The Role of Multimodality Imaging in Cardiomyopathy

Fig. 1. Apical Hypertrophic Cardiomyopathy. Apical hypertrophic cardiomyopathy was not seen on the initial echocardiography (A) but later diagnosed on a repeat study a year later (B). Cardiac magnetic resonance imaging confirmed the diagnosis by demonstrating the “spade-like” apex on cine (C) and patchy fibrosis in the hypertrophied segments (blue arrows) on late gadolinium enhancement imaging (D)

Fig. 2. Examples of Late Gadolinium Enhancement in a Variety of Nonischemic Cardiomyopathies. (Top left) A 4-chamber view of patchy distribution of late midwall and epicardial late gadolinium enhancement (LGE) (arrows) in cardiac sarcoidosis. (Top right) A 3-chamber view of a midwall stripe pattern of LGE (arrows) in dilated cardiomyopathy (CMP). (Middle left) A 4-chamber view of patchy epicardial and midwall LGE along the lateral wall (arrows) in myocarditis. (Middle right) A midventricular short-axis image of LGE in the anterior and inferior right ventricular insertion points (arrows) in pulmonary hypertension (Pulm HTN) with right ventricular (RV) hypertrophy (*). (Bottom left) A 3-chamber view of a LGE image in cardiac amyloidosis. The left ventricular blood pool is nulled (*), and there is subtle circumferential subendocardial LGE throughout the left ventricle. The LGE is most pronounced at the base of the left ventricle within hypertrophied myocardium (arrow). (Bottom right) A midventricular short-axis image in a patient with hypertrophic cardiomyopathy with evidence of asymmetrical septal hypertrophy with extensive midwall LGE within the hypertrophied myocardium (arrows). Adapted…

Fig. 3. Native T1 and ECV Mapping in Different Cardiomyopathies.In native T1, most cardiomyopathies cause increase in values except for iron deposition and Fabry disease (A). For extracellular volume mapping (ECV), the percentage is elevated with fibrosis, infiltration, and edema (B). Adapted from Robinson et al. JACC Cardiovasc Imaging, 2019. 12(11 Pt 2):2332–2344, with permission from Elsevier [54]

Fig. 4. Suspected Transthyretin Cardiac Amyloidosis Diagnosed by 99mTc-pyrophosphate Scintigraphy. (Top) Patient with new heart failure and severe concentric hypertrophy parasternal long-axis view on echocardiography. (Bottom) 99mTc-pyrophosphate scintigraphy showed increase myocardial uptake compared to contralateral chest with a ratio of 1.79, consistent with transthyretin cardiac amyloidosis

Fig. 5. 18F-fluorodeoxyglucose Positron Emission Tomography in Active Cardiac Sarcoidosis. An example of mismatched pattern in active sarcoidosis with 18F-fluorodeoxyglucose (FDG) uptake (A) and 13N-ammonia (N13)perfusion defect (B) in the basal to mid lateral wall (blue arrows). A horizontal long axis side by side comparison (C) of FDG uptake and N13 perfusion. From left to right, the views go from posterior to anterior

Fig. 6. Cardiac Computed Tomography and Transesophageal Echocardiogram for Evaluation of Left Atrial Appendage Thrombus.Three examples of left atrial appendage thrombus evaluations by early and delayed computed tomography angiography (CTA) and transesophageal echocardiogram (TEE). Normal early and delayed filling of left atrial appendage (A) is a negative finding for thrombus. A left atrial appendage filling defect (yellow arrows) is also negative if it resolves on delayed imaging (B), otherwise it is positive if the defect has a typical appearance of a thrombus (C). Adapted from Bilchick et al. Heart Rhythm, 2016. 13(1):12–9, with permission from Elsevier [100]

Fig. 7. Obstruction of the Outflow Graft of Left Ventricular Assist Device. Cardiac computed tomography (CCT) in a longitudinal (A) and axial (B) plane shows a weblike thrombus (blue arrows) in the outflow graft of a left ventricular assist device (LVAD). Invasive angiography (C) demonstrated narrowing (yellow arrows) at the level of obstruction and the patient underwent stenting (D)