MRI Heart Inotropic Stress There is no relevant literature to support the use of MRI heart inotropic for the evaluation of arrhythmogenic cardiomyopathies. MRI Heart Vasodilator Stress There is no relevant literature to support the use of MRI heart vasodilator stress for the evaluation of arrhythmogenic cardiomyopathies. Echocardiography Transesophageal There is no relevant literature to support the use of transesophageal echocardiography for the evaluation of arrhythmogenic cardiomyopathies. Echocardiography Transthoracic Stress There is no relevant literature to support the use of echocardiographic transthoracic stress for the evaluation of arrhythmogenic cardiomyopathies. Variant 5: Suspected inflammatory cardiomyopathy. Ischemic cardiomyopathy already excluded. Initial imaging. Inflammatory myocardial disease can present either in acute or subacute fashion. Acute myocarditis is due to infections (viral, bacterial, fungal, or tuberculosis), toxins, drugs, injuries, or idiopathic etiology. It can present with acute chest pain, elevated cardiac enzymes, and ECG changes that may mimic acute coronary syndrome (MINOCA). Other presentations include LV dysfunction, arrhythmias, and sudden cardiac death. Acute myocarditis accounts for up to 75% of patients who present with MINOCA, 12% of those with sudden death, and 9% of DCM [132]. Patients may recover or progress to DCM. Sarcoidosis may occasionally present in an acute fashion similar to acute myocarditis. Myocarditis can also be seen in rheumatological diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis [133]. Chagas diseases are caused by a parasite, Trypanosoma cruzi, which is endemic in Central and South America, with 13% of the population at risk and 11% affected [134].
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . MRI Heart Inotropic Stress There is no relevant literature to support the use of MRI heart inotropic for the evaluation of arrhythmogenic cardiomyopathies. MRI Heart Vasodilator Stress There is no relevant literature to support the use of MRI heart vasodilator stress for the evaluation of arrhythmogenic cardiomyopathies. Echocardiography Transesophageal There is no relevant literature to support the use of transesophageal echocardiography for the evaluation of arrhythmogenic cardiomyopathies. Echocardiography Transthoracic Stress There is no relevant literature to support the use of echocardiographic transthoracic stress for the evaluation of arrhythmogenic cardiomyopathies. Variant 5: Suspected inflammatory cardiomyopathy. Ischemic cardiomyopathy already excluded. Initial imaging. Inflammatory myocardial disease can present either in acute or subacute fashion. Acute myocarditis is due to infections (viral, bacterial, fungal, or tuberculosis), toxins, drugs, injuries, or idiopathic etiology. It can present with acute chest pain, elevated cardiac enzymes, and ECG changes that may mimic acute coronary syndrome (MINOCA). Other presentations include LV dysfunction, arrhythmias, and sudden cardiac death. Acute myocarditis accounts for up to 75% of patients who present with MINOCA, 12% of those with sudden death, and 9% of DCM [132]. Patients may recover or progress to DCM. Sarcoidosis may occasionally present in an acute fashion similar to acute myocarditis. Myocarditis can also be seen in rheumatological diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis [133]. Chagas diseases are caused by a parasite, Trypanosoma cruzi, which is endemic in Central and South America, with 13% of the population at risk and 11% affected [134].