Monteiro Pedro, Peixoto Tiago, Rodrigues Patrícia, Carvalho João Gomes
Department of Cardiology, Unidade Local de Saúde de Santo António, Porto, Portugal.
Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
Echocardiography. 2025 Feb;42(2):e70104. doi: 10.1111/echo.70104.
Cardiomyopathies represent a diverse group of myocardial disorders characterized by structural and functional abnormalities in the absence of significant coronary artery disease or other primary causes. This review highlights the diagnostic and prognostic value of cardiac magnetic resonance and computed tomography in the assessment of cardiomyopathies. While echocardiography remains the first-line imaging modality, cardiac magnetic resonance (CMR) and cardiac computerized tomography (CCT) offer superior tissue characterization, morphological assessment, and functional evaluation, crucial for phenotyping cardiomyopathies into hypertrophic, dilated, restrictive, arrhythmogenic, and non-dilated left ventricular subtypes. For hypertrophic cardiomyopathy, CMR enables precise identification of fibrosis, hypertrophy distribution, and risk stratification for sudden cardiac death. CMR is pivotal in identifying phenocopies, like cardiac amyloidosis and Anderson-Fabry disease, and differentiating between pathological and physiological remodeling in athlete's heart. For dilated cardiomyopathy, late gadolinium enhancement, T1 mapping, and extracellular volume measurements aid in distinguishing etiologies and predicting adverse outcomes. In arrhythmogenic right ventricular cardiomyopathy, CMR demonstrates superior sensitivity for detecting structural abnormalities in the right ventricle, and the presence of fibrosis which is associated with arrhythmic risk. CCT main roles are excluding coronary artery disease and complementing CMR. This review proposes a diagnostic pathway integrating multimodality imaging for clinical management in cardiomyopathies.
心肌病是一组多样的心肌疾病，其特征是在无显著冠状动脉疾病或其他原发性病因的情况下出现结构和功能异常。本综述重点介绍了心脏磁共振成像和计算机断层扫描在心肌病评估中的诊断和预后价值。虽然超声心动图仍是一线成像方式，但心脏磁共振成像（CMR）和心脏计算机断层扫描（CCT）在组织特征描述、形态学评估和功能评价方面具有优势，这对于将心肌病分为肥厚型、扩张型、限制型、致心律失常型和非扩张型左心室亚型的表型分析至关重要。对于肥厚型心肌病，CMR能够精确识别纤维化、肥厚分布以及心脏性猝死的风险分层。CMR对于识别心脏淀粉样变性和安德森 - 法布里病等拟表型，以及区分运动员心脏的病理性和生理性重塑至关重要。对于扩张型心肌病，钆延迟强化、T1 图谱和细胞外容积测量有助于区分病因并预测不良结局。在致心律失常性右心室心肌病中，CMR对检测右心室结构异常以及与心律失常风险相关的纤维化具有更高的敏感性。CCT的主要作用是排除冠状动脉疾病并补充CMR。本综述提出了一种整合多模态成像的诊断途径，用于心肌病的临床管理。
