Understanding Myocardial Ischemia: Cardiac Magnetic Resonance Insight Into Coronary Macro- and Microcirculation Pathophysiology

The purpose of this paper is to summarize the recent myocardial perfusion cardiovascular magnetic resonance (CMR) studies in the context of the diagnostic and prognostic value of epicardial coronary artery disease (CAD), coronary microvascular dysfunction (CMD) and the non-ischemic heart disease. Recent developments of the sequence and the post-processing of myocardial perfusion CMR images have enabled the quantitative assessment of myocardial perfusion, facilitating a significant shift from qualitative to quantitative assessment of stress perfusion CMR. Quantitative assessment of perfusion CMR allows objective and accurate assessment of myocardial ischemia in the detection of CAD, and may have the potential to assess CMD. Moreover, the integration of quantitative perfusion CMR with cine for functional assessment and late gadolinium enhancement and T1/T2 mapping for tissue characterization techniques allows for a deeper understanding of the pathophysiology and a capability of prognostic stratification for various cardiovascular diseases.