Cardiac magnetic resonance in hypertrophic and dilated cardiomyopathies
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CARDIAC RADIOLOGY
Cardiac magnetic resonance in hypertrophic and dilated cardiomyopathies Silvia Pradella1 · Giulia Grazzini1 · Cristian De Amicis1 · Mayla Letteriello1 · Manlio Acquafresca1 · Vittorio Miele1 Received: 5 June 2020 / Accepted: 3 September 2020 © Italian Society of Medical Radiology 2020
Abstract Cardiomyopathies are a heterogeneous entity. The progress in the field of genetics has allowed over the years to determine its origin more and more often. The classification of these pathologies has changed over the years; it has been updated with new knowledge. Imaging allows to define the phenotypic characteristics of the different forms of cardiomyopathy. Cardiac magnetic resonance (CMR) allows a morphological evaluation of the associated (and sometimes pathognomonic) cardiac findings of any form of cardiomyopathy. The tissue characterization sequences also make magnetic resonance imaging unique in its ability to detect changes in myocardial tissue. This review aims to define the features that can be highlighted by CMR in hypertrophic and dilated forms and the possible differential diagnoses. In hypertrophic forms, CMR provides: precise evaluation of wall thickness in all segments, ventricular function and size and evaluation of possible presence of areas of fibrosis as well as changes in myocardial tissue (measurement of T1 mapping and extracellular volume values). In dilated forms, cardiac resonance is the gold standard in the assessment of ventricular volumes. CMR highlights also the potential alterations of the myocardial tissue. Keywords Cardiac magnetic resonance (CMR) · Myocardium · Cardiac hypertrophy · Cardiac dilatation · Late gadolinium enhancement (LGE) · T1 mapping
Introduction Cardiomyopathy (CMP) is a disease that primarily affects the heart muscle with a heterogeneous clinical presentation and natural history [1, 2]. “Primary forms” of CMP must be distinguished from “Secondary forms,” in which the myocardial alteration is caused by a different pathology, such as a ventricular dilatation post-myocardial infarction associated with coronary artery disease (CAD). Although single forms are relatively rare, the overall prevalence of CMP reaches 3% [3]. In recent years, advances in genetics have made it possible to classify an increasing number of CMPs previously classified as being of “unknown origin” [4]. The recognition of familial CMP is important in creating a patient’s pathway, highlighting when screening of relatives is necessary, and distinguishing familial CMP from non-genetic forms of the disease (i.e., post-viral, autoimmune, immune-mediated * Silvia Pradella [email protected] 1
Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
sporadic CMPs, or from toxicity linked to endogenous or exogenous causes such as drugs and toxic agents). However, in the context of a complex diagnosis process, the recognition of a specific mutation can be associated with several different CMPs [5]. Since the World Health Organization (WHO) provided the
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