Feature | Advanced Imaging in Cardiomyopathies - American College of Cardiology (2023)

Feature | Advanced Imaging in Cardiomyopathies - American College of Cardiology (1)

Heart failure (HF) is an increasing problem in cardiology. While ischemic cardiomyopathy remains the more understood subset, there is increasing interest in better evaluation of nonischemic cardiomyopathies, a condition commonly found in clinical practice.1

There are a number of reasons for this interest, such as different etiologies underlying dilated cardiomyopathies (DCM) having noticeably different natural histories, and that identifying specific etiologies2 provides opportunities for better care including targeted therapies and evidence-based screening and preventive efforts.

New technology allows for extra precision. For example, nearly 50% of patients with cardiomyopathy coming to a major medical center in 2000 had no clear etiology for their condition.3 If that study was repeated today, it is quite likely that the idiopathic category would be significantly diminished given that current advanced imaging makes it possible to identify subsets of patients that were previously difficult to diagnose.

Unlike in the past where management was geared towards general principles (e.g., addressing risk factors or treating fluid overload) or targeting some activated pathways (e.g., neurohormonal antagonism), there is now a focus on identifying the underlying genetic causes and specific pathophysiological mechanisms, when possible, in all patients with cardiomyopathies. This strategy could improve care and outcomes in patients with both syndromic and non-syndromic etiologies of DCM.

Advanced imaging plays an important role towards this goal, with the promise of offering unique noninvasive signatures of the disease. This can be utilized effectively in early detection of the disease, defining the underlying etiology of cardiomyopathies, revealing mechanistic insights, and providing valuable information about morphology of cardiovascular involvement, disease staging, prognostication and in some cases even guiding specific therapies.

There are, in general, three presentations that often bring the patient to the imaging laboratories, albeit with significant overlap among these categories: 1) the dilated heart, 2) the hypertrophic heart and 3) the arrhythmic heart. Each of these categories has a distinct differential diagnosis and clinical questions for the imager.

(Video) 2022 Advanced Cardiac Imaging Lecture Series - June 4th

The Dilated Heart

Ischemic cardiomyopathy is relatively easy to differentiate from DCM, but cardiovascular magnetic resonance (CMR) is now revealing overlapping conditions where a DCM can coexist with significant coronary artery disease (CAD).4

In this situation, the late gadolinium enhancement (LGE) pattern is not consistent with what is typical for CAD-related scarring (significant congruent gadolinium uptake in the subendocardial region that follows a coronary artery distribution). Such cases need further evaluation to separate the contributions of CAD and DCM towards morphology, clinical features and outcomes.

Once a diagnosis of DCM is made, advanced imaging, especially CMR, is often used to answer other clinically focused questions. What makes CMR unique is the ability to provide precise tissue characteristics, something no other modality has been able to do as effectively. Combining that with an ability to provide exquisite information on structure and function as well as an accurate evaluation of inducible ischemia makes CMR a one-stop-shop for testing in DCM (Figure 1).

Tissue characterization in CMR depends mainly on identifying fibrosis and disrupted myocardial interstitium. There are two kinds of fibrosis that need different techniques for identification. LGE is the workhorse to identify macroscopic scarring, e.g., that seen in an infarcted heart (Figure 1).

A special sequence is used to make the normal myocardium dark and areas that remain white in a good study are considered to be fibrosed (scar). The location, pattern and extent of LGE expressed as % of myocardium has robust diagnostic and prognostic significance5,6 (Figure 2).

Another form of fibrosis is not detected by LGE. LGE depends on contrast between normal and abnormal tissue and this is difficult to achieve when the disease is diffusely distributed in the myocardium, like interstitial fibrosis in the setting of heart failure with preserved ejection fraction or hypertensive heart disease.7

In this case, tests like T1 mapping (a dye-free test that is a useful marker of abnormal myocardium, for both the myocyte and interstitial components) and extracellular volume (ECV; relatively specific for interstitial abnormalities like fibrosis and edema but is not dye-free since it uses T1 values before and after gadolinium administration) are needed. Gadolinium is used judiciously, especially in patients with advanced chronic kidney disease (CKD).

(Video) Exploring Cardiac Imaging

While CKD is not an absolute contraindication with current gadolinium formulations, it is best to be cautious about its use, because some of the earlier forms of the dye were associated with nephrogenic systemic fibrosis and gadolinium can be retained in the central nervous system for long periods of time, albeit without any clear clinical surrogate to this finding to date.

T1 and ECV are displayed as plots for visual evaluation and quantified with numerical values. However, it is important to remember that these values are affected by sequences as well scanners used in the study.8 High native T1 values are very sensitive and conditions like cardiac amyloid can often be diagnosed just with the presence of very high T1, while reserving the dye for the indeterminate cases.9

Very low T1 values are seen in Fabry's disease. Myocardial iron overload needs T2* imaging and very low values correlate well with the degree of iron overload and prognosis.10 Lastly, myocardial edema can be diagnosed with accuracy with T2 mapping and helps differentiate acute from chronic myocardial injury.

While both LGE and parametric mapping (T1 and ECV) predict multiple adverse cardiovascular outcomes independently over conventional risk markers, mapping appears to add more value (Figure 3). Thus, current comprehensive imaging protocols report on all these parameters.

The Hypertrophied Heart

Evaluating the cause of severe left ventricular hypertrophy (LVH) is a common but vexing clinical question. One needs to differentiate between hypertensive heart disease, hypertrophic cardiomyopathy (HCM), cardiac amyloid, Fabry's disease and, in some practices, Danon's disease.

Strain imaging has a role,11,12 but the most definitive test is tissue characterization with CMR. It shows the exact morphology (e.g., classic vs. reverse curve vs. apical HCM) better than other imaging tests, while LGE/T1 values provide additional diagnostic value. LGE is common in HCM, often in the hypertrophied septal area as well as at the right ventricular (RV) insertion points. Danon's disease looks like HCM with extensive LGE, but surprisingly LGE is infrequent in the mid-interventricular septum despite severe LVH.13 T1 is low in Fabry's, but starts to increase in the late stages of the disease once there is extensive LVH and LGE.

Amyloid is a special case for imaging because the findings are highly variable depending on stage of the disease and amyloid burden; nuclear imaging using bone avid or fibril avid tracers is useful for screening while CMR can confirm tissue involvement. Tc-99m-PYP is the most common tracer used in the U.S. for evaluating amyloid, and has high sensitivity, and good specificity when there is higher grade of uptake (Perugini 2 and 3).14

Some mutations do not pick up PYP and may need imaging with the newer amyloid fibril avid tracers (thioflavin analogues like F-18-florbetapir, F-18-florbetaben or PiB). These tests also can better quantify disease burden and monitor response to therapy.15

(Video) Revascularization in Ischemic Cardiomyopathy - Cardiology Rounds with Dr. Quinton Barry

CMR can show varied patterns in cardiac amyloidosis but a combination of high T1, very high ECV and diffuse LGE (failure to null the myocardium) is highly suggestive. These parameters also can be used to track disease progression, as well as more recently, regression with specific therapies.16 As in other conditions, worsening values of LGE, T1 mapping and ECV correlate well with disease stages and predict an adverse prognosis.

The Arrhythmic Heart

Advanced imaging is finding an increasing role in evaluating patients with cardiac arrhythmia. CMR is good for identifying the substrates of high-grade arrhythmia (LV/RV dysfunction, remodeling, and fibrosis) as well as some arrhythmia triggers like myocardial inflammation (e.g., in sarcoidosis and myocarditis).

Most of the risk stratification is based on LGE burden and patterns as discussed above. LGE as well as mapping add value even in patients with less severe LV dysfunction.17 The risk is continuous with increasing amounts of LGE, but involvement of 5% or more of the LV has been shown to add value over ejection fraction (EF) as a marker of risk and may help in deciding about ICD implantation.

LGE of 15% or more is thought to be a good marker of high risk in HCM. Scar texture and signal intensity might carry deeper information about risk and are the subject of recent studies, including those involving artificial intelligence, machine learning and radiomics.18

Combining information about scar with peri-scar inflammation (in the form of fluorodeoxyglucose uptake) seems to help predict risk and treatment in sarcoidosis; an inflamed scar seems to be more responsive to steroids and immunosuppressive therapy than a scar without inflammation.19 Newer tracers could allow fibrosis imaging at an earlier stage and detect other components of inflammation, like macrophage infiltration.20

Evidence is emerging for a distinct arrhythmic cardiomyopathy (AC) involving the LV (ALVC), in addition to the well-known condition involving the RV (ARVC). AC can be due to specific underlying disorders (mutations in Lamin A/C [LMNA], sodium channel NAv1.5 [SCN5A], filamin C [FLNC] and desmoplakin [DSP]). AC is underrecognized as it lacks specific diagnostic criteria; rhythm disturbances seem to occur independent of EF and LV size. Imaging signatures might allow early risk stratification for sudden cardiac death. Unfortunately, there isn't yet a unique ALVC imaging phenotype for these conditions, but near complete rings of LGE in the mid to epicardial LV walls may offer an intriguing clue to these high-risk conditions.21

CMR For Every HF Patient?

It's easy to get excited about new technology. But how it changes the clinician's strategy and whether it improves patient outcomes should be the litmus test for its utility. Imaging undoubtedly provides valuable information, but should every patient with a cardiomyopathy get a CMR study? Early data suggest that a CMR-first strategy clarifies the etiology better and faster than conventional pathways, however this has not translated yet into better near-term outcomes.22 This will remain a challenge for wider implementation of newer imaging modalities.

What's Ahead For Imaging?

Imaging technology is changing rapidly in both speed and resolution. It's likely that evolving technology will allow us to identify deeper pathophysiologic components mediating the genesis and progression of HF. Parameters that were nearly impossible to measure noninvasively in the past, like myocardial stiffness or directly imaging the microvasculature, are now within clinical reach with high-frame rate imaging (at 5,000 frames per second).23,24

(Video) Cardiac Amyloidosis and Sarcoidosis: Imaging and Diagnosis of Infiltrative Cardiomyopathies

Diffusion tensor imaging is allowing us to identify changes in fiber orientation and how that affects disease progression.25 Tracers measuring neuronal uptake allow us to define innervation of the failing heart.26 Artificial intelligence and machine learning are likely to revolutionize what clinical information we can extract from any set of images,27 and this will one day allow us to combine the entire EMR with imaging parameters to come up with entirely different classifications of disease and its risk. The future is very exciting – stay tuned!

Feature | Advanced Imaging in Cardiomyopathies - American College of Cardiology (5)
Feature | Advanced Imaging in Cardiomyopathies - American College of Cardiology (6)

This article was authored by Soma Sen, MD, FACC, consultant cardiologist and director of Nuclear Cardiology Imaging, Park Nicollet Health Partners Care Group and Methodist Hospital, St. Louis Park, MN, and Y. S. Chandrashekhar MD, FACC, professor of medicine, University of Minnesota and chief of cardiology, Veterans Administration Medical Center, in Minneapolis. He is editor-in-chief of JACC: Cardiovascular Imaging.


  1. Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet 2017;390:400-14.
  2. Hershberger RE, Hedges DJ, Morales A. Dilated cardiomyopathy: the complexity of a diverse genetic architecture. Nat Rev Cardiol 2013;10:531–547.
  3. Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000;342:1077-84.
  4. Assomull RG, Shakespeare C, Kalra PR, et al. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation 2011;124:1351-60.
  5. Halliday BP, Baksi AJ, Gulati A, et al. Outcome in dilated cardiomyopathy related to the extent, location, and pattern of late gadolinium enhancement. JACC Cardiovasc Imaging 2019;12(8 Pt 2):1645-55.
  6. Gulati A, Jabbour A, Ismail TF, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. JAMA 2013;309:896-908.
  7. Halliday B, Prasad S, et al. The interstitium in the hypertrophied heart. JACC Cardiovasc Imaging 2019;12 (11_Part_2):2357-68.
  8. Puntmann VO, Peker E, Chandrashekhar Y, Nagel E. T1 mapping in characterizing myocardial disease: a comprehensive review. Circ Res 2016;119:277-99.
  9. Baggiano A, Boldrini M, Martinez-Naharro A, et al. Noncontrast magnetic resonance for the diagnosis of cardiac amyloidosis. JACC Cardiovasc Imaging 2020;13 (1_Part_1) 69–80.
  10. Triadyaksa P, Oudkerk M, Sijens PE. Cardiac T2* mapping: Techniques and clinical applications. J Magn Reson Imaging 2020;52:1340-51.
  11. Smiseth OA, Torp H, Opdahl A, et al. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 2016;37:1196-207.
  12. Potter E, Marwick TH. Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging 2018;11(2 Pt 1):260-74.
  13. Rigolli M, Kahn A, Brambatti M, et al. Cardiac magnetic resonance imaging in danon disease cardiomyopathy. JACC Cardiovasc Imaging 2021;14 (2):514-16.
  14. Dorbala S, Cuddy S, Falk RH. How to image cardiac amyloidosis: a practical approach. JACC Cardiovasc Imaging 2020;13:1368-83.
  15. Cuddy S, Bravo P, Falk R, et al. Improved quantification of cardiac amyloid burden in systemic light chain amyloidosis. JACC Cardiovasc Imaging 2020;13:1325-36.
  16. Fontana M, Martinez-Naharro A, Chacko L, et al. Reduction in CMR derived extracellular volume with patisiran indicates cardiac amyloid regression. JACC Cardiovasc Imaging 2021;14:189-99.
  17. Kanagala P, Cheng A, Singh A, et al. Relationship between focal and diffuse fibrosis assessed by cmr and clinical outcomes in heart failure with preserved ejection fraction. JACC Cardiovasc Imaging 2019;12:2291-2301.
  18. Fahmy A, Rowin E, Jaafar N, et al. Radiomics of late gadolinium enhancement reveals prognostic value of myocardial scar heterogeneity in hypertrophic cardiomyopathy. JACC Cardiovasc Imaging 2023;In Press.
  19. Dweck MR, Abgral R, Trivieri MG, et al. Hybrid magnetic resonance imaging and positron emission tomography with fluorodeoxyglucose to diagnose active cardiac sarcoidosis. JACC Cardiovasc Imaging 2018;11(1):94-107.
  20. Dilsizian V, Chandrashekhar Y, et al. Molecular imaging. JACC Cardiovasc Imaging 2022;15:2019-21.
  21. Muser D, Nucifora G, Pieroni M, et al. Prognostic value of nonischemic ringlike left ventricular scar in patients with apparently idiopathic non sustained ventricular arrhythmias. Circulation 2021;143:1359-73.
  22. Paterson DI, Wells G, Erthal F, et al. A randomized controlled trial of routine versus selective cardiac magnetic resonance for patients with nonischemic heart failure (IMAGE-HF 1B). Circulation 2020;141:818-27.
  23. Villemain O, Correia M, Mousseaux E, et al. Myocardial stiffness evaluation using noninvasive shear wave imaging in healthy and hypertrophic cardiomyopathic adults. JACC Cardiovasc Imaging 2019;12:1135-45.
  24. Demeulenaere O, Sandoval Z, Mateo P, et al. Coronary flow assessment using 3-dimensional ultrafast ultrasound localization microscopy. JACC Cardiovasc Imaging 2022;15:1193-1208.
  25. Khalique Z, Ferreira PF, Scott AD, et al. Diffusion tensor cardiovascular magnetic resonance imaging: a clinical perspective. JACC Cardiovasc Imaging 2020;13:1235-55.
  26. Zelt J, deKemp R, Rotstein B, et al. Nuclear imaging of the cardiac sympathetic nervous system. JACC Cardiovasc Imaging 2020;13:1036-54.
  27. Dey D, Slomka PJ, Leeson P, et al. Artificial intelligence in cardiovascular imaging: JACC state-of-the-art review. J Am Coll Cardiol 2019;73:1317-35.

Keywords: ACC Publications, Cardiology Magazine, Cardiomyopathy, Dilated, Laboratories, Cardiomegaly, Heart Failure, Cardiology, Diagnostic Imaging


What imaging is best for cardiomyopathy? ›

Echocardiogram, cardiac MRI, cardiac CT, and nuclear medicine imaging are the primary imaging modalities used for both work up and follow up on patients with cardiomyopathies.

What is the future of cardiology imaging? ›

Future Trends in Cardiovascular Imaging

Advanced imaging protocols will provide safer (less radiation, less procedural complications) and cost-effective algorithms to diagnose obstructive, flow-limiting coronary artery lesions as an adjunct to invasive coronary angiography.

What is the role of cardiac MR imaging in cardiomyopathies? ›

Cardiac MRI is central to evaluation of patients with cardiomyopathy owing to its ability to allow evaluation of many different tissue properties in a single examination. For example, cine MRI is the standard of care for assessment of myocardial structure and function.

Can cardiomyopathy be seen on CT scan? ›

CT is useful in cardiomyopathies in several ways, particularly in the evaluation of coronary arteries, characterization of cardiomyopathy phenotype, quantification of cardiac volumes and function, treatment-planning, and post-treatment evaluation.

What is the best diagnostic test for cardiomyopathy? ›

Electrocardiogram (EKG or ECG): An EKG records the heart's electrical activity, showing how fast the heart is beating and whether its rhythm is steady or irregular. An EKG can detect cardiomyopathy as well as other problems, including heart attacks, arrhythmias (abnormal heartbeats) and heart failure.

What is the best diagnostic for cardiomyopathy? ›

A heart biopsy, or myocardial biopsy, is used to diagnose some types of cardiomyopathy. For this test, your doctor will remove a very small piece of your heart muscle to check for signs of cardiomyopathy. This can be done during cardiac catheterization.

What is the latest heart scan technology? ›

Cardiac CT uses advanced CT technology, with or without intravenous (IV) contrast (dye) to better visualize your heart structure and associated blood vessels. With multi-slice scanning, your healthcare provider can get high-resolution, 3D images of your moving heart and great vessels.

Is cardiology stressful? ›

It seems obvious, given the aforementioned hours, heavy emotional toll, and potential legal issues. As a cardiologist, the responsibility of saving the lives of patients can put stress on your own heart, and even raise your blood pressure.

Are heart scans worth it? ›

Heart scans are considered most useful for those with a known “moderate” risk of heart disease or for those whose risk is uncertain.

Can an MRI show cardiomyopathy? ›

We use cardiac MRI to diagnose a wide range of heart conditions. These include coronary heart disease, congenital heart disease (in children and adults), inherited heart conditions (such as hypertrophic cardiomyopathy or dilated cardiomyopathy), heart valve disease and cardiac tumours.

Which imaging method is most important for the diagnostics of cardiac disease? ›

Echocardiography is central to cardiac imaging. (A) shows an apical 4 chamber two-dimensional transthoracic image. (B) shows an apical 4 chamber three-dimensional transthoracic image. (C) and (D) show the quantification of ventricular volume and function (more...)

Can an MRI detect dilated cardiomyopathy? ›

Cardiac magnetic resonance imaging (MRI) plays an important role in the evaluation of dilated cardiomyopathy, and is the gold-standard technique in identifying the var- ious etiological factors and differentiating one from the other.

Can a heart scan show blocked arteries? ›

A heart scan is not a substitute for stress testing and can tell you how blocked a coronary artery is, furthermore it does not detect any non-calcified plaque that may be present.

Can you see heart inflammation on CT scan? ›

Once the scan is done, trained medical professionals will carefully review the findings and alert you if there could be signs of a problem. These signs might include clogged arteries, inflammation and other abnormal blockages. The scan itself is noninvasive, painless and is done in a matter of minutes.

Can you see cardiomyopathy on echo? ›

The distinguishing features of the various forms of cardiomyopathies are easily identified by echocardiography. In the case of dilated and hypertrophic cardiomyopathies—the most common forms of cardiomyopathy—the definitions reflect the underlying ventricular function, wall thickness, and chamber size.

What is the new treatment for cardiomyopathy? ›

Mavacamten is an oral medication that works as a cardiac myosin inhibitor, reducing the contractility of the heart muscle.

What is the most common treatment for cardiomyopathy? ›

Treatment options for cardiomyopathy
  • Lifestyle changes. Stopping alcohol use. Monitoring salt intake.
  • Medicines. Lower blood pressure. ...
  • Surgically implanted device that helps maintain proper heart rhythm.
  • Ablation procedure. Removes extra heart tissue to reduce thickening. ...
  • Heart transplant (for a severely damaged heart)

What is the most accurate test for heart problems? ›

A coronary angiogram is a type of X-ray used to examine the coronary arteries supplying blood to your heart muscle. It's considered to be the best method of diagnosing coronary artery disease - conditions that affect the arteries surrounding the heart.

Which type of cardiomyopathy has poor prognosis? ›

In most cases DCM is progressive, leading to heart failure and death. Without a transplant, the survival rates are poor. DCM has many causes and all of them affect the ventricular function to a varying degree.

Which cardiomyopathy has the best prognosis? ›

Patients with peripartum cardiomyopathy appear to have a better prognosis than those with other forms of cardiomyopathy. Patients with cardiomyopathy due to infiltrative myocardial diseases, HIV infection, or doxorubicin therapy have an especially poor prognosis.

What should you not do with cardiomyopathy? ›

Avoiding alcohol and illegal drugs. Getting enough sleep and rest. Reducing stress. Treating underlying conditions, such as diabetes and high blood pressure.

What does the $49 heart scan consist of? ›

Calcium heart scan

A calcium test for your heart can reveal your risk of heart disease and help prevent a heart attack. It's a safe, simple way to show your heart some love. The $49 heart scan takes only 15 minutes – and within 48 hours you'll know your coronary calcium score.

What is the difference between a heart scan and an echocardiogram? ›

Though they sound similar, they are two different tests. An electrocardiogram measures the pattern of electric pulses generated by the heart's rhythm, whereas an echocardiogram uses sound waves to check the structure of your heart.

Is a cardiac MRI better than an echocardiogram? ›

The primary difference is that a cardiac MRI is more focused on diseases and defects that affect the heart, while an echocardiogram provides detailed information on the functioning of the heart and its valves.

How much do most cardiologists make? ›

For example Interventional Cardiologist jobs pay as much as $26,518 (8.6%) more than the average Cardiologist salary of $307,349.

What is the highest salary cardiologist? ›

Highest salary that a Cardiologist can earn is ₹97.0 Lakhs per year (₹8.1L per month). How does Cardiologist Salary in India change with experience? An Entry Level Cardiologist with less than three years of experience earns an average salary of ₹30.3 Lakhs per year.

What is the burnout rate for cardiologists? ›

Resources For Clinician Wellness

In addition to the new research presented at ACC. 21 showing a doubling in burnout rates among cardiovascular clinicians in the last year to 38%, the most current survey from Medscape found that 43% of cardiologists described themselves as "burned out."

Can you reverse plaque buildup in your arteries? ›

A. If you have the gumption to make major changes to your lifestyle, you can, indeed, reverse coronary artery disease. This disease is the accumulation of cholesterol-laden plaque inside the arteries nourishing your heart, a process known as atherosclerosis.

What are the warning signs of clogged arteries? ›

  • Chest pain (angina). You may feel pressure or tightness in your chest. ...
  • Shortness of breath. You may feel like you can't catch your breath.
  • Fatigue. If the heart can't pump enough blood to meet your body's needs, you may feel unusually tired.
  • Heart attack.
May 25, 2022

What is a good calcium score for a 65 year old? ›

What is a normal calcium score? At any age, a calcium score of 0 is considered optimal and normal. This score indicates that no “calcified” plaque is present in the coronary arteries, a positive sign for heart health.

Can you be misdiagnosed with cardiomyopathy? ›

Athletic adults. Someone with athlete's heart may be misdiagnosed as having hypertrophic cardiomyopathy. Athletes' hearts are larger than normal, including their muscle walls and chambers.

Can you have cardiomyopathy and not know it? ›

There might be no signs or symptoms in the early stages of cardiomyopathy. But as the condition advances, signs and symptoms usually appear, including: Breathlessness with activity or even at rest. Swelling of the legs, ankles and feet.

What should you not do before a cardiac MRI? ›

Please avoid caffeine 12 hours before your exam. You will be asked to fast for 4 hours prior to your exam. You may take your usual medications with small amounts of water. Cardiac Stress Perfusion exams are done in the Main Hospital only.

What is the best imaging for coronary arteries? ›

A computerized tomography (CT) coronary angiogram is an imaging test that looks at the arteries that supply blood to the heart. A CT coronary angiogram uses a powerful X-ray machine to produce images of the heart and its blood vessels. The test is used to diagnose a variety of heart conditions.

What are the signs of an unhealthy heart? ›

6 Signs of an Unhealthy Heart
  • Chest pain. Poor blood flow to the heart can cause pain or discomfort in the chest, a condition called angina. ...
  • Fatigue. ...
  • Heart palpitations. ...
  • Pain, numbness, weakness or coldness in the arms or legs. ...
  • Shortness of breath. ...
  • Swelling in your legs, ankles or feet.
Oct 6, 2022

What is the best imaging technique for heart? ›

An echocardiogram (echo) uses ultrasound (high-frequency sound waves) to produce images. It creates videos of your heart's chambers, valves, walls and blood vessels. Doppler echocardiograms can also be used to measure the flow of blood through different chambers of your heart.

What is the gold standard for diagnosis of dilated cardiomyopathy? ›

Echocardiogram. This is the main test for diagnosing dilated cardiomyopathy. Sound waves produce images of the heart in motion. An echocardiogram shows how blood moves in and out of the heart and heart valves.

Can a blood test detect cardiomyopathy? ›

Your doctor may recommend a blood test to check for B-type natriuretic peptide, a protein that the heart secretes to keep blood pressure stable. These levels increase with heart failure. A blood test may also be performed to look for substances that are associated with heart and lung damage.

Does echo show dilated cardiomyopathy? ›

Echocardiography has crucial importance in the diagnosis of dilated cardiomyopathy (DCM). Echocardiographic features of DCM are left ventricular (LV) dilation and systolic dysfunction with impaired global contractility and normal LV wall thickness and LV diastolic dysfunction with elevation in LV filling pressure.

Which artery is the most common to have blockage? ›

Although blockages can occur in other arteries leading to the heart, the LAD artery is where most blockages occur. The extent of the blockage can vary widely from 1% to 100%.

How do you clear blocked arteries without surgery? ›

Through angioplasty, our cardiologists are able to treat patients with blocked or clogged coronary arteries quickly without surgery. During the procedure, a cardiologist threads a balloon-tipped catheter to the site of the narrowed or blocked artery and then inflates the balloon to open the vessel.

How much artery blockage is normal? ›

A moderate amount of heart blockage is typically that in the 40-70% range, as seen in the diagram above where there is a 50% blockage at the beginning of the right coronary artery. Usually, heart blockage in the moderate range does not cause significant limitation to blood flow and so does not cause symptoms.

How do you know if you have inflammation around your heart? ›

Rapid or irregular heartbeat (arrhythmias) Shortness of breath, at rest or during activity. Light-headedness or feeling like you might faint. Flu-like symptoms such as headache, body aches, joint pain, fever or sore throat.

Can you have heart inflammation and not know it? ›

Common causes include viral or bacterial infections and medical conditions such as autoimmune diseases. Heart inflammation can happen suddenly or progress slowly and may have severe symptoms or almost no symptoms.

What does inflammation around the heart feel like? ›

It usually feels sharp or stabbing. However, some people have dull, achy or pressure-like chest pain. Pericarditis pain usually occurs behind the breastbone or on the left side of the chest.

What 5 abnormalities can be found on the echocardiogram? ›

Echo is the tool of choice for the assessment of valvular abnormalities.
  • Aortic stenosis. The etiology of aortic stenosis (AS) can be confirmed by the visualization of either a bicuspid valve or calcification. ...
  • Aortic regurgitation. ...
  • Mitral stenosis. ...
  • Mitral regurgitation. ...
  • Mitral valve prolapse. ...
  • Paraprosthetic regurgitation.

How often should you repeat an echocardiogram? ›

Monitoring Existing Heart Conditions:

You may require regular echocardiograms every 6 to 12 months or more frequently if the situation warrants closer monitoring.

Can an echo tell heart failure? ›

A test called an echocardiogram is often the best test to diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months.

Does a cardiac MRI show cardiomyopathy? ›

We use cardiac MRI to diagnose a wide range of heart conditions. These include coronary heart disease, congenital heart disease (in children and adults), inherited heart conditions (such as hypertrophic cardiomyopathy or dilated cardiomyopathy), heart valve disease and cardiac tumours.

What is the gold standard imaging for hypertrophic cardiomyopathy? ›

With a higher image quality, spatial resolution, and the identification of morphological variants of HCM, CMR has become the gold standard imaging modality in the assessment of HCM.

Which is better at evaluating heart disease MRI or CT? ›

'For the majority of patients, cardiac CT is sufficient to come up with good decision-making,' Prof. Bamberg concluded, 'but MR is a good way to go when you need more information of the myocardium.

Can you see cardiomyopathy on ultrasound? ›

An echocardiogram is an ultrasound test that checks the structure and function of your heart. An echo can diagnose a range of conditions including cardiomyopathy and valve disease.

What does a cardiac MRI show that an echo doesn t? ›

The primary difference is that a cardiac MRI is more focused on diseases and defects that affect the heart, while an echocardiogram provides detailed information on the functioning of the heart and its valves.

Can cardiac MRI show blockages? ›

MRI scan can also detect blockage in the coronary arteries in the heart, to determine the risk of heart attack. Hence, doctors can provide proper treatment. The study was funded by the British National Institute of Health Research (NIHR) via the Biomedical Research Centre (BRC).

What does an echocardiogram show with cardiomyopathy? ›

This is the main test for diagnosing dilated cardiomyopathy. Sound waves produce images of the heart in motion. An echocardiogram shows how blood moves in and out of the heart and heart valves. It can tell if the left ventricle is enlarged.

What is the best diagnostic test for hypertrophic cardiomyopathy? ›

An echocardiogram is commonly used to diagnose hypertrophic cardiomyopathy. This test uses sound waves (ultrasound) to see if the heart's muscle is unusually thick. It also shows how well the heart's chambers and valves are pumping blood.

What is the life expectancy of someone with hypertrophic cardiomyopathy? ›

Research has shown that with proper treatment and follow-ups, most people with HCM live a normal life. A database of 1,297 patients with HCM from the Minneapolis Heart Institute Foundation identified that 2% of the patients can live past 90 years, and 69% of them were women.

What are the 4 stages of hypertrophic cardiomyopathy? ›

These clinical stages include subclinical HCM, the classic HCM phenothype, adverse remodelling and overt dysfunction, or end-stage HCM.

What is the most accurate test for heart disease? ›

A coronary angiogram is a type of X-ray used to examine the coronary arteries supplying blood to your heart muscle. It's considered to be the best method of diagnosing coronary artery disease - conditions that affect the arteries surrounding the heart.

What is the best imaging for heart blockage? ›

Cardiac MRI can provide an accurate look at the heart muscle, heart chamber sizes and function, and connecting blood vessels. It is an excellent tool to look for scarring of the heart muscle like you might see in a heart attack, or inflammation of the heart as you might see with heart infection.

What is a good heart scan score? ›

A calcium score of 0 means there is no evidence of heart disease. 1-10 is for minimal evidence of heart disease. 11-100 is for mild evidence of heart disease. 101-400 is for moderate evidence of heart disease.


1. Cardiac Tamponade and Miscellaneous Cardiomyopathies with Dr. Brown
(UofL Internal Medicine Lecture Series)
2. Cardiotoxicity from Immunotherapy: Can Advanced Cardiac Imaging Meet the Challenge?
(Yale Cardiovascular Medicine Grand Rounds)
3. Building the Paradigms: Cardiac MRI for Cardiomyopathy
(RWJMS: Division of Cardiovascular Disease)
4. Hypertrophic Cardiomyopathy - Prof. Magdy Abdelhamid
(Cardiology Department Cairo University)
5. Cardiac: Cardiac MRI Part 1
(Radiology Residency Learning Center)
6. Cardiomyopathies in echocardiograpghy, Dr Ahmed Onsy
(Cardiology Department Ain Shams)


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