Other studies have shown that delayed-enhancement MRI findings can be predictive of the potential for recovery of function in LV dysfunctional segments in chronic IHD [90,94]. Transmural extent of infarction can predict recovery of regional function in dysfunctional segments in patients evaluated before and several months after surgical revascularization [96]. Late gadolinium enhancement with a microvascular obstruction pattern is associated with greater infarct mass, infarction size, and extent of transmurality, lower ejection fraction, more adverse cardiac events early and late, and more severe late LV remodeling [91]. Infarct size at the baseline has proved to be the strongest predictor of adverse long-term LV remodeling [92]. There is a strong linear relation between scar size, LV end-systolic and end-diastolic volumes, and LVEF. Scar size is the strongest predictor of LVEF, independent of scar location and transmurality [97]. Baseline infarct size, infarct heterogeneity, and myocardial salvage are significantly associated with 90-day LVEF [93]. MRI Heart Function and Morphology Without IV Contrast MRI heart function and morphology without IV contrast provides assessment of ejection fraction and ventricular volumes including LVEF and ESVI with a higher sensitivity to detect prior myocardial infarct than ischemia. There is no relevant literature to support the use of MRI heart function and morphology without IV contrast in the initial evaluation of patients with chronic chest pain and a high probability of CAD with known IHD. MRI Heart Function with Stress Without and With IV Contrast MRI with function/wall motion (dobutamine stress test) and MRI with vasodilator stress perfusion (adenosine/regadenoson stress test) have been used to diagnose hemodynamically significant CAD in patients with an intermediate to high likelihood of having significant stenosis.
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. Other studies have shown that delayed-enhancement MRI findings can be predictive of the potential for recovery of function in LV dysfunctional segments in chronic IHD [90,94]. Transmural extent of infarction can predict recovery of regional function in dysfunctional segments in patients evaluated before and several months after surgical revascularization [96]. Late gadolinium enhancement with a microvascular obstruction pattern is associated with greater infarct mass, infarction size, and extent of transmurality, lower ejection fraction, more adverse cardiac events early and late, and more severe late LV remodeling [91]. Infarct size at the baseline has proved to be the strongest predictor of adverse long-term LV remodeling [92]. There is a strong linear relation between scar size, LV end-systolic and end-diastolic volumes, and LVEF. Scar size is the strongest predictor of LVEF, independent of scar location and transmurality [97]. Baseline infarct size, infarct heterogeneity, and myocardial salvage are significantly associated with 90-day LVEF [93]. MRI Heart Function and Morphology Without IV Contrast MRI heart function and morphology without IV contrast provides assessment of ejection fraction and ventricular volumes including LVEF and ESVI with a higher sensitivity to detect prior myocardial infarct than ischemia. There is no relevant literature to support the use of MRI heart function and morphology without IV contrast in the initial evaluation of patients with chronic chest pain and a high probability of CAD with known IHD. MRI Heart Function with Stress Without and With IV Contrast MRI with function/wall motion (dobutamine stress test) and MRI with vasodilator stress perfusion (adenosine/regadenoson stress test) have been used to diagnose hemodynamically significant CAD in patients with an intermediate to high likelihood of having significant stenosis.