Prognostic significance of cardiac magnetic resonance imaging: Update 2010

Cardiac magnetic resonance imaging (CMR) has become an indispensible imaging technique for the diagnosis and treatment of patients with cardiovascular diseases. Technical advances in the past have rendered CMR unique in the evaluation of cardiovascular anatomy, physiology, and pathophysiology due to its unique ability to produce high resolution tomographic images of the human heart and vessels in any arbitrary orientation, with soft tissue contrast that is superior to competing imaging modalities without the use of ionizing radiation. CMR imaging is the gold standard for assessing left and right ventricular function and for detecting myocardial tissue abnormalities like edema, infarction, or scars. For prognostic reasons abnormal structure and dysfunction of the heart, and the detection of myocardial ischemia and/or myocardial scars are the main targets for CMR imaging. In this review we briefly describe the prognostic significance of several CMR imaging techniques and special CMR parameters in patients with coronary artery disease (CAD), with cardiomyopathies, and with chronic heart failure. Myocardial ischemia proved to be a strong predictor of an adverse outcome in patients with CAD. Microvascular obstruction in acute myocardial infarction is a new and independent parameter of negative left ventricular remodeling and a worse prognosis. Myocardial scars in patients with CAD and unrecognized myocardial infarction heralds a negative outcome. Scar in patients with dilated or hypertrophic cardiomyopathy are a strong predictor of both life-threatening ventricular tachyarrhythmias and prognosis. CMR imaging may improve the assessment of inter- and intraventricular dyssynchrony and provide prognostic information by detecting myocardial scars. (Cardiol J 2010; 17, 6: 549-557