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Kardiologie up2date 2010; 6(4): 335-352
DOI: 10.1055/s-0030-1255966
Koronare Herzerkrankung und Atherosklerose

© Georg Thieme Verlag KG Stuttgart · New York

Kardiale Magnetresonanztomografie bei koronarer Herzerkrankung

Cosima  Jahnke, Nikolaus  Marx, Ingo  Paetsch
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Publication Date:
13 January 2011 (online)

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Abstract

The accurate noninvasive diagnosis and functional evaluation of patients with suspected or known coronary artery disease represents the cornerstone in clinical decision making to enable appropriate selection of therapeutic strategies. Over the past decade, a plethora of evidence has been gathered demonstrating the importance of cardiac magnetic resonance (CMR) imaging in the diagnostic workup of patients with chronic coronary artery disease and acute coronary syndromes. CMR techniques have become mature for determining myocardial ischemia, viability and scar and are widely employed in clinical routine. Comprehensive CMR imaging is mainly based on the versatility of the imaging modality and supplies the clinician with a broad range of useful morphological and functional information regarding cardiovascular diseases.

Kernaussagen

  • Der klinische Nutzen und die Wertigkeit der CMR zur Abbildung myokardialer Ischämiereaktionen und zur Infarktnarbendarstellung ist gut validiert. Die CMR ist daher inzwischen ein fester Bestandteil der klinischen Routinediagnostik und Verlaufsbeurteilung von Patienten mit bekannter oder vermuteter KHK.

  • Die CMR bietet die einzigartige Möglichkeit einer umfassenden nicht invasiven Beurteilung von myokardialer Viabilität, Ischämie und Infarktnarbe durch die Kombination von regionaler Wandbewegungs- und Perfusionsanalyse in Ruhe und unter pharmakologischer Belastung zusammen mit Spätaufnahmen („delayed enhancement”).

  • Die CMR kann zur Diagnostik eines akuten Koronarsyndroms hinzugezogen werden und bietet vor allem den Vorteil einer breiten differenzialdiagnostischen Abklärung von Patienten mit Thoraxschmerzen.

  • Die CMR leistet einen wichtigen Beitrag zur Risikoeinschätzung kardiovaskulärer Patienten. Bei negativem Stress-CMR-Befund ist die Rate kardialer Ereignisse in den folgenden 2 Jahren gering (< 1 %).

  • Die Darstellung und Charakterisierung der koronararteriellen Gefäßwand könnte die kardiovaskuläre Risikoeinschätzung optimieren. In diesem Bereich kann man künftig aufgrund der technischen Weiterentwicklung eine weitere Verbesserung entsprechender CMR-Bildgebungsansätze erwarten.

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PD Dr. Cosima Jahnke

Universitätsklinikum RWTH Aachen
Medizinische Klinik I – Kardiologie, Pneumologie und Angiologie

Pauwelsstraße 30
52074 Aachen

Email: cjahnke@ukaachen.de

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