Figure 1

Column A = Late gadolinium-enhancement CMR in the short axis. Column B = Rest perfusion CMR at peak myocardial enhancement in the identical location. Column C = Adenosine stress perfusion CMR with identical image parameters to column B. Column D = Corresponding X-ray coronary angiogram. Top Row = Example of Q-wave STEMI, showing a large septal scar with a central area of microvascular obstruction (A; full arrow). There is also a small inferior scar (A; dotted arrow). Rest perfusion CMR (B) shows a defect corresponding predominantly to the area of the microvascular obstruction. Stress perfusion CMR (C) shows the perfusion defect in the entire infarct and extending marginally into the peri-infarct zone. Coronary angiography (D) revealed an occluded proximal LAD at the site of a previous stent. Middle Row = Example of Non Q-wave STEMI, showing a small inferior scar (A; arrow). Rest perfusion CMR (B) shows the small inferior scar is not detected as a fixed perfusion defect. The stress perfusion image (C) shows a large inducible perfusion defect infero-laterally, extending beyond the scar into the peri-infarct zone (C; arrow). The coronary angiogram (D) shows a severe stenosis in the mid circumflex artery. Bottom Row = Example of NSTEMI, showing a small subendocardial scar in the antero-septal segment (A). Rest perfusion CMR (B) appears homogenous outside the scar. The stress perfusion image (C) shows a large area of inducible antero-septal ischemia. On coronary angiography (D), severe disease in the left anterior descending artery was found.