Identifying the etiology: a systematic approach using delayed-enhancement cardiovascular magnetic resonance

Heart Fail Clin. 2009 Jul;5(3):349-67, vi. doi: 10.1016/j.hfc.2009.02.009.


In patients who have heart failure, treatment and survival are directly related to the cause. Clinically, as a practical first step, patients are classified as having either ischemic or non-ischemic cardiomyopathy, a delineation usually based on the presence or absence of epicardial coronary artery disease. However, this approach does not account for patients with non-ischemic cardiomyopathy who also have coronary artery disease, which may be either incidental or partly contributing to myocardial dysfunction (mixed cardiomyopathy). By allowing direct assessment of the myocardium, delayed-enhancement cardiovascular magnetic resonance (DE-CMR) may aid in addressing these conundrums. This article explores the use of DE-CMR in identifying ischemic and non-ischemic myopathic processes and details a systematic approach to determine the cause of cardiomyopathy.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Algorithms
  • Cardiomyopathies / classification
  • Cardiomyopathies / diagnosis*
  • Cardiomyopathies / etiology
  • Cardiomyopathies / physiopathology
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnosis
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Myocardial Ischemia / complications
  • Myocardial Ischemia / diagnosis