Prof. Sven Plein
The session was opened with a presentation on the physiological concepts underpinning CMR stress testing. Dr. Almeida described the two principal methods in common use - Dobutamine stress CMR (DSMR) and vasolidator-stress myocardial perfusion stress CMR (Perfusion-CMR). In the context of the ischaemic cascade, perfusion-CMR is expected to detect earlier pathology, but DSMR in particular when combined with strain analysis offers a highly accurate alternative. Dr Kelle presented further data for the clinical use of DSMR, focusing in particular on the long-term prognostic value of the method. Showing data of a recent large two-centre study involving over 3,000 patients, he demonstrated that DSMR offers incremental value over other scar imaging alone and provides a “warranty period” with low cardiovascular risk of at least 3 years. Dr. Husser's presentation focused on the value of a combined assessment of myocardial perfusion and wall motion during dipyridamole CMR. He presented data from a recent multi-centre registry of over 1,500 patients, which showed that patients who develop a wall motion abnormality during dipyridamole stress had significantly worse outcome than patients with perfusion defects only. Interestingly, patients with a perfusion defect but without inducible wall motion abnormalities had a similar outcome as patients with normal perfusion. In a subsequent discussion, it was suggested that this observation likely reflected a larger ischaemia burden in the patients with inducible wall motion abnormalities. The final presentation was given by Dr Schwitter, who demonstrated in a number of case examples how CMR can be used in patients with complex coronary artery disease. In clinical practice, CMR is used to guide treatment choices by identifying fully infarcted and ischaemic myocardial territories. It was noted, however, that data from prospective clinical studies was needed to better inform such decisions. The session chairs, Dr. Rademakers and Dr. Plein, concluded an interesting and comprehensive session that presented the whole spectrum of CMR stress testing and an impressive amount of emerging outcome data for CMR.
Stress cardiovascular magnetic resonance (CMR) in coronary heart disease
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