European Heart Journal Advance Access originally published online on April 14, 2005
European Heart Journal 2005 26(15):1461-1474; doi:10.1093/eurheartj/ehi258
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Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies
1Division of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, 70376 Stuttgart, Germany
2The Duke Cardiovascular MR Centre, Durham, NC, USA
Received 31 December 2004; revised 26 February 2005; accepted 15 March 2005; online publish-ahead-of-print 14 April 2005.
* Corresponding author. Tel: +49 711 8101 3456; fax: +49 711 8101 3790. E-mail address: heiko.mahrholdt{at}rbk.de
Non-ischaemic cardiomyopathies (NICMs) are chronic, progressive myocardial diseases with distinct patterns of morphological, functional, and electrophysiological changes. In the setting of cardiomyopathy (CM), determining the exact aetiology is important because the aetiology is directly related to treatment and patient survival. Determining the exact aetiology, however, can be difficult using currently available imaging techniques, such as echocardiography, radionuclide imaging or X-ray coronary angiography, since overlap of features between CMs may be encountered.
Cardiovascular magnetic resonance (CMR) imaging has recently emerged as a new non-invasive imaging modality capable of providing high-resolution images of the heart in any desired plane. Delayed contrast enhanced CMR (DE-CMR) can be used for non-invasive tissue characterization and may hold promise in differentiating ischaemic from NICMs, as the typical pattern of hyperenhancement can be classified as ‘ischaemic-type’ or ‘non-ischaemic type’ on the basis of pathophysiology of ischaemia.
This article reviews the potential of DE-CMR to distinguish between ischaemic and NICM as well as to differentiate non-ischaemic aetiologies. Rather than simply describing various hyperenhancement patterns that may occur in different disease states, our goal will be (i) to provide an overall imaging approach for the diagnosis of CM and (ii) to demonstrate how this approach is based on the underlying relationships between contrast enhancement and myocardial pathophysiology.
Key Words: CMR • Cardiomyopathy • MRI • Contrast enhancement • Delayed enhancement
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