Multi-Modality Imaging in Dilated Cardiomyopathy: With a Focus on the Role of Cardiac Magnetic Resonance

Mitropoulou, Panagiota; Georgiopoulos, Georgios; Figliozzi, Stefano; Klettas, Dimitrios; Nicoli, Flavia; Masci, Pier Giorgio

doi:10.3389/fcvm.2020.00097

Cited by 27 publications

(20 citation statements)

References 170 publications

(205 reference statements)

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“…Cine imaging with CMR is the reference standard for calculation of both LVEF and RVEF and allows accurate classification of heart failure with preserved ejection fraction (HFpEF), heart failure with midrange ejection fraction (HFmEF), or heart failure with reduced ejection fraction (HFrEF) with treatment consequences [16,25]. CMR yields excellent delineation of cardiac morphology to identify dilated [26], hypertrophic [26] and noncompacted myocardium [27,28] and combinations of these findings with implications not just for individual patients but also for family members at risk of heritable conditions [29][30][31]. Myocardial disease resulting in heart failure or cardiomyopathy may span ischemic injury, non-ischemic fibrosis, infiltrative processes, or inflammatory damage.…”

Section: Heart Failure or Cardiomyopathymentioning

confidence: 99%

30-minute CMR for common clinical indications:Â aÂ Society for Cardiovascular Magnetic Resonance white paper

Raman

Markl

Patel

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Background Despite decades of accruing evidence supporting the clinical utility of cardiovascular magnetic resonance (CMR), adoption of CMR in routine cardiovascular practice remains limited in many regions of the world. Persistent use of long scan times of 60 min or more contributes to limited adoption, though techniques available on most scanners afford routine CMR examination within 30 min. Incorporating such techniques into standardize protocols can answer common clinical questions in daily practice, including those related to heart failure, cardiomyopathy, ventricular arrhythmia, ischemic heart disease, and non-ischemic myocardial injury. Body In this white paper, we describe CMR protocols of 30 min or shorter duration with routine techniques with or without stress perfusion, plus specific approaches in patient and scanner room preparation for efficiency. Minimum requirements for the scanner gradient system, coil hardware and pulse sequences are detailed. Recent advances such as quantitative myocardial mapping and other add-on acquisitions can be incorporated into the proposed protocols without significant extension of scan duration for most patients. Conclusion Common questions in clinical cardiovascular practice can be answered in routine CMR protocols under 30 min; their incorporation warrants consideration to facilitate increased access to CMR worldwide.

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Section: Heart Failure or Cardiomyopathymentioning

confidence: 99%

30-minute CMR for common clinical indications:Â aÂ Society for Cardiovascular Magnetic Resonance white paper

Raman

Markl

Patel

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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“…Thus, by enabling accurate quantification of biventricular and atrial function, providing insights into myocardial morphology, contributing to exact diagnosis and yielding incremental prognostic information, the fundamental role of CMR imaging and FT deformation analyses become apparent across different cardiomyopathies for establishing their etiologies, defining stages of the disease and determining prognostic implications [82].…”

Section: Cmr-ft In Non-ischemic Cardiomyopathiesmentioning

confidence: 99%

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

Lange

Schuster

2021

Curr Heart Fail Rep

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Purpose of Review Cardiac magnetic resonance-feature-tracking (CMR-FT)-based deformation analyses are key tools of cardiovascular imaging and applications in heart failure (HF) diagnostics are expanding. In this review, we outline the current range of application with diagnostic and prognostic implications and provide perspectives on future trends of this technique. Recent Findings By applying CMR-FT in different cardiovascular diseases, increasing evidence proves CMR-FT-derived parameters as powerful diagnostic and prognostic imaging biomarkers within the HF continuum partly outperforming traditional clinical values like left ventricular ejection fraction. Importantly, HF diagnostics and deformation analyses by CMR-FT are feasible far beyond sole left ventricular performance evaluation underlining the holistic nature and accuracy of this imaging approach. Summary As an established and continuously evolving technique with strong prognostic implications, CMR-FT deformation analyses enable comprehensive cardiac performance quantification of all cardiac chambers.

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“…Tissue characterization using the late gadolinium enhancement (LGE)-CMR technique enables the identification and quantification of regional areas of replacement fibrosis; this refers histologically to a process of reparative microscopic scarring occurring in response to myocyte necrosis ( 21 ). It has been found to be a clinically useful tool for distinguishing DCM from other important differentials of LV dysfunction such as coronary disease or sarcoidosis, subtyping the etiology of DCM, as well as for predicting the trajectory of the disease ( Figure 3 ) ( 22 , 23 ). Up to 45% of DCM patients are affected, usually in a mid-wall distribution, with <15% showing an ischaemic pattern that crucially, would not be sufficient to explain the degree of ventricular dysfunction ( 22 , 24 ).…”

Section: Current Diagnosis and Characterization Of Dcmmentioning

confidence: 99%

The Role of AI in Characterizing the DCM Phenotype

Asher

Puyol‐Antón

Rizvi

et al. 2021

Front. Cardiovasc. Med.

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Dilated Cardiomyopathy is conventionally defined by left ventricular dilatation and dysfunction in the absence of coronary disease. Emerging evidence suggests many patients remain vulnerable to major adverse outcomes despite clear therapeutic success of modern evidence-based heart failure therapy. In this era of personalized medical care, the conventional assessment of left ventricular ejection fraction falls short in fully predicting evolution and risk of outcomes in this heterogenous group of heart muscle disease, as such, a more refined means of phenotyping this disease appears essential. Cardiac MRI (CMR) is well-placed in this respect, not only for its diagnostic utility, but the wealth of information captured in global and regional function assessment with the addition of unique tissue characterization across different disease states and patient cohorts. Advanced tools are needed to leverage these sensitive metrics and integrate with clinical, genetic and biochemical information for personalized, and more clinically useful characterization of the dilated cardiomyopathy phenotype. Recent advances in artificial intelligence offers the unique opportunity to impact clinical decision making through enhanced precision image-analysis tasks, multi-source extraction of relevant features and seamless integration to enhance understanding, improve diagnosis, and subsequently clinical outcomes. Focusing particularly on deep learning, a subfield of artificial intelligence, that has garnered significant interest in the imaging community, this paper reviews the main developments that could offer more robust disease characterization and risk stratification in the Dilated Cardiomyopathy phenotype. Given its promising utility in the non-invasive assessment of cardiac diseases, we firstly highlight the key applications in CMR, set to enable comprehensive quantitative measures of function beyond the standard of care assessment. Concurrently, we revisit the added value of tissue characterization techniques for risk stratification, showcasing the deep learning platforms that overcome limitations in current clinical workflows and discuss how they could be utilized to better differentiate at-risk subgroups of this phenotype. The final section of this paper is dedicated to the allied clinical applications to imaging, that incorporate artificial intelligence and have harnessed the comprehensive abundance of data from genetics and relevant clinical variables to facilitate better classification and enable enhanced risk prediction for relevant outcomes.

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Multi-Modality Imaging in Dilated Cardiomyopathy: With a Focus on the Role of Cardiac Magnetic Resonance

Cited by 27 publications

References 170 publications

30-minute CMR for common clinical indications:Â aÂ Society for Cardiovascular Magnetic Resonance white paper

30-minute CMR for common clinical indications:Â aÂ Society for Cardiovascular Magnetic Resonance white paper

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

The Role of AI in Characterizing the DCM Phenotype

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