Using LGE, 19% of additional patients gained an indication for ICD, and 11% avoided a previously planned ICD compared with standard of care [98]. High T1 and ECV values show more sensitivity than LGE [68]. Native T1 value, ECV value, presence and extent of LGE, and EF correlate with adverse prognosis [99]. In chemotherapy cardiomyopathy, MRI helps in arbitrating discrepancies between imaging modalities, which may affect management. A reduction of EF by >10% or a reduction of EF >5% in symptomatic individuals is diagnostic of this entity (as long as the resultant EF is <53%) [83,100]. Early markers of cardiac involvement include elevated LV end-systolic volume (seen within 1 month); increased LV mass (due to edema); RWMA (decreased mid wall circumferential strain); high T1, T2, and ECV values; high signal in T2-weighted images (edema); and EGE [83]. Patients with edema are more likely to have right ventricular ejection fraction (RVEF) reduction at follow-up [100]. LGE can be seen in 0% to 100% of patients, either in mid myocardial or subepicardial distribution and rarely diffuse, indicating irreversible damage [101]. In late-onset cardiomyopathy in cancer survivors, abnormal or subnormal LVEF and RVEF, as well as high LV volumes without LGE, were seen at a median of 7.8 years after anthracycline therapy [102]. Increased ECV has been shown in cancer survivors [100]. LGE has been shown in 9% to 18% in mid myocardial, subepicardial, or RV insertion point distributions [101]. In peripartum cardiomyopathy, MRI provides additional information pertaining to diagnosis and prognosis, which are not obtained in echocardiography. Gadolinium contrast is avoided until after delivery. LV dilation, global LV systolic dysfunction, RV dysfunction, and LGE are seen [84].
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . Using LGE, 19% of additional patients gained an indication for ICD, and 11% avoided a previously planned ICD compared with standard of care [98]. High T1 and ECV values show more sensitivity than LGE [68]. Native T1 value, ECV value, presence and extent of LGE, and EF correlate with adverse prognosis [99]. In chemotherapy cardiomyopathy, MRI helps in arbitrating discrepancies between imaging modalities, which may affect management. A reduction of EF by >10% or a reduction of EF >5% in symptomatic individuals is diagnostic of this entity (as long as the resultant EF is <53%) [83,100]. Early markers of cardiac involvement include elevated LV end-systolic volume (seen within 1 month); increased LV mass (due to edema); RWMA (decreased mid wall circumferential strain); high T1, T2, and ECV values; high signal in T2-weighted images (edema); and EGE [83]. Patients with edema are more likely to have right ventricular ejection fraction (RVEF) reduction at follow-up [100]. LGE can be seen in 0% to 100% of patients, either in mid myocardial or subepicardial distribution and rarely diffuse, indicating irreversible damage [101]. In late-onset cardiomyopathy in cancer survivors, abnormal or subnormal LVEF and RVEF, as well as high LV volumes without LGE, were seen at a median of 7.8 years after anthracycline therapy [102]. Increased ECV has been shown in cancer survivors [100]. LGE has been shown in 9% to 18% in mid myocardial, subepicardial, or RV insertion point distributions [101]. In peripartum cardiomyopathy, MRI provides additional information pertaining to diagnosis and prognosis, which are not obtained in echocardiography. Gadolinium contrast is avoided until after delivery. LV dilation, global LV systolic dysfunction, RV dysfunction, and LGE are seen [84].