Clinical applications of first-pass myocardial perfusion by cardiovascular magnetic resonance; Clinical case reports using state-of-the-art methodologies

The clinical assessment of myocardial perfusion plays a central role in the diagnosis, management, and prognosis of ischemic heart disease patients. Since 1990 when Atkinson et al. introduced heart imaging after injection of a bolus of Gd-DTPA to observe contrast agent transit through the cardiac chambers and myocardium, this approach, first-pass perfusion (FPP) cardiovascular magnetic resonance (CMR), has been undergoing a wide range of changes with the continuous technical development, experimental validation, and clinical evaluation in concert with a better understanding of the pathophysiology of the heart diseases ,particularly identifying hemodynamically significant coronary artery disease (CAD).This technique has been using to:1) Quantify absolute myocardial blood flow (ml/min/gr) at rest and stress, 2) Provide absolute values of distribution and regional myocardial perfusion by Color maps to determine relative index of myocardial perfusion reserve, 3) Define the presence or absence of flow-limiting CAD as the cause of symptoms, 4) evaluate severity of coronary arterial stenosis 5) delineate infarct scar, 6) Detect microvascular obstruction in the distinction of chronic from acute infarcts 7) elucidate the cause of chest pain in patients without significant CAD or syndrome X and non-ischemic cardiomyopathy, 8) assess Ischemic cardiomyopathy, 9) demonstrate subendocardial perfusion abnormalities in aortic coarectation, HCM, LVH, 9) Evaluate the prognosis value of patients with chest pain or dyspnea and suspected CAD through stress perfusion, 10) Correlate the presence or absence of first-pass hypoenhancement and delayed Hyper enhancement of dysfunctional myocardial regions with myocardial viability 11) identify Coronary microvascular disease with diffuse myocardial fibrosis,12) Show biventricular performance in pulmonary hypertension.The presentation will address all hemodynamic and functional aspects of FPP-CMRI through quantitative analysis of each myocardial segment Signal Intensity- Time curve and dynamic multi parametric CMRI including ultrafast cine imaging, first-pass DCE-MRI coupled with the LGE imaging in our patients with and without CAD.