Stress Echocardiography Versus Stress CMR

Abstract

Recently, cardiovascular magnetic resonance (CMR) imaging has emerged as a new noninvasive imaging modality providing high-resolution images in any desired plane of the heart, combined with the potential to assess and monitor left and right ventricular function [1, 2]. Although early attempts to use stress CMR, combined with dipyridamole [3] or dobutamine [4] stress, with standard (low-temporal resolution) gradient-echo techniques date back to the early 1990s, the scientific and clinical interest in stress CMR rose strikingly in the last 5 years as a consequence of technological improvements (Table 40.1). To assess cardiac function, cine MR imaging is performed with gradient-echo pulse sequences. Between 20 and 30 frames with a temporal resolution of 50 ms or less are usually sufficient to evaluate the entire cardiac cycle and are displayed in a cine loop, allowing a dynamic read with the same format, projections, segment assignment (17-segment model), and reading criteria (from 1 = normal to 4 = dyskinetic) as for stress echocardiography [5]. Gradient-echo images provide an excellent contrast between intracavitary blood and the endocardium without the use of contrast medium and provide an accurate delineation of the endocardium and epicardium.