Role of Imaging Techniques for Diagnosis, Prognosis and Management of Heart Failure Patients: Cardiac Magnetic Resonance

Abstract

Cardiac Magnetic Resonance (CMR) has evolved into a major tool for the diagnosis and assessment of prognosis of patients suffering from heart failure. Anatomical and structural imaging, functional assessment, T1 and T2 mapping tissue characterization and late gadolinium enhancement (LGE) have provided clinicians with tools to distinguish between non-ischemic and ischemic cardiomyopathies and to identify the etiology of non-ischemic cardiomyopathies. LGE is a useful tool to predict the likelihood of functional recovery after revascularization in patients with CAD and to guide the LV lead placement in those who qualify for cardiac resynchronization (CRT) therapy. In addition, the presence of LGE and its extent in myocardial tissue relates to overall cardiovascular outcomes. Emerging roles for cardiac imaging in Heart Failure with Preserved Ejection Fraction (HFpEF) are being studied and CMR continues to be among the most promising noninvasive imaging alternatives in the diagnosis of this disease.

Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy

“…CMR has emerged as an important tool to identify the etiology of nonischemic cardiomyopathies,27 and predict risk of adverse outcomes based on the extent of LGE 4, 8, 10, 14, 15, 27. LGE can detect foci of myocardial damage as small as 0.7 g of myocardial tissue 28.…”

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012

“…It is the best alternative cardiac imaging modality for patients with nondiagnostic echocardiographic studies (particularly for imaging of the right heart) and is the method of choice in patients with complex congenital heart diseases. 91,101,102 CMR is the preferred imaging method to assess myocardial fibrosis using late gadolinium enhancement (LGE) along with T1 mapping and can be useful for establishing HF aetiology. 91,103 For example, CMR with LGE allows differentiation between ischaemic and non-ischaemic origins of HF and myocardial fibrosis/scars can be visualized.…”

“…91,101,102 CMR is the preferred imaging method to assess myocardial fibrosis using late gadolinium enhancement (LGE) along with T1 mapping and can be useful for establishing HF aetiology. 91,103 For example, CMR with LGE allows differentiation between ischaemic and non-ischaemic origins of HF and myocardial fibrosis/scars can be visualized. In addition, CMR allows the characterization of myocardial tissue of myocarditis, amyloidosis, sarcoidosis, Chagas disease, Fabry disease non-compaction cardiomyopathy and haemochromatosis.…”

“…In addition, CMR allows the characterization of myocardial tissue of myocarditis, amyloidosis, sarcoidosis, Chagas disease, Fabry disease non-compaction cardiomyopathy and haemochromatosis. 91,101,103,104 CMR may also be used for the assessment of myocardial ischaemia and viability in patients with HF and CAD (considered suitable for coronary revascularization). However, limited evidence from RCTs has failed to show that viability assessed by CMR or other means identified patients who obtained clinical benefit from revascularization.…”

Clinical profile and management of outpatients with non-ischemic and non-hypertensive systolic heart failure: Analysis of the Polish DATA-HELP registry

“…After exclusions of the aforementioned diagnosed and potential causes of HF in 108 patients (2% of all studied patients with HF and 20% of patients classified primary as non-ischemic and non-hypertensive etiology), no possible etiology has been found and can be classified as idiopathic HF. Especially in this population of patients with HF, it appears to be justified to perform more sophisticated investigations like cardiac magnetic resonance or even heart biopsy, however it must be pointed out, that these kinds of examinations should take place only in clinics with experience in performing and describing results of these procedures [13][14][15][16][17][18][19][20][21].…”