State of the art: multimodality imaging in dilated cardiomyopathy

Abstract

Dilated cardiomyopathy represents a common phenotype expressed in individuals with a family of overlapping myocardial diseases due to acquired and/or genetic susceptibility. Disease trajectory, response to therapy and outcomes vary widely; therefore, further refinement of the diagnosis can help guide therapy and inform prognosis. Multimodality imaging plays a key role in this process, as well as excluding alternative causes which may mimic a primary myocardial disease. The following article discusses the role of different imaging modalities as well as what the future may look like in the context of recent research innovations.

Precision therapy in dilated cardiomyopathy: Pipedream or paradigm shift?

“…Whilst echocardiography (TTE) serves as the initial modality for diagnosing patients with heart failure with reduced ejection fraction, it is unable to reliably discriminate the cause of left ventricular dysfunction. Much data supports the use of cardiac magnetic resonance (CMR) imaging as a valuable tool for discriminating between ischaemic and non-ischaemic aetiologies and refining the cause and mechanism of non-ischaemic LV dysfunction (Japp et al, 2016 ; Halliday, 2022 ). It does so through detailed tissue characterisation using late gadolinium enhancement (LGE) imaging and parametric mapping (Japp et al, 2016 ; Halliday, 2022 ; Merlo et al, 2023 ).…”

“…Much data supports the use of cardiac magnetic resonance (CMR) imaging as a valuable tool for discriminating between ischaemic and non-ischaemic aetiologies and refining the cause and mechanism of non-ischaemic LV dysfunction (Japp et al, 2016 ; Halliday, 2022 ). It does so through detailed tissue characterisation using late gadolinium enhancement (LGE) imaging and parametric mapping (Japp et al, 2016 ; Halliday, 2022 ; Merlo et al, 2023 ). This insight currently provides important information that guides selection of patients for ICDs and may also help individualise other treatment decisions in the future.…”

“… Dilated cardiomyopathy (DCM) – a family of diseases. Selected syndromic causes of dilated cardiomyopathy include Barth syndrome, haemochromatosis, Kearns–Sayre syndrome, and Carvajal syndrome (adapted with permission from Halliday, 2022 ). …”

Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies

“…In relation with sequences like T2-STIR, T1, T2 and Extracellular volume (ECV) mapping there is controversial data some experts state that T1 and ECV have limited value that is explained by the reduced precision in NIDCM due to thinning of the myocardium[ 9 ]. Other authors have claimed some potential value of T1 and ECV, elevated ECV and T1 measurements have demonstrated prognostic significance regardless of LV ejection fraction (LVEF) and the presence of LGE[ 10 ].…”

Heartbeat: valve-sparing root replacement comes of age

“…The Education in Heart article in this issue6 provides a comprehensive review and practical guidance for the use of multimodality imaging in diagnosis of patients with dilated cardiomyopathy (figure 3).…”