MRI and cine MRI of asymmetric septal hypertrophic cardiomyopathy

Cardiomyopathies (hypertrophy and failure): what can offer cardiac magnetic resonance imaging?

In routine, cardiomyopathy, confirmed or not, is a frequent reason for cardiac MRI evaluation. Step by step, by using a wide panel of sequences, cardiac MRI is able to characterize cardiomyopathies by their morphologic and functional phenotype as well as by tissue characterization. Cardiac-MRI is also considered as the most appropriate technique for the follow-up of this disease. The purpose of this article is to browse an overview of the main MRI features of cardiomyopathy, focusing the purpose on hypertrophic forms and myocardial diseases leading to cardiac failure.

[Current indications for cardiac MR imaging]

MRI has acquired over the years a role in the evaluation of cardiovascular pathology especially with regards to its ability to assess right and left ventricular function and delayed postcontrast "viability" sequences. Current class I clinical indications include: viability for patients with ischemic cardiomyopathy and acute coronary syndrome, etiology and prognostic evaluation of non-ischemic cardiomyopathies including myocarditis and arrhytmogenic right ventricular cardiomyopathy, chronic pericarditis and cardiac masses, non-urgent aortic aneurysm and dissection, congenital cardiopathies: vascular malformations and follow-up after curative or palliative surgery. MRI provides a complete non operator dependent evaluation, and is particularly useful for follow-up since it may be repeated due to its absence of ionizing radiation

Cardiac imaging in myocardial sarcoidosis and other cardiomyopathies

PURPOSE OF REVIEW

The clinical role of emerging imaging technologies for diagnosing cardiac sarcoidosis and other cardiomyopathies is evolving. An up-to-date review of the role of various imaging modalities in the evaluation of cardiac sarcoidosis and other cardiomyopathies is presented.

RECENT FINDINGS

No study prospectively established the accuracy of each of the various techniques for diagnosing myocardial involvement in patients with suspected cardiac sarcoidosis. Cardiac magnetic resonance imaging (CMR) is demonstrated to have a sensitivity of 100% and specificity of approximately 80%, and positive predictive value of approximately 55% in diagnosing cardiac sarcoidosis. Recent studies have shown that 18F-2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) has 100% sensitivity of detecting earlier stages of sarcoidosis. Both the FDG-PET and CMR may provide complementary information for the diagnosis and assessment of efficacy of therapy in patients with cardiac involvement from sarcoidosis.

SUMMARY

Clinical and subclinical cardiac involvement is common among patients with sarcoidosis. A structured clinical assessment incorporating advanced cardiac imaging with CMR and FDG-PET scanning is more sensitive than the established clinical criteria. CMR is an established imaging modality in the diagnosis of various other cardiomyopathies. Well designed prospective clinical trials are awaited to define the exact role of these imaging studies in the diagnosis and guidance of therapy.

Cardiac magnetic resonance imaging findings are useful for differentiating between hypertrophic obstructive cardiomyopathy and aortic valve stenosis in elderly patients

OBJECTIVE

The objective of this study was to assess whether cardiac magnetic resonance (MR) imaging is useful for differentiating between hypertrophic obstructive cardiomyopathy (HOCM) and aortic valve stenosis (AS) in 21 elderly patients (>75 years old).

METHODS

Cine and delayed contrast-enhanced cardiac MR imaging was performed and used to assess the regional wall thickness, myocardial mass, mitral valve motion, and myocardial hyperenhancement in elderly patients with HOCM and AS.

RESULTS

The basal anterior septal and midventricular inferior septal walls were significantly thicker, the ejection fraction was higher, and the ratio between the basal and midventricular inferior wall thicknesses was lower in patients with HOCM than those in patients with AS. Apical wall thinning and abnormal mitral valve motion were detected in patients with HOCM.

CONCLUSIONS

Structural and functional parameters that are characteristic of HOCM can be assessed in cardiac MR imaging, and these parameters may be useful for differentiating between HOCM and AS in elderly patients.

Noninvasive cardiac imaging in patients with hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and the most common cause of cardiac death in young athletes in the U.S. Noninvasive imaging plays an important role in detecting the disease, understanding its pathophysiology, and selecting as well as guiding appropriate therapy. In this review, we discuss the existing methodology with emphasis on current and emerging clinical applications in patients with HCM.

Magnetic resonance imaging of primary cardiomyopathies

Cardiomyopathies are diseases of the myocardium of unknown etiology associated with cardiac dysfunction. On the grounds of their morphology and pathophysiology, primary or idiopathic cardiomyopathies may be classified into a number of disorders; namely, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy, and restrictive cardiomyopathy. The term "secondary cardiomyopathies" is reserved to specific heart muscle diseases clinically very similar to primary cardiomyopathies. Cardiac magnetic resonance imaging has long been used to study cardiac morphology and, more recently, to assess blood flow, perfusion, and contractile function. The emerging role of magnetic resonance imaging for the understanding and treatment of primary cardiomyopathies cannot be underestimated. From a clinical point of view, an examination based on a single, efficient, and noninvasive MR study focusing on the clinically relevant features of cardiomyopathies is an objective and reproducible means for diagnosing and monitoring hypertrophic, arrhythmogenic, dilated, and restrictive cardiomyopathies.

Imaging cardiac structure and pump function

This article describes magnetic resonance imaging approaches for assessing cardiac structure and myocardial pump function. The article is divided into cardiac structure and ventricular function. Throughout, representative images are included. There are numerous applications of magnetic resonance imaging for assessing cardiac structure and function, and magnetic resonance imaging compared favorably to other imaging modalities.