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Stress Perfusion CMR — EECC MCQ

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ModerateCoronary Artery DiseaseStress Perfusion CMREECC

A 65-year-old man undergoes stress perfusion CMR with adenosine. The images show a subendocardial perfusion defect in the anterior wall during stress that is not present at rest. LGE imaging shows no scar. What is the interpretation?

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Correct answer: B — Inducible myocardial ischaemia in the LAD territory without infarction; this finding supports revascularisation of a haemodynamically significant LAD lesion

Stress perfusion CMR with adenosine or regadenoson is a high-resolution functional test for detecting myocardial ischaemia. A subendocardial perfusion defect during stress (dark area on first-pass gadolinium perfusion) that resolves at rest indicates inducible ischaemia in the corresponding coronary territory. Absence of LGE confirms no previous infarction (viable myocardium). The CE-MARC and MR-INFORM trials demonstrated that stress CMR has excellent diagnostic accuracy for significant CAD (sensitivity ~90%, specificity ~80%) and can guide management decisions (revascularisation vs medical therapy). The 2024 ESC CCS Guidelines include stress CMR as a first-line non-invasive functional test for patients with intermediate PTP.

Reference: ESC (2024): CCS Guidelines; CE-MARC/MR-INFORM Trials