[Ischemic heart disease : More than just chronic CAD].

Clinical/methodological Issue: Myocardial ischemia as a reduction in perfusion with therefore oxygen deficiency of vital cardiomyocytes. Thus primary and secondary prophylaxis of myocardial infarction and it's complications.

Standard Radiological Methods: Adenosine-regadenoson stress magnetic resonance imaging (AR-stress MRI), computed tomography coronary angiography (CTCA).

Methodological Innovations: Non-invasive stress testing using AR-stress MRI to exclude relevant obstructive coronary artery disease (CAD).

Performance: Meta-analysis: The diagnosis of obstructive CAD at the coronary artery level has a pooled sensitivity of 87.7% and a specificity of 88.6%. Diagnostic accuracy is better than single photon emission computed tomography (SPECT; AUC 0.89 vs. 0.74).

Achievements: AR-stress MRI can be used to assess myocardial ischemia in the setting of obstructive CAD. Current clinical guidelines for myocardial revascularization have strengthened the use of stress MRI in patients with intermediate risk of CAD and stable symptoms. Cardiac MR imaging using late gadolinium enhancement (LGE) is considered gold standard for myocardial viability assessment in vivo. Both viability and ischemia are considered prognostic factors for major adverse cardiac events.

Practical Recommendations: AR-stress MRI is used to diagnose myocardial ischemia in combination with viability imaging (LGE). Dobutamine-atropine (DoA) stress MRI is an alternative in the setting of contraindications for AR or specific clinical questions.