"Non-Ischemic Cardiomyopathy" - Cased-Based Webinar (CME)-Video

Video Transcription

Video Summary

The webinar focused on the value of cardiac MRI (CMR) in non-ischemic cardiomyopathy (NICM), emphasizing its role in diagnosis, treatment guidance, and prognosis. The speakers highlighted that CMR is the gold standard for measuring ejection fraction and is especially useful when paired with late gadolinium enhancement (LGE), T1/T2 mapping, perfusion imaging, phase contrast, and T2* mapping.<br /><br />Through six illustrative cases, CMR was shown to detect a wide range of NICM phenotypes, including coronary microvascular dysfunction with mid-wall fibrosis, arrhythmogenic right ventricular cardiomyopathy (ARVC), ischemic injury missed by angiography, cardiac amyloidosis, myocarditis, and iron overload cardiomyopathy. In several cases, CMR changed the diagnosis and directly altered management, such as prompting ICD placement, anticoagulation, chemotherapy, or immunosuppressive therapy.<br /><br />Key teaching points included:<br />- NICM can present with diverse imaging phenotypes, not just ventricular dilation.<br />- LGE provides major prognostic information and helps distinguish ischemic from non-ischemic disease.<br />- Quantitative mapping improves detection of diffuse processes like amyloidosis and myocarditis.<br />- Stress perfusion CMR can identify microvascular dysfunction and ischemia.<br />- T2* mapping is lifesaving in iron overload by guiding chelation therapy.<br /><br />In the Q&A, the panel discussed when to use stress CMR, follow-up imaging in genotype-positive ARVC, how to distinguish microvascular obstruction from scar, and practical issues around mapping, fat suppression, and normal values. The session concluded that CMR is a powerful, adaptable tool that significantly improves care in NICM.

Keywords

cardiac MRI

CMR

non-ischemic cardiomyopathy

late gadolinium enhancement

ejection fraction

T1/T2 mapping

myocarditis

cardiac amyloidosis

arrhythmogenic right ventricular cardiomyopathy

iron overload cardiomyopathy