Cardiovascular Magnetic Resonance Imaging Tissue Characterization in Non-ischemic Cardiomyopathies

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

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.

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.