Assessing the Value of Stress Cardiac Magnetic Resonance Imaging in Detection of Myocardial Ischemia

Motivation: Coronary microvascular dysfunction (CMD) can cause myocardial ischemia without significant coronary artery disease, hindering its diagnosis. Goal(s): To evaluate the diagnostic performance of non-invasive stress cardiac magnetic resonance (CMR) perfusion parameters, particularly myocardial perfusion reserve (MPR), in detecting and distinguishing CMD from obstructive coronary artery disease (CAD). Approach: We prospectively analyzed stress CMR perfusion data from patients with suspected myocardial ischemia. Patients underwent coronary angiography and/or coronary computed tomography angiography for comparison. Results: Stress CMR detected ischemia in more patients and myocardial segments relative to resting perfusion imaging. MPR showed high diagnostic accuracy for CMD. Impact: This study demonstrates the utility of stress CMR for identifying CMD, even in patients with non-obstructive CAD, thus enabling earlier diagnosis and potential intervention. Further research is needed concerning the long-term prognostic and therapeutic utilities of stress CMR for CMD.