Recorded live on February 8th, 2024
In this recorded Cardiology Grand Rounds presentation, Director of Cardiac Magnetic Resonance Imaging at Brigham and Women's Hospital and Professor at Harvard Medical School, Dr. Raymond Kwong discusses stress cardiac magnetic resonance imaging (CMR) and its applications in diagnosing and managing coronary artery disease. In his lecture Dr. Kwong covers the need for a highly accurate and physiologic tool like stress CMR for assessing myocardial ischemia. He discusses lessons learned from clinical trials (ISCHEMIA, COURAGE, BARI 2D). Dr. Kwong also highlights the advantages of stress CMR over other modalities. He explains the quantitative blood flow mapping technique, which allows for pixel-level assessment of myocardial perfusion and ischemic burden. Dr. Kwong then presents several case examples demonstrating the diagnostic and prognostic value of stress CMR in various scenarios, including acute chest pain, stable angina, and non-ischemic cardiomyopathies. He highlights the ability of stress CMR to differentiate between obstructive and non-obstructive coronary artery disease, guide revascularization decisions, and identify non-ischemic etiologies such as hypertrophic cardiomyopathy, myocarditis, and pericardial diseases. Dr. Kwong explains that despite the advantages of stress CMR, its adoption has been limited due to factors such as the need for trained personnel, long scan times, and competition for scanner time with other modalities. Finally, Dr. Kwong discusses the implementation of AI-assisted CMR protocols at Brigham and Women's Hospital, which has significantly improved scan efficiency, consistency, and diagnostic quality.
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Learning Objectives:
1. Implement quantitative blood flow mapping techniques for stress CMR to accurately assess the extent and severity of myocardial ischemia on a pixel-level basis.
2. Evaluate the presence and extent of peri-infarct ischemia in patients with myocardial infarction, as it is associated with a higher risk of adverse cardiovascular events.
3. Provide training and education for physicians and technologists to interpret and utilize stress CMR data, including quantitative blood flow mapping and overlay of ischemic and infarct territories, for clinical decision-making.
4. Conduct multi-center registry studies to further validate the diagnostic and prognostic value of quantitative stress CMR across different vendors and in a broader patient population.
5. Advocate for the inclusion of stress CMR as a class 1 recommended test for evaluating stable and acute chest pain in clinical practice guidelines
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