Magnetic resonance imaging in the evaluation of non-ischemic cardiomyopathies: Current applications and future perspectives

Abstract

Patients with non-ischemic cardiomyopathy often represent a diagnostic challenge, and correct etiologic diagnosis may influence outcomes. Lately, delayed myocardial enhancement MR imaging has been developed and is currently being used for a growing number of clinical applications. On delayed enhancement MR images, scarring or fibrosis appears as an area of high signal intensity, and the pattern by which this enhancement occurs in the myocardium allows distinction of many different pathologies. In nonischemic cardiomyopathy, the delayed enhancement usually does not occur in a coronary artery distribution and is often midwall rather than subendocardial or transmural. It could also guide myocardial biopsy to an affected area, increasing its yield. Cardiac magnetic resonance imaging has now a definitive role in clinical practice, and its capability to non-invasively provide high resolution images of the heart with good tissue characterization is redefining the understanding of the conditions that can adversely affect the myocardium.

Left Ventricular Midwall Fibrosis as a Predictor of Mortality and Morbidity After Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy

“…In nonischemic dilated cardiomyopathy (DCM), fibrosis tends to be patchy, subepicardial, or midmyocardial in distribution (13)(14)(15). It has been shown that non-CRT patients with DCM and midwall fibrosis have a higher risk of mortality and unplanned hospitalizations, as well as a higher risk of sudden cardiac death (16).…”

Delayed enhancement cardiac magnetic resonance imaging reveals typical patterns of myocardial injury in patients with various forms of non-ischemic heart disease

“…It appears, therefore, that the extent of myocardial tissue injury, rather than the mere deterioration of cardiac contractile function, is a crucial risk factor in NIHD patients. To date, systematic data on the extent and distribution pattern of LHE in patients with NIHD are scarce although a number of excellent review articles addressed the topic [9][10][11][12]. The methodological evaluation of these parameters would likely be valuable for longitudinal studies and clinical trials.…”

Cardiac Magnetic Resonance Imaging for the Assessment of the Myocardium After Doxorubicin-based Chemotherapy

“…In addition, it allows for the precise determination of left ventricular ejection fraction (LVEF). 8 To date, a number of studies evaluating the clinical occurrence of AICM have been reported using 2-dimensional (2D) echocardiographic indices in the setting of breast cancer, 9,10 acute myeloid leukemia, 11 and lymphomas. [12][13][14] However, recent studies conducted in adults have shown that conventional 2D echocardiographic indices may not accurately predict the onset of heart failure in patients with AICM.…”