Foundations of CMR: Level 1 Virtual Course-SESSION 3: CMR IN ISCHAEMIC HEART DISEASE

Video Transcription

Video Summary

The session focused on imaging in ischemic heart disease, especially myocardial viability and MINOCA, using cardiac MRI and nuclear techniques.<br /><br />Dr. Ashita explained myocardial viability as myocardium that is dysfunctional at rest but may recover after revascularization. She reviewed the main tests used—SPECT, PET, dobutamine stress echo, and cardiac MRI—and highlighted MRI’s advantages: high spatial resolution, no radiation, and excellent scar definition with late gadolinium enhancement (LGE). She showed multiple cases demonstrating how MRI identifies regional wall motion abnormalities, infarct extent, microvascular obstruction, thrombus, aneurysm, and ventricular septal rupture. A key principle was that scar transmurality predicts recovery: less scar means higher likelihood of functional improvement.<br /><br />Dr. Chiara discussed MINOCA, emphasizing that it is not a benign diagnosis and requires cardiac MRI to distinguish myocarditis, Takotsubo syndrome, small infarction, or type 2 MI. She showed how edema and LGE patterns help classify the cause and stressed that MRI often changes the diagnosis and management. The discussion also addressed guideline support for early CMR in MINOCA.<br /><br />Dr. Parag focused on ischemic cardiomyopathy and how LGE-CMR can define ischemic injury even when history, ECG, or angiography are inconclusive. He highlighted that ischemic LGE is typically subendocardial/transmural in a coronary territory, and that non-ischemic or mixed cardiomyopathies can coexist with CAD. He also discussed using scar patterns to infer the culprit vessel and mentioned dark-blood LGE methods for subtle infarcts.<br /><br />Dr. Ron Jacob compared PET and CMR for viability. PET is strong for metabolism and perfusion, while CMR is best for scar characterization and anatomy. He reviewed evidence from STICH and REVIVED-BSICS2 and emphasized that viability imaging should be integrated with coronary anatomy and patient factors.<br /><br />The session concluded that CMR is a cornerstone test for ischemic heart disease, viability, and MINOCA.

Keywords

ischemic heart disease

myocardial viability

MINOCA

cardiac MRI

nuclear imaging

late gadolinium enhancement

SPECT

PET

dobutamine stress echo

myocarditis

Takotsubo syndrome

ischemic cardiomyopathy

microvascular obstruction

scar transmurality

coronary anatomy