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Stress cardiovascular magnetic resonance (CMR) is an emerging non-invasive imaging technique for the assessment of known or suspected ischaemic heart disease (IHD). Stress CMR provides information on myocardial perfusion, wall motion, ventricular dimensions and volumes, as well as late gadolinium enhancement (LGE) scar imaging in a single test without ionising radiation. Data from numerous multicentre randomised studies show high diagnostic and prognostic utility, its efficacy as a gatekeeper to invasive coronary angiography and use for guiding coronary revascularisation decisions. Stress CMR is cost-effective across multiple healthcare settings, yet its uptake and usage varies worldwide and is an underutilised technology. New developments include rapid acquisition protocols, automated quantification of perfusion and myocardial blood flow, and artificial intelligence-aided automated analysis and reporting. Stress CMR is becoming more accessible and standardised around the globe and is ready for ‘prime time’ use in the non-invasive assessment of patients with suspected IHD.

A 72-year-old woman presented for routine echocardiography 6 months following percutaneous insertion of a left atrial appendage occluder (LAAO) due to atrial fibrillation with contraindications to anticoagulation. The procedure was uncomplicated, and she was clinically well. On echocardiography an abnormality was seen in the posterior pericardial space (Figure 1, arrows). Figure 1 Transthoracic Echocardiogram: left, parasternal long axis. right, parasternal short axis …

In this review discuss the application of cardiac magnetic resonance (CMR) to the evaluation and quantification of mitral regurgitation and provide a systematic literature review for comparisons with echocardiography. Using the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology, we searched Medline and PubMed for original research articles published since 2000 that provided data on the quantification of mitral regurgitation by CMR. We identified 220 articles of which 33 were included. Four main techniques of mitral regurgitation quantification were identified. Reproducibility varied substantially between papers but was high overall for all techniques. However, quantification differed between the techniques studied. When compared with two-dimensional echocardiography, mitral regurgitation fraction and regurgitant volume measured by CMR were comparable but typically lower. CMR has high reproducibility for the quantification of mitral regurgitation in experienced centres, but further technological refinement is needed. An integrated and standardised approach that combines multiple techniques is recommended for optimal reproducibility and precise mitral regurgitation quantification. Definitive outcome studies using CMR as a basis for treatment are lacking but needed.

A 39-year-old man was referred with a history of progressive shortness of breath, NYHA class II, for further evaluation. Clinical examination revealed prominent V-waves in the jugular venous pulse, a parasternal heave and a soft systolic murmur at the left sternal edge. Respiratory function tests were normal and d-dimer was negative. Echocardiography demonstrated severe RV dilation, severe tricuspid regurgitation and an apically displaced septal leaflet of the tricuspid valve typical of Ebstein's anomaly (see online supplementary appendix movie 1). An abnormality was noted attached to the atrial aspect of the tricuspid valve on transthoracic and transoesophageal imaging (Figure 1A, B as well as online …