Advancing Cardiovascular Diagnostics: The Expanding Role of CMR in Heart Failure and Cardiomyopathies

Q: What are the key findings of this study?

Cardiovascular magnetic resonance serves as the gold standard for non-invasive ventricular quantification and tissue characterization to guide diagnosis and prognosis across cardiomyopathies.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Heart failure and cardiomyopathies (including dilated, hypertrophic, arrhythmogenic, restrictive, left ventricular noncompaction, Takotsubo syndrome, iron overload, and Anderson-Fabry disease). Intervention: Cardiovascular magnetic resonance (CMR) imaging (including T1, T2, and T2 mapping, extracellular volume quantification, late gadolinium enhancement, strain, and 4D flow) vs. Echocardiography and computed tomography.

Q: What does this research mean for the field?

Cardiovascular magnetic resonance serves as the gold standard for non-invasive ventricular quantification and tissue characterization to guide diagnosis and prognosis across cardiomyopathies and heart failure phenotypes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Antonio Luca Maria Parlati; Ermanno Nardi; Federica Marzano; Cristina Madaudo; Mariafrancesca Di Santo; Ciro Cotticelli; Simone Agizza; Giuseppe Maria Abbellito; Fabrizio Perrone Filardi; Francesca Annunziata; Isabel Martone; Maria Prastaro; Stefania Paolillo; Pasquale Perrone Filardi; Paola Gargiulo

doi:10.3390/jcm14030865

January 28, 2025Journal of Clinical MedicineOpen Access

Advancing Cardiovascular Diagnostics: The Expanding Role of CMR in Heart Failure and Cardiomyopathies

View Full Paper

Ask AI

Bookmark

Share

Key result

CMR remains the gold standard for ventricular quantification and tissue characterization across cardiomyopathies.

Figures

Why the study?

Recent advancements in CMR have expanded its diagnostic value and tissue characterization capabilities, motivating a review of its role in heart failure and cardiomyopathies.

Key Points

To review the evolving clinical applications, diagnostic precision, and prognostic utility of cardiovascular magnetic resonance imaging in heart failure and varied cardiomyopathies.
Narrative review synthesizing evidence on cardiovascular magnetic resonance (CMR) capabilities compared with echocardiography and other modalities.
Evaluated advanced imaging sequences including cine imaging, late gadolinium enhancement (LGE), T1, T2, and T2 parametric mapping, and extracellular volume (ECV) quantification.
Modern cine CMR achieves spatial resolution ≤1.5 mm² and temporal resolution ≤45 ms without ionizing radiation, functioning as the gold standard for quantifying ventricular volumes and ejection fraction.
Advanced tissue characterization via LGE and parametric mapping reliably differentiates ischemic subendocardial patterns from non-ischemic etiologies by detecting interstitial fibrosis, edema, and cardiomyocyte injury.
Key practical constraints include routine exam durations of 25–30 min (frequently prolonged by arrhythmias or limited cooperation), serial breath-holds of 5–10 s, restricted accessibility, and nephrogenic systemic fibrosis risks in advanced renal dysfunction (GFR < 30 mL/min/1.73 m²).

Structured PICO

P

Population

Patients with cardiovascular disease, specifically heart failure (HFrEF, HFmrEF, HFpEF) and diverse cardiomyopathies (dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, restrictive cardiomyopathy / cardiac amyloidosis, left ventricular noncompaction, Takotsubo syndrome, iron overload cardiomyopathy, and Anderson-Fabry disease)

I

Intervention

Cardiovascular magnetic resonance (CMR) imaging utilizing cine SSFP sequences, late gadolinium enhancement (LGE), native T1, T2, and T2 mapping, extracellular volume (ECV) quantification, myocardial strain (GLS), and 4D flow imaging

C

Comparator

Echocardiography and other cardiac imaging modalities (within a multimodal imaging approach)

O

Outcome

Diagnostic accuracy, non-invasive tissue characterization (fibrosis, edema, infiltration), risk stratification, and prognostic evaluation (including sudden cardiac death, mortality, heart failure hospitalization, and response to CRT/ICD therapy)

Limitations

CMR examinations are time-consuming compared to cardiac ultrasound and CT scans (25-30 min plus patient preparation, positioning, and entry/exit times)
Standard CMR protocols depend on breath-holding (5-10 seconds) to reduce motion artifacts, and limited patient cooperation or arrhythmias degrade image quality
High cost of CMR equipment, maintenance, and specialized training limits accessibility, especially in resource-limited settings
Contraindications and challenges exist for non-conditional cardiac devices, abandoned or epicardial leads, claustrophobia, clinical instability, and first-trimester pregnancy
Gadolinium-based contrast agents carry a small risk of nephrogenic systemic fibrosis in patients with advanced renal dysfunction (GFR < 30 mL/min/1.73 m2)
Time-consuming examination duration compared to echocardiography and CT
Reliance on patient cooperation for multiple 5-10 second breath-holds and reduced image quality in arrhythmias
High equipment and maintenance costs and need for specialized operator/interpreter training limiting accessibility
Relative or strict contraindications including non-MRI-conditional devices, abandoned/epicardial leads, claustrophobia, and clinical instability
Risk of nephrogenic systemic fibrosis with gadolinium-based contrast agents in patients with severe renal impairment (GFR < 30 mL/min/1.73 m2)

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

This narrative review synthesizes how advanced cardiovascular magnetic resonance techniques—including LGE, parametric mapping (T1, T2, T2, ECV), strain, and 4D flow—serve as the gold standard for tissue characterization, differential diagnosis, and arrhythmic/prognostic risk stratification across heart failure phenotypes and cardiomyopathies.

Abstract

Cardiovascular magnetic resonance (CMR) imaging has become a cornerstone in the diagnosis, risk stratification, and management of cardiovascular disease (CVD), particularly heart failure (HF) and cardiomyopathies. Renowned as the gold standard for non-invasive quantification of ventricular volumes and ejection fraction, CMR delivers superior spatial and temporal resolution with excellent tissue-blood contrast. Recent advancements, including T1, T2, and T2* mapping, extracellular volume quantification, and late gadolinium enhancement, enable precise tissue characterization, allowing early detection of myocardial changes such as fibrosis, edema, and infiltration. These features provide critical insights into the pathophysiological mechanisms underlying HF phenotypes and diverse cardiomyopathies, enhancing diagnostic accuracy and guiding therapeutic decisions. This review explores the expanding role of CMR in CV disease, highlighting its diagnostic value in HF and in several cardiomyopathies, as well as its contribution to improving patient outcomes through detailed tissue characterization and prognosis.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Parlati et al. (2025) conducted a review in Heart failure and cardiomyopathies (including dilated, hypertrophic, arrhythmogenic, restrictive, left ventricular noncompaction, Takotsubo syndrome, iron overload, and Anderson-Fabry disease). Cardiovascular magnetic resonance (CMR) imaging (including T1, T2, and T2 mapping, extracellular volume quantification, late gadolinium enhancement, strain, and 4D flow) vs. Echocardiography and computed tomography was evaluated. Cardiovascular magnetic resonance serves as the gold standard for non-invasive ventricular quantification and tissue characterization to guide diagnosis and prognosis across cardiomyopathies.

synapsesocial.com/papers/6a80aab6abf3b9c038cadd36 https://doi.org/10.3390/jcm14030865

View Full Paper

Ask AI

Bookmark

Share

Advancing Cardiovascular Diagnostics: The Expanding Role of CMR in Heart Failure and Cardiomyopathies

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Advancing Cardiovascular Diagnostics: The Expanding Role of CMR in Heart Failure and Cardiomyopathies

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading