Role of multimodality imaging in the diagnosis and management of cardiomyopathies

• Published in: Archives of cardiovascular diseases 2019-10, Vol.112 (10), p.615-629
• Main Authors: Ederhy, Stéphane, Mansencal, Nicolas, Réant, Patricia, Piriou, Nicolas, Barone-Rochette, Gilles
• Format: Article
• Language: English
• Subjects: Cardiac magnetic resonance imaging; Cardiac nuclear imaging; Cardiomyopathie; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - epidemiology; Cardiomyopathies - physiopathology; Cardiomyopathies - therapy; Cardiomyopathy; Computed tomography scan; Humans; Imagerie multimodalité; Imagerie nucléaire cardiaque; Imagerie par résonance magnétique cardiaque; Life Sciences; Multimodal Imaging - methods; Multimodality imaging; Predictive Value of Tests; Prognosis; Reproducibility of Results; Risk Factors; Tomodensitométrie; Transthoracic echocardiography; Échocardiographie transthoracique
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2019.07.004

Multimodality imaging plays an important role in the initial evaluation, diagnosis and management of patients suspected of having a cardiomyopathy. Beyond functional and anatomical information, multimodality imaging provides important variables that facilitate risk stratification and prognosis evaluation. Whatever the underlying suspected cardiomyopathy, echocardiography is the most common initial imaging test used to establish the presence of cardiomyopathy, by depicting structural and functional abnormalities. However, echocardiographic findings are non-specific, and therefore have a limited role in identifying the underlying aetiology. Cardiac magnetic resonance imaging allows characterization of myocardial tissue, which can be of great help in identifying the aetiology of the cardiomyopathy. When a specific aetiology is suspected, particularly inflammation, 18F-fluorodeoxyglucose positron emission tomography is recommended. The clinician should be capable of selecting the appropriate imaging techniques for each clinical scenario. Each technique has strengths and weaknesses, which should be known. In order to improve diagnostic performance, and as proposed by the European Association for Cardiovascular Imaging, cardiovascular imaging groups must be composed of experts from all modalities. The future of multimodality imaging in the diagnosis and management of cardiomyopathies will also involve evolution of its use in care, teaching and research. Training goals for future cardiac imaging experts must be defined; academic and industry partnerships should enable the connection to be made between imaging data and clinical data on the one hand and outcomes on the other hand, using big-data analysis and artificial intelligence. L’imagerie multimodale joue un rôle important dans l’évaluation initiale, le diagnostic et la prise en charge des patients suspectés d’avoir une cardiomyopathie. Au-delà des informations fonctionnelles et anatomiques, l’imagerie multimodale fournit des variables importantes qui facilitent la stratification du risque et l’évaluation du pronostic. Quelle que soit la cardiomyopathie présumée sous-jacente, l’échocardiographie est le test d’imagerie initial le plus couramment utilisé pour établir la présence d’une cardiomyopathie, en décrivant des anomalies structurelles et fonctionnelles. Cependant, les résultats échocardiographiques ne sont pas spécifiques et ont donc un rôle limité dans l’identification de l’étiologie sous-jacente. L’imag