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Cardiovascular Magnetic Resonance Imaging Tissue Characterization in Non-ischemic Cardiomyopathies

  • Imaging (Q Truong, Section Editor)
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Abstract

Purpose of review

In this review, we will focus the role of CMR in dilated cardiomyopathy and genetic cardiomyopathy.

Recent findings

Non-invasive imaging plays a crucial rule in the diagnostic workup of cardiomyopathies. In these entities, echocardiography is the first-line imaging tool for diagnostic assessment, but CMR has the unique capability to identify and differentiate the underlying pathology, mainly through tissue characterization, even if the EF is preserved. Myocardial tissue characterization is crucial for adequate prognostication and guiding of therapy. Visual, semi-quantitative, and quantitative methods allow the accurate description of myocardial pathologies such as edema, hyperemia, hypoperfusion, and fibrosis. Basic CMR protocols and standardized post-processing methods are well established and routinely performed.

Summary

CMR has the ability to characterize concomitantly the myocardial tissue characteristics using techniques such as LGE, T1 mapping with ECV measurements, and T2 mapping, and also deformation functional parameters (i.e., strain) and thus provides important insights into the underlying etiology of cardiomyopathy and prognosis. The results of several studies show that CMR findings are associated with clinical outcomes and can inform the management of these patients, including longitudinal assessment of treatment response. CMR should be routinely used in the workup of patients with non-ischemic cardiomyopathy for both diagnostic and prognostic applications.

The presence of LV dilatation and systolic dysfunction in the absence of significant coronary artery disease together with valvular diseases represents a significant etiology to cause cardiomyopathy in cardiology practices. Additionally, other etiologies as infiltrative heart diseases, channelopathy/genetic cardiomyopathy and cardiac involvement in systemic diseases and oncologic process complete the spectrum that may range from isolated LV involvement or biventricular failure. Non-invasive imaging plays a crucial rule in the diagnostic workup of cardiomyopathies. In these entities, echocardiography is the first-line imaging tool for diagnostic assessment, but CMR has the unique capability to identify and differentiate the underlying pathology, mainly through tissue characterization, even if the EF is preserved. Myocardial tissue characterization is crucial for adequate prognostication and guiding of therapy. Visual, semi-quantitative, and quantitative methods allow the accurate description of myocardial pathologies such as edema, hyperaemia, hypoperfusion, and fibrosis. Basic CMR protocols and standardized post-processing methods are well established and routinely performed.

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Authors and Affiliations

  1. Orlando Health Heart Institute, Orlando, FL, USA

    J. Rodriguez-Ortiz MD

  2. Alaska Heart and Vascular Institute, Anchorage, AK, 99508, USA

    A. Abuzaid MD, FACP, FASE, FACC

  3. Department of Cardiology, University of California, San Francisco, CA, 94115, USA

    Agbor-Etang Brian MD

  4. Department of Radiology, University of California, San Francisco, CA, 94115, USA

    K. Ordovas MD MAS, FNASCI, FSCMR

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  1. J. Rodriguez-Ortiz MD
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  2. A. Abuzaid MD, FACP, FASE, FACC
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  3. Agbor-Etang Brian MD
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  4. K. Ordovas MD MAS, FNASCI, FSCMR
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Correspondence to A. Abuzaid MD, FACP, FASE, FACC.

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Rodriguez-Ortiz, J., Abuzaid, A., Brian, AE. et al. Cardiovascular Magnetic Resonance Imaging Tissue Characterization in Non-ischemic Cardiomyopathies. Curr Treat Options Cardio Med 22, 16 (2020). https://doi.org/10.1007/s11936-020-00813-1

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