Imaging modalities for the assessment of CMVO

Coronary microvascular obstruction (CMVO) and no-reflow (NR) are relatively common after primary percutaneous coronary intervention (PCI) with a strong prognostic impact on patients’ outcome. Therefore the correct and precise detection of CMVO to identify patients at high risk for future cardiovascular events is clinically important. CMVO can be assessed using different invasive and noninvasive techniques (see also Chapters 7: Angiography and Electrocardiography for the Assessment of Coronary Microvascular Obstruction, 8: Invasive Assessment of Coronary Microvascular Obstruction, 10: Intracoronary Imaging for Assessing the Risk of Coronary Microvascular Obstruction, 11: A Comprehensive Prognostic Assessment of STEMI by Cardiac MRI). Imaging techniques can provide the detection and quantification of NR extension. Myocardial contrast echocardiography (MCE) and contrast-enhanced cardiac magnetic resonance (CMR) are the most common noninvasive imaging techniques for its diagnosis. However, it is not yet well established, which is the most accurate tool to visualize and quantify microvascular damage. Of note, the incidence of NR is related to the accuracy of the assessment method, ranging from 10% by using angiographic assessment to 60% by using CMR or MCE. In the following chapter the clinical relevance of the most studied imaging modalities for CMVO/NR detection will be described.