Advanced Non-invasive Imaging Techniques in Chronic Heart Failure and Cardiomyopathies

Focus on Cardiac Magnetic Resonance Imaging and Computed Tomographic
  • Gianluca Di BellaEmail author
  • Fausto Pizzino
  • Rocco Donato
  • Dalia Di Nunzio
  • Cesare de Gregorio
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1067)


Cardiomyopathies (Cs) are a heterogeneous group of myocardial diseases with structural and/or functional abnormalities.

The aetiology is due to genetic-family substrate in most cases, however, the correct and detailed analysis of morphofunctional abnormalities (severity and distribution of hypertrophy, ventricular dilatation, ventricular dysfunction) and tissue characteristics (myocardial fibrosis, myocardial infiltration) are a crucial element for a definite diagnosis.

Among the different diagnostic imaging modalities applied in clinical practice (echocardiography, nuclear medicine), cardiac magnetic resonance (CMR) has emerged as a non-invasive diagnostic tool having high ability to quantify systolic function and tissue abnormalities that represent the substrates of many Cs.

The main added value of CMR is the ability to identify cardiomyopathies with respect to ischemic heart disease and, above all, to discriminate the major types of cardiomyopathies based on morpho-functional presentation patterns and the presence and location of myocardial fibrosis.

Many CMR elements allow increasing diagnostic accuracy but CMR data should be integrated with an appropriate clinical and instrumental context.

Computed Tomographic (CT) scan technology has showed a complementary role in patients having Cs and HF.

In this chapter, the diagnostic, pathophysiologic and prognostic value of CMR and CT in heart failure due to the most common cardiomyopathies will be discussed.


Cardiac magnetic resonance Cardiomyopathy Dilated cardiomyopathy Hypertrophic cardiomyopathy Myocarditis 


  1. Allen BD, Choudhury L, Barker AJ, van Ooij P, Collins JD, Bonow RO et al (2015) Three-dimensional haemodynamics in patients with obstructive and non-obstructive hypertrophic cardiomyopathy assessed by cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 16(1):29–36. Scholar
  2. Aquaro GD, Pingitore A, Strata E, Di Bella G, Molinaro S, Lombardi M (2010a) Cardiac magnetic resonance predicts outcome in patients with premature ventricular complexes of left bundle branch block morphology. J Am Coll Cardiol 56(15):1235–1243. Scholar
  3. Aquaro GD, Positano V, Pingitore A, Strata E, Di Bella G, Formisano F et al (2010b) Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy. Cardiovasc Magn Reson 12:21. Scholar
  4. Authors/Task Force members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F et al (2014) 2014 ESC guidelines on diagnosis and Management of Hypertrophic Cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35(39):2733–2779. Scholar
  5. Barison A, Aquaro GD, Pugliese NR, Cappelli F, Chiappino S, Vergaro G et al (2015a) Measurement of myocardial amyloid deposition in systemic amyloidosis: insights from cardiovascular magnetic resonance imaging. J Intern Med 277(5):605–614. Scholar
  6. Barison A, Del Torto A, Chiappino S, Aquaro GD, Todiere G, Vergaro G et al (2015b) Prognostic significance of myocardial extracellular volume fraction in nonischaemic dilated cardiomyopathy. J Cardiovasc Med 16(10):681–687. Scholar
  7. Bhatti S, Hakeem A, Yousuf MA, Al-Khalidi HR, Mazur W, Shizukuda Y (2011) Diagnostic performance of computed tomography angiography for differentiating ischemic vs nonischemic cardiomyopathy. J Nucl Cardiol 18(3):407–420CrossRefPubMedGoogle Scholar
  8. Brouwer WP, Baars EN, Germans T, de Boer K, Beek AM, van der Velden J et al (2014) In-vivo T1 cardiovascular magnetic resonance study of diffuse myocardial fibrosis in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:28. Scholar
  9. Bruder O, Wagner A, Jensen CJ, Schneider S, Ong P, Kispert EM et al (2010) Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 56(11):875–887. Scholar
  10. Cademartiri F, Di Cesare E, Francone M, Ballerini G, Ligabue G, Maffei E et al (2015) Italian registry of cardiac computed tomography. Radiol Med 120(10):919–929CrossRefPubMedGoogle Scholar
  11. Cerny V, Kuchynka P, Marek J, Lambert L, Masek M, Palecek T et al (2017 Dec) Utility of cardiac CT for evaluating delayed contrast enhancement in dilated cardiomyopathy. Herz 42(8):776–780CrossRefPubMedGoogle Scholar
  12. Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T et al (2014) Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 130(6):484–495. Scholar
  13. de Gregorio C, Andò G (2014) Risk of sudden death and outcome in patients with hypertrophic cardiomyopathy with benign presentation and without risk factors: a word of comfort to younger patients? Am J Cardiol 114(3):500–501. Scholar
  14. Di Bella G, Gaeta M, Pingitore A, Oreto G, Zito C, Minutoli F, et al (2010a) Myocardial deformation in acute myocarditis with normal left ventricular wall motion–a cardiac magnetic resonance and 2-dimensional strain echocardiographic study. Circ J 74:1205–13. Scholar
  15. Di Bella G, Minutoli F, Mazzeo A, Vita G, Oreto G, Carerj S et al (2010b) MRI of cardiac involvement in transthyretin familial amyloid polyneuropathy. AJR 195:W394–W399. Scholar
  16. Di Bella G, Pizzino F, Minutoli F, Zito C, Donato R, Dattilo G et al (2014) The mosaic of the cardiac amyloidosis diagnosis: role of imaging in subtypes and stages of the disease. Eur Heart J Cardiovasc Imaging 15(12):1307–1315. Scholar
  17. Di Bella G, Minutoli F, Madaffari A, Mazzeo A, Russo M, Donato R et al (2016a) Left atrial function in cardiac amyloidosis. J Cardiovasc Med 17(2):113–121. Scholar
  18. Di Bella G, Pingitore A, Piaggi P, Pizzino F, Barison A, Terrizzi A et al (2016b) Usefulness of late gadolinium enhancement MRI combined with stress imaging in predictive significant coronary stenosis in new-diagnosed left ventricular dysfunction. Int J Cardiol 224:337–342. Scholar
  19. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P et al (2008) Classification of the cardiomyopathies: a position statement from the European Society of cardiology working group on myocardial and pericardial diseases. Eur Heart J 29(2):270–276. Scholar
  20. Fischbach R, Juergens KU, Ozgun M, Maintz D, Grude M, Seifarth H et al (2007) Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging. Eur Radiol 17:1009–1017CrossRefPubMedGoogle Scholar
  21. Fontana M, Chung R, Hawkins PN, Moon JC (2015) Cardiovascular magnetic resonance for amyloidosis. Heart Fail Rev 20(2):133–144. Scholar
  22. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT et al (2009) Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 53(17):1475–1487. Scholar
  23. Galderisi M, Cardim N, D’Andrea A, Bruder O, Cosyns B, Davin L et al (2015) The multi-modality cardiac imaging approach to the Athlete’s heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(4):353. Scholar
  24. Grothoff M, Pachowsky M, Hoffmann J, Posch M, Klaassen S, Lehmkuhl L et al (2012) Value of cardiovascular MR in diagnosing left ventricular non-compaction cardiomyopathy and in discriminating between other cardiomyopathies. Eur Radiol 22(12):2699–2709. Scholar
  25. Gulati A, Ismail TF, Jabbour A, Ismail NA, Morarji K, Ali A et al (2013) Clinical utility and prognostic value of left atrial volume assessment by cardiovascular magnetic resonance in non-ischaemic dilated cardiomyopathy. Eur J Heart Fail 15(6):660–670. Scholar
  26. Gulati V, Harikrishnan P, Palaniswamy C, Aronow WS, Jain D, Frishman WH (2014) Cardiac involvement in hemochromatosis. Cardiol Rev 22(2):56–68. Scholar
  27. Hinojar R, Varma N, Child N, Goodman B, Jabbour A, Yu CY et al (2015) T1 mapping in discrimination of hypertrophic phenotypes: hypertensive heart disease and hypertrophic cardiomyopathy: findings from the international T1 multicenter cardiovascular magnetic resonance study. Circ Cardiovasc Imaging 8(12):e003285. Scholar
  28. Jacquier A, Thuny F, Jop B, Giorgi R, Cohen F, Gaubert JY et al (2010) Measurement of trabeculated left ventricular mass using cardiac magnetic resonance imaging in the diagnosis of left ventricular non-compaction. Eur Heart J 31(9):1098–1104. Scholar
  29. Kristen AV, aus dem Siepen F, Scherer K, Kammerer R, Andre F, Buss SJ et al (2015) Comparison of different types of cardiac amyloidosis by cardiac magnetic resonance imaging. Amyloid Int J Exp Clin Invest 22(2):132–141. Scholar
  30. Lee HJ, Im DJ, Youn JC, Chang S, Suh YJ, Hong YJ et al (2017 Apr) Assessment of myocardial delayed enhancement with cardiac computed tomography in cardiomyopathies: a prospective comparison with delayed enhancement cardiac magnetic resonance imaging. Int J Card Imaging 33(4):577–584CrossRefGoogle Scholar
  31. Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D’Agostino RB, Kannel WB et al (2002) Lifetime risk for developing congestive heart failure: the Framingham heart study. Circulation 106:3068–3072CrossRefPubMedGoogle Scholar
  32. Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I et al (2005) Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation 111(2):186–193. Scholar
  33. Madonna R, Cevik C, Cocco N (2014) Multimodality imaging for pre-clinical assessment of Fabry’s cardiomyopathy. Eur Heart J Cardiovasc Imaging 15(10):1094–1100. Scholar
  34. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA et al (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation 121(13):1533–1541. Scholar
  35. Maron BJ (2008) The 2006 American heart association classification of cardiomyopathies is the gold standard. Circ Heart Fail 1:72–75. Scholar
  36. Maron MS (2012) Clinical utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 14:13. Scholar
  37. Maron BJ, Pelliccia A, Spataro A, Granata M (1993) Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. Br Heart J 69(2):125–128CrossRefPubMedPubMedCentralGoogle Scholar
  38. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D et al (2006) Contemporary definitions and classification of the cardiomyopathies: an American Heart Association scientific statement from the council on clinical cardiology, heart failure and transplantation committee; quality of care and outcomes research and functional genomics and translational biology interdisciplinary working groups; and council on epidemiology and prevention. Circulation 113:1807–1816. Scholar
  39. Mavrogeni S, Bratis K, Papavasiliou A, Skouteli E, Karanasios E, Georgakopoulos D et al (2013) CMR detects subclinical cardiomyopathy in mother-carriers of Duchenne and Becker muscular dystrophy. JACC Cardiovasc Imaging 6(4):526–528. Scholar
  40. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52(25):2135–2144CrossRefPubMedGoogle Scholar
  41. Petersen SE, Selvanayagam JB, Francis JM, Myerson SG, Wiesmann F, Robson MD et al (2005a) Differentiation of athlete’s heart from pathological forms of cardiac hypertrophy by means of geometric indices derived from cardiovascular magnetic resonance. J Cardiovasc Magn Reson 7(3):551–558CrossRefPubMedGoogle Scholar
  42. Petersen SE, Selvanayagam JB, Wiesmann F, Robson MD, Francis JM, Anderson RH et al (2005b) Left ventricular non-compaction: insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol 46(1):101–105. Scholar
  43. Pieruzzi F, Pieroni M, Zachara E, Marziliano N, Morrone A, Cecchi F (2015) Heart involvement in Anderson-Fabry disease: Italian recommendations for diagnostic, follow-up and therapeutic management. G Ital Cardiol (Rome) 16(11):630–638. Scholar
  44. Puchalski MD, Williams RV, Askovich B, Sower CT, Hor KH, Su JT et al (2009) Late gadolinium enhancement: precursor to cardiomyopathy in Duchenne muscular dystrophy? Int J Card Imaging 25(1):57–63. Scholar
  45. Punn R, Silverman NH (2010) Cardiac segmental analysis in left ventricular noncompaction: experience in a pediatric population. J Am Soc Echocardiogr 23(1):46–53. Scholar
  46. Ramazzotti A, Pepe A, Positano V, Rossi G, De Marchi D, Brizi MG et al (2009) Multicenter validation of the magnetic resonance T2* technique for segmental and global quantification of myocardial iron. J Magn Reson Imag 30(1):62–68. Scholar
  47. Rovai D, Di Bella G, Rossi G, Lombardi M, Aquaro GD, L’Abbate A et al (2007) Q-wave prediction of myocardial infarct location, size and transmural extent at magnetic resonance imaging. Coron Artery Dis 5:381–389. Scholar
  48. Sado DM, White SK, Piechnik SK, Banypersad SM, Treibel T, Captur G et al (2013) Identification and assessment of Anderson-Fabry disease by cardiovascular magnetic resonance noncontrast myocardial T1 mapping. Circ Cardiovasc Imaging 6(3):392–398. Scholar
  49. Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, de Feyter P et al (2008 Feb) Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a writing group deployed by the working group nuclear cardiology and cardiac CT of the European society of cardiology and the European council of nuclear cardiology. Eur Heart J 29(4):531–556CrossRefPubMedGoogle Scholar
  50. Silva MC, Meira ZM, Gurgel Giannetti J, da Silva MM, Campos AF, Barbosa Mde M et al (2007) Myocardial delayed enhancement by magnetic resonance imaging in patients with muscular dystrophy. J Am Coll Cardiol 49(18):1874–1879. Scholar
  51. Syed IS, Glockner JF, Feng D, Araoz PA, Martinez MW, Edwards WD et al (2010) Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. JACC Cardiovasc Imaging 3(2):155–164. Scholar
  52. Takaoka H, Funabashi N, Uehara M, Iida Y, Kobayashi Y (2017 Feb 1) Diagnostic accuracy of CT for the detection of left ventricular myocardial fibrosis in various myocardial diseases. Int J Cardiol 228:375–379CrossRefPubMedGoogle Scholar
  53. Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American college of cardiology foundation appropriate use criteria task force, the society of cardiovascular computed tomography, the American college of radiology, the American heart association, the American society of echocardiography, the American society of nuclear cardiology, the North American society for cardiovascular imaging, the society for cardiovascular angiography and interventions, and the society for cardiovascular magnetic resonance. J Am Coll Cardiol 56(22):1864–1894CrossRefPubMedGoogle Scholar
  54. Todiere G, Pisciella L, Barison A, Del Franco A, Zachara E, Piaggi P et al (2014) Abnormal T2-STIR magnetic resonance in hypertrophic cardiomyopathy: a marker of advanced disease and electrical myocardial instability. PLoS One 9(10):e111366. Scholar
  55. Ugo F, Iannaccone M, D’Ascenzo F, Gaibazzi N, Cademartiri F, Aldrovandi A et al (2015) Accuracy of 64-slice coronary computed tomography in patients with tako-tsubo cardiomyopathy. Int J Cardiol 186:196–197CrossRefPubMedGoogle Scholar
  56. Wicker P, Roudaut R, Haissaguere M, Villega-Arino P, Clementy J, Dallocchio M (1983) Prevalence and significance of asymmetric septal hypertrophy in hypertension: an echocardiographic and clinical study. Eur Heart J 4(Suppl G):1–5CrossRefPubMedGoogle Scholar
  57. Yilmaz A, Ferreira V, Klingel K, Kandolf R, Neubauer S, Sechtem U (2013) Role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis of acute and chronic myocarditis. Heart Fail Rev 18(6):747–760. Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Gianluca Di Bella
    • 1
    Email author
  • Fausto Pizzino
    • 1
  • Rocco Donato
    • 2
  • Dalia Di Nunzio
    • 1
  • Cesare de Gregorio
    • 1
  1. 1.Graduate School of Medicine and Surgery, Post-graduate Residency School in Cardiology, Department of Clinical and Experimental Medicine – Cardiology UnitUniversity Hospital Medical School “Gaetano Martino”MessinaItaly
  2. 2.Graduate School of Medicine and Surgery, Post-graduate Residency School in Cardiology, Department of Radiological Sciences – Radiology UnitUniversity Hospital Medical School “Gaetano Martino”MessinaItaly

Personalised recommendations