br />The first major lecture, by Amadeo Chiribiri, focused on interpreting stress CMR in patients with non-CAD. He emphasized starting with late gadolinium enhancement to avoid mistaking scar for ischemia, then assessing stress perfusion for true subendocardial defects with a dynamic epicardial-to-endocardial filling pattern. He explained how to distinguish real ischemia from dark-rim artifacts and illustrated cases including severe RCA ischemia, diffuse microvascular disease, peri-infarct ischemia, and perfusion interpretation challenges after CABG.  <br /><br />A second talk covered ANOCA, INOCA, and MINOCA. The speaker reviewed mechanisms such as microvascular dysfunction, vasospasm, and endothelial dysfunction, and explained how CMR fits into guideline-supported evaluation alongside PET and invasive testing. MINOCA was framed as true infarction without obstructive coronary disease, where CMR helps confirm infarction and identify alternative diagnoses like myocarditis or takotsubo.  <br /><br />Mark Fogel then presented stress CMR in children and adolescents, explaining when it is used, why it matters, and how it is performed with exercise, adenosine/regadenoson, or dobutamine. He reviewed congenital, acquired, and surgically altered coronary problems, plus “non-coronary” uses such as transplant vasculopathy and Fontan physiology.  <br /><br />Finally, Mark Westwood showed multiple “thick heart” cases, mostly hypertrophic cardiomyopathy, highlighting the difficulty of separating fibrosis from ischemia on stress perfusion and the value of combining late enhancement, perfusion maps, and mapping data.

Keywords

stress CMR

non-CAD

late gadolinium enhancement

stress perfusion

subendocardial defects

dark-rim artifacts

ANOCA

INOCA

MINOCA

microvascular dysfunction

vasospasm

myocardial infarction

pediatric cardiology

hypertrophic cardiomyopathy

perfusion mapping