Similar to MRI, extracellular volume (ECV) can be quantified with CT either using a single- or dual-energy CT technique [18]. CT strain imaging to quantify regional function [19] and CT evaluation of diastolic function are not routinely used in clinical practice [20]. Coronary calcium score is used for risk stratification of CAD in asymptomatic patients and does not have a specific role in evaluation of NICM. Coronary Arteriography Coronary arteriography is used to evaluate CAD as a cause of HF, especially in high-risk patients. Right and left heart catheterizations are useful in pulmonary hypertension, providing cardiac hemodynamics and prognostic value. Right heart and simultaneous right and left heart catheterization is useful in distinguishing restrictive cardiomyopathies from constrictive pericarditis [31]. A ventriculogram can be used to evaluate associated regional wall motion abnormalities (RWMA). Endomyocardial biopsy is used to establish etiology in cases that are indeterminate after imaging. Discussion of Procedures by Variant Variant 1: Suspected hypertrophic cardiomyopathy. Ischemic cardiomyopathy already excluded. Initial imaging. HCM is an inherited myocardial hypertrophy with heterogeneous phenotypic expression (asymmetric septal, apical, mid ventricular, lateral wall, mass-like, and concentric types) [32]. Patients with HCM can present with diastolic dysfunction, LV outflow tract (LVOT) obstruction, ischemic chest pain, arrhythmias, or sudden cardiac death [33]. Occasionally, clinical symptoms are produced by papillary muscle abnormalities (anomalous chordal attachment to the base of anterior leaflet, double bifid muscles, apical displacement, hypermobility, elongated anterior mitral leaflet) without significant myocardial hypertrophy [34]. Asymptomatic family members of HCM often undergo imaging as a screening test.
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . Similar to MRI, extracellular volume (ECV) can be quantified with CT either using a single- or dual-energy CT technique [18]. CT strain imaging to quantify regional function [19] and CT evaluation of diastolic function are not routinely used in clinical practice [20]. Coronary calcium score is used for risk stratification of CAD in asymptomatic patients and does not have a specific role in evaluation of NICM. Coronary Arteriography Coronary arteriography is used to evaluate CAD as a cause of HF, especially in high-risk patients. Right and left heart catheterizations are useful in pulmonary hypertension, providing cardiac hemodynamics and prognostic value. Right heart and simultaneous right and left heart catheterization is useful in distinguishing restrictive cardiomyopathies from constrictive pericarditis [31]. A ventriculogram can be used to evaluate associated regional wall motion abnormalities (RWMA). Endomyocardial biopsy is used to establish etiology in cases that are indeterminate after imaging. Discussion of Procedures by Variant Variant 1: Suspected hypertrophic cardiomyopathy. Ischemic cardiomyopathy already excluded. Initial imaging. HCM is an inherited myocardial hypertrophy with heterogeneous phenotypic expression (asymmetric septal, apical, mid ventricular, lateral wall, mass-like, and concentric types) [32]. Patients with HCM can present with diastolic dysfunction, LV outflow tract (LVOT) obstruction, ischemic chest pain, arrhythmias, or sudden cardiac death [33]. Occasionally, clinical symptoms are produced by papillary muscle abnormalities (anomalous chordal attachment to the base of anterior leaflet, double bifid muscles, apical displacement, hypermobility, elongated anterior mitral leaflet) without significant myocardial hypertrophy [34]. Asymptomatic family members of HCM often undergo imaging as a screening test.