Diagnostic and prognostic value of cardiovascular magnetic resonance in non-ischaemic cardiomyopathies
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REVIEW
Open Access
Diagnostic and prognostic value of cardiovascular magnetic resonance in non-ischaemic cardiomyopathies Chirine Parsai1,2, Rory O’Hanlon1,3, Sanjay K Prasad1,4 and Raad H Mohiaddin1,4*
Abstract Cardiovascular Magnetic Resonance (CMR) is recognised as a valuable clinical tool which in a single scan setting can assess ventricular volumes and function, myocardial fibrosis, iron loading, flow quantification, tissue characterisation and myocardial perfusion imaging. The advent of CMR using extrinsic and intrinsic contrast-enhanced protocols for tissue characterisation have dramatically changed the non-invasive work-up of patients with suspected or known cardiomyopathy. Although the technique initially focused on the in vivo identification of myocardial necrosis through the late gadolinium enhancement (LGE) technique, recent work highlighted the ability of CMR to provide more detailed in vivo tissue characterisation to help establish a differential diagnosis of the underlying aetiology, to exclude an ischaemic substrate and to provide important prognostic markers. The potential application of CMR in the clinical approach of a patient with suspected non-ischaemic cardiomyopathy is discussed in this review.
Review Introduction
Cardiomyopathies encompass a broad spectrum of myocardial conditions which can affect the heart as a primary disease process or as part of a systemic disorder, evolving toward heart failure or cardiovascular death. Progress of modern molecular biology and its introduction into clinical cardiovascular medicine has considerably changed the approach to cardiomyopathies and has led to new classification schemes. .While cardiomyopathies were initially defined as disorders that were idiopathic, expert panels classify cardiomyopathies now into: primary, acquired and mixed [1]. This results from the data published by the latest AHA (2006) and ESC (2008) classifications segregating cardiomyopathies into familial/genetic and non-familial/non-genetic [2,3]. Both recommendations define a cardiomyopathy as ‘a myocardial disorder in which the heart muscle is structurally and functionally abnormal in the absence of coronary heart disease, * Correspondence: [email protected] 1 Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK 4 National Heart and Lung Institute, Imperial College, London, UK Full list of author information is available at the end of the article
hypertension, valvular heart disease and congenital heart disease sufficient to cause the observed myocardial abnormality’ [3]. Cardiomyopathies are therefore grouped into specific morphological and functional phenotypes and sub-classified into familial and non-familial forms. Whilst prevalence of dilated cardiomyopathy reaches 36 cases per 100 000 population, these figures as well as those reported for other cardiomyopathies, underestimate the frequency of the disorder as a number of patients are asymptomatic until reaching advanced stages of the disease. In addition, accurate diagnostic a
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