Stress perfusion cardiovascular magnetic resonance imaging: a guide for the general cardiologist

Stress cardiovascular magnetic resonance (CMR) is an emerging non-invasive imaging technique for the assessment of known or suspected ischaemic heart disease (IHD). Stress CMR provides information on myocardial perfusion, wall motion, ventricular dimensions and volumes, as well as late gadolinium enhancement (LGE) scar imaging in a single test without ionising radiation. Data from numerous multicentre randomised studies show high diagnostic and prognostic utility, its efficacy as a gatekeeper to invasive coronary angiography and use for guiding coronary revascularisation decisions. Stress CMR is cost-effective across multiple healthcare settings, yet its uptake and usage varies worldwide and is an underutilised technology. New developments include rapid acquisition protocols, automated quantification of perfusion and myocardial blood flow, and artificial intelligence-aided automated analysis and reporting. Stress CMR is becoming more accessible and standardised around the globe and is ready for 'prime time' use in the non-invasive assessment of patients with suspected IHD.

Automated summary

Stress cardiovascular magnetic resonance (CMR) is an emerging non-invasive imaging technique that provides information on various aspects of the heart and has shown high diagnostic and prognostic utility in the assessment of known or suspected ischaemic heart disease (IHD). It is cost-effective and has the potential to guide coronary revascularisation decisions. However, its usage varies worldwide and it is still an underutilised technology. New developments, such as rapid acquisition protocols, automated quantification, and artificial intelligence-aided analysis, are making stress CMR more accessible and standardised globally.