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Dilated CMP
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Author: Meng Jiang

Date: 11/1/2017

Indications and Purpose of the Scan

  • In patients with dilated ventricular chamber, CMR is recommended for etiological diagnosis and of prognostic value.

Description

  • Dilated CMP is characterized by left or biventricular dilatation with impaired contractility in the absence of abnormal loading conditions and severe coronary artery disease, and it is associated with significant morbidity and mortality due to progressive heart failure and sudden cardiac death. Identification of prognostic factors is necessary to enable physicians to accurately stratify risk in patients with dilated CMP and tailor management accordingly.

Why CMR (specific advantages)

  • Differential diagnosis between ischemic and non-ischemic dilated CMP1
  • Differential diagnosis in non-ischemic dilated CMP2
  • Accurate assessment of ventricular volumes, wall thickness, and contractile function, as well as tissue characterization (pretreatment and follow-up)
  • Provide prognostic information (LGE, T1 mapping, ECV, etc.)3-5.

Evidence

  • Provide prognostic information: (472 patients): Assessment of mid-wall fibrosis with LGE-CMR imaging provided independent prognostic information beyond LVEF in patients with non-ischemic dilated cardiomyopathy. LGE-CMR imaging improved risk stratification beyond LVEF for all-cause mortality and sudden cardiac death3. (637 patients): Non-invasive measure of diffuse myocardial disease by T1 mapping was significantly predictive of all-cause mortality and heart failure events in non-ischemic dilated CMP4.
  • Monitor therapy response and aid risk stratification: (130 patients): Dilated CMP patients revealed elevated levels of ECV reflecting diffuse myocardial fibrosis, which had contributed to monitor therapy response and aid risk stratification in different stages of Dilated CMP5.

Contraindications

  • Including the presence of contraindications to MRI and severe renal failure (eGFR<30).

More Information

  • Weintraub RG, Semsarian C and Macdonald P. Dilated cardiomyopathy. Lancet (London, England). 2017; 390:400-414.
  • Japp AG, Gulati A, Cook SA, Cowie MR and Prasad SK. The Diagnosis and Evaluation of Dilated Cardiomyopathy. Journal of the American College of Cardiology. 2016; 67:2996-3010.

References

  1.  McCrohon JA, Moon JC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJ and Pennell DJ. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003;108:54-59.
  2.  Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN radiology. 2014;2014:365404.
  3.  Gulati A, Jabbour A, Ismail TF, Guha K, Khwaja J, Raza S, Morarji K, Brown TD, Ismail NA, Dweck MR, Di Pietro E, Roughton M, Wage R, Daryani Y, O'Hanlon R, Sheppard MN, Alpendurada F, Lyon AR, Cook SA, Cowie MR, Assomull RG, Pennell DJ and Prasad SK. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. Jama. 2013;309:896-908.
  4.  Puntmann VO, Carr-White G, Jabbour A, Yu CY, Gebker R, Kelle S, Hinojar R, Doltra A, Varma N, Child N, Rogers T, Suna G, Arroyo Ucar E, Goodman B, Khan S, Dabir D, Herrmann E, Zeiher AM and Nagel E. T1-Mapping and Outcome in Nonischemic Cardiomyopathy: All-Cause Mortality and Heart Failure. JACC Cardiovascular imaging. 2016;9:40-50.
  5.  Aus dem Siepen F, Buss SJ, Messroghli D, Andre F, Lossnitzer D, Seitz S, Keller M, Schnabel PA, Giannitsis E, Korosoglou G, Katus HA and Steen H. T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance: quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy. European heart journal cardiovascular Imaging. 2015;16:210-216.
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