Fig. 2
Examples of inducible myocardial ischemia on stress CMR in patients with known CKD. A normal. 77-year-old male with hypertension and history of CKD (GFR 38 ml/min/m2), presenting atypical angina. Stress CMR revealed no perfusion defect and LGE was negative, ruling out the diagnosis of myocardial ischemia. B Inducible ischemia. 69-year-old female with and history of CKD (GFR 56 ml/min/m2), presenting dyspnea on exertion. First-pass myocardial stress perfusion images revealed a reversible perfusion defect of the anteroseptal wall (white arrows) without LGE, indicative of myocardial inducible ischemia suggestive of significant LAD stenosis, confirmed by coronary angiography. C Myocardial scar without ischemia. 70-year-old female with diabetes mellitus, hypertension and history of CKD (GFR 41 ml/min/m2), presenting dyspnea on exertion. Stress CMR showed a subendocardial lateral scar on LGE (orange arrows), with a colocalization of the perfusion defect (white arrows) and, therefore, no inducible ischemia. Coronary angiography confirmed the absence of significant stenosis. D Myocardial scar with additional inducible ischemia. 67-year-old male with diabetes mellitus, hypertension and history of CKD (GFR 55 ml/min/m2), presenting atypical angina. Stress CMR showed a subendocardial scar on the antero-septo-apical wall on LGE sequences (orange arrows), and a perfusion defect of the inferior and infero-septal wall (white arrows) on first-pass perfusion images, indicative of inducible myocardial ischemia. Coronary angiography revealed high-grade stenoses of the RCA. CAD coronary artery disease; CMR cardiovascular magnetic resonance; Cx circumflex coronary artery; LAD left anterior descending; LGE late gadolinium enhancement; MI myocardial infarction; NSTEMI non-ST segment elevation myocardial infarction; PCI percutaneous coronary intervention; RCA right coronary artery; STEMI ST segment elevation myocardial infarction