Diagnosis and prognosis of ischemic heart disease: the framework of cardiac magnetic resonance

Cardiac magnetic resonance is considered the gold standard in the evaluation of morphology, function, viability and tissue characterization owing to its high spatial resolution and excellent signal-to-noise ratio. Its accuracy and reproducibility, also thanks to steady-state free precession sequences allowing superior blood-myocardium delineation, are ascertained. Its current indications in the field of ischemic heart disease are multiple and continuously evolving. This technology can provide information on myocardium at risk, infarcted myocardium, microvascular obstruction and intramyocardial haemorrhage. The evaluation of each of these indexes has pivotal importance from a prognostic point of view. Rapid technological innovation engenders faster sequences and new contrast agents whereby a more accurate study of the myocardium and coronary artery disease is possible. On the contrary, there is the huge potentiality of noncontrast cardiac magnetic resonance that is especially appealing as a screening tool in asymptomatic younger patients because of radiation-free ionizing. Last but not the least, it is necessary to underline that the employment of cardiac magnetic resonance in clinical practice is restricted to few centres. This is mainly due to the need for a very high competence level and to the complexity of technical challenges required to industrial engineering, whereas the concerns expressed for its relatively high costs seem partly unfounded.