CMR and detection of coronary artery disease

Cardiovascular magnetic resonance (CMR) imaging plays a major role in the diagnosis and assessment of coronary artery disease (CAD). This chapter will focus on the diagnosis of ischaemia by CMR with brief reference to viability assessment, which is covered in detail elsewhere. Perfusion-CMR has matured to a reliable technique for the assessment of CAD. It detects and excludes CAD with a high diagnostic performance. There is also increasing evidence from single-centre studies and the European CMR registry for the high prognostic value of ischaemia detection by perfusion-CMR and a normal CMR study in patients with or without known CAD predicts a rate for MACE of 0.3–1%/year. Coronary angiography by CMR will not be discussed in this chapter, however, as it is only recommended for delineation of the course of coronary artery anomalies.

The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.