The Contemporary Role of Cardiovascular Magnetic Resonance in Ischemic Cardiomyopathy

Q: What are the key findings of this study?

Cardiovascular magnetic resonance provides multiparametric assessment of function, ischemia, and scar transmurality in ischemic cardiomyopathy.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Ischemic cardiomyopathy and ischemic heart disease. Intervention: Cardiovascular magnetic resonance (CMR) including cine, stress perfusion, and late gadolinium enhancement (LGE) vs. Echocardiography, computed tomography, and nuclear imaging.

Q: What does this research mean for the field?

Cardiovascular magnetic resonance provides accurate multiparametric assessment of ventricular function, myocardial ischemia, and scar transmurality to predict recovery and guide therapy in ischemic cardiomyopathy. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Desak Gede Widyawati; Lynette Teo; Ching Ching Ong; Marie Houdmont; Ping Chai; Ching‐Hui Sia

doi:10.3390/jcm14217479

October 22, 2025Journal of Clinical MedicineOpen Access

The Contemporary Role of Cardiovascular Magnetic Resonance in Ischemic Cardiomyopathy

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Key result

CMR guides ischemic cardiomyopathy management through multiparametric evaluation of ischemia, viability, and scar transmurality.

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Why the study?

Many conventional techniques are unable to provide accurate automated assessments of myocardial tissue properties, prompting the emergence of new quantitative and artificial intelligence-based cardiovascular magnetic resonance approaches in ischemic cardiomyopathy.

Does cardiovascular magnetic resonance (CMR) improve diagnostic assessment, viability prediction, and prognostic risk stratification in patients with ischemic cardiomyopathy?

Key Points

Review the established clinical applications of cardiovascular magnetic resonance (CMR) in ischemic cardiomyopathy and assess emerging quantitative and artificial intelligence-based imaging techniques.
Narrative review evaluating cardiovascular magnetic resonance protocols for assessing left ventricular function, myocardial perfusion, tissue viability, and post-infarction remodeling in ischemic heart disease.
Synthesized diagnostic performance data for vasodilator and inotropic stress imaging, wall thickness thresholds, and late gadolinium enhancement tissue characterization.
Dobutamine stress CMR achieves a sensitivity of 79% to 88% and a specificity of 81% to 91% for detecting coronary artery disease, while adenosine stress CMR demonstrates a sensitivity of 67% to 94% and a specificity of 61% to 85%.
An end-diastolic wall thickness cutoff of 5.5 mm yields 92% sensitivity but only 56% specificity for predicting myocardial functional recovery, with nearly 20% of dysfunctional, thinned segments retaining viability.
Cine steady-state free precession imaging provides gold-standard volumetric and functional measurements without geometric assumptions, while late gadolinium enhancement differentiates subendocardial ischemic scarring from nonischemic patterns.

Structured PICO

Does cardiovascular magnetic resonance (CMR) improve diagnostic assessment, viability prediction, and prognostic risk stratification in patients with ischemic cardiomyopathy?

P

Population

Patients with known or suspected ischemic heart disease and ischemic cardiomyopathy undergoing cardiovascular magnetic resonance for functional, perfusion, and viability assessment.

I

Intervention

Cardiovascular magnetic resonance (CMR), including cine steady-state free precession imaging, stress perfusion CMR (with vasodilators such as adenosine, dipyridamole, regadenoson, or inotropic agents like dobutamine), late gadolinium enhancement (LGE), quantitative perfusion (qPerf), strain imaging, and artificial intelligence-based analysis

C

Comparator

Other non-invasive imaging modalities (echocardiography, nuclear imaging, computed tomography) and varying CMR stress/quantification protocols

O

Outcome

Diagnostic accuracy for CAD/ischemia detection, prediction of myocardial viability and functional recovery post-revascularization, and prognostic risk stratification for major adverse cardiovascular events (MACE), ventricular arrhythmias, and mortality

Cardiovascular magnetic resonance serves as a gold-standard, radiation-free modality for quantifying ventricular function, myocardial ischemia, and scar burden in ischemic cardiomyopathy, with emerging quantitative perfusion and AI techniques poised to further refine risk stratification and clinical decision-making.

Limitations

Less accessible and more resource-intensive than echocardiography or CT
Requires patient cooperation (lying flat for 30 to 60 min and breath-holding) and has limited use in unstable patients
Theoretical risk of nephrogenic systemic sclerosis with gadolinium contrast in severe renal failure (eGFR < 15 mL/min)
Image quality may be affected by cardiac devices and claustrophobia or non-MRI-compatible devices remain practical barriers
Lack of a universally accepted standard for quantifying late gadolinium enhancement (LGE)
CMR remains less accessible and more resource-intensive than echocardiography or CT
Requires patient cooperation (lying flat for 30 to 60 min and following breath-holding instructions) and has limited use in unstable patients
Gadolinium contrast carries a theoretical risk of nephrogenic systemic sclerosis in patients with renal failure (eGFR < 15 mL/min)
Claustrophobia, non-MRI-compatible devices, and artifacts from cardiac devices remain practical barriers
No universally accepted standard exists for quantifying LGE, and conventional stress analysis relies largely on subjective visual interpretation

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Implication

Supports CMR for multiparametric assessment in ischemic cardiomyopathy; leaves open the impact of emerging AI and quantitative mapping on outcomes.

Abstract

Ischemic cardiomyopathy is the leading cause of heart failure globally. While echocardiography is the cornerstone of cardiovascular imaging, cardiovascular magnetic resonance (CMR) plays a crucial role in providing a thorough assessment of both cardiac structure and function. CMR can deliver accurate information on cardiac function, perfusion, and tissue characterization, all while avoiding ionizing radiation and overcoming challenges associated with imaging window quality. Across the different stages of ischemic heart disease, CMR provides a precise assessment of infarct age, size, and related complications, while also supporting treatment decisions and predicting recovery. This review emphasizes not only the established diagnostic and prognostic roles of CMR in ischemic cardiomyopathy but also explores emerging quantitative and artificial intelligence-based approaches poised to redefine clinical practice.

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Cite This Study

Widyawati et al. (2025) conducted a review in Ischemic cardiomyopathy and ischemic heart disease. Cardiovascular magnetic resonance (CMR) including cine, stress perfusion, and late gadolinium enhancement (LGE) vs. Echocardiography, computed tomography, and nuclear imaging was evaluated. Cardiovascular magnetic resonance provides multiparametric assessment of function, ischemia, and scar transmurality in ischemic cardiomyopathy.

synapsesocial.com/papers/6a163a0210348063628e963e https://doi.org/10.3390/jcm14217479

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The Contemporary Role of Cardiovascular Magnetic Resonance in Ischemic Cardiomyopathy

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Contemporary Role of Cardiovascular Magnetic Resonance in Ischemic Cardiomyopathy

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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