Modern Imaging Techniques in Cardiomyopathies

Abstract

Modern advanced imaging techniques have allowed increasingly more rigorous assessment of the cardiac structure and function of several types of cardiomyopathies. In contemporary cardiology practice, echocardiography and cardiac magnetic resonance imaging are widely used to provide a basic framework in the evaluation and management of cardiomyopathies. Echocardiography is the quintessential imaging technique owing to its unique ability to provide real-time images of the beating heart with good temporal resolution, combined with its noninvasive nature, cost-effectiveness, availability, and portability. Cardiac magnetic resonance imaging provides data that are both complementary and uniquely distinct, thus allowing for insights into the disease process that until recently were not possible. The new catchphrase in the evaluation of cardiomyopathies is multimodality imaging, which is purported to be the efficient integration of various methods of cardiovascular imaging to improve the ability to diagnose, guide therapy, or predict outcomes. It usually involves an integrated approach to the use of echocardiography and cardiac magnetic resonance imaging for the assessment of cardiomyopathies, and, on occasion, single-photon emission computed tomography and such specialized techniques as pyrophosphate scanning.

Cardiomyopathies

“…Echocardiography and other imaging modalities typically show dilatation of all 4 cardiac chambers, with increased end-systolic volumes of both ventricles. 15 Mitral and tricuspid regurgitation because of annular dilatation are frequent and intensify the hemodynamic burden.…”

“…44,45 In addition, the article on cardiac imaging deals with echocardiographic findings in HCM, 15 whereas the article on pediatric cardiomyopathies discusses HCM in this age group as well. 20 …”

“…Late gadolinium enhancement (LGE) has been shown in >80% of patients, including patients without evidence of this disorder by echocardiography. 61 Marked elevations in T1 and extracellular volume 15 may be useful for diagnosis and monitoring response to therapy. 62 Encouraging results of treatment have been reported by Pilebro et al 63 using the tracer C-Pittsburgh compound B, which has been shown to detect cardiac amyloid by positron emission tomography (PET).…”

“…CMR provides a powerful tool in the recognition and assessment of myocarditis. 15 This technique can reveal regions of myocardial edema, represented by elevated T2 relaxation times 15 ; hyperemia/ capillary leak, which can be detected by early gadolinium enhancement; and irreversible cell injury with fibrous tissue replacement as LGE. 22 Endomyocardial biopsy with histology, immunohistochemistry, and viral genome analysis remain the gold standard for providing the definitive diagnosis in highrisk patients with suspected myocarditis.…”

“…15 Although echocardiography 100 has been for decades and currently remains the work horse of cardiac imaging ( Table), the ability of CMR imaging to assess myocardial tissue characteristics has become of intense interest. The oldest approach is LGE, which identifies focal deposition of collagen in the extracellular matrix, reflecting areas of fibrosis.…”