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Myocardial disease
Clinical use of multimodality imaging in the assessment of dilated cardiomyopathy
  1. João Silva Marques,
  2. Fausto J Pinto
  1. Department of Cardiology, University Hospital Santa Maria, Lisbon Academic Medical Centre, CCUL, University of Lisbon, Lisbon, Portugal
  1. Correspondence to Professor Fausto J Pinto, Faculty of Medicine of Lisbon University, Cardiology Department, University Hospital Santa Maria/CHLN, Av Prof Egas Moniz, Lisbon 1649-028, Portugal; faustopin{at}gmail.com

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Learning objectives

  • To understand the use of cardiovascular imaging for diagnosis, evaluation of prognosis and for supporting treatment decisions and monitoring therapy in patients with dilated cardiomyopathy by providing morphologic, functional and etiologic information, including refined assessment of ventricular function.

  • To provide to the clinical cardiologist the information on what to expect from each imaging modality and how to work together with the cardiovascular imaging expert to fully explore the potential of complementary imaging techniques.

  • To provide a look into the future role of new imaging modalities such as molecular imaging.

Curriculum topic: non invasive imaging Scope of the problem and challenges to the clinician

Dilated cardiomyopathy (DCM) is a heart muscle disorder that frequently leads to heart failure. It is defined by the presence of left ventricular (LV) dilatation and LV systolic dysfunction in the absence of abnormal loading conditions or extensive coronary artery disease (CAD).1 In that regard, the accurate and reproducible assessment of cardiac dimensions and function is paramount, but there is also a need to fully characterise valve function and the presence and functional consequences of CAD. This is particularly important because coronary heart disease is considered the most frequent cause for finding a dilated, dysfunctional heart in clinical practice. Also, LV enlargement and dysfunction are late features of chronic volume or pressure overload that are seen in patients with severe valve disease. Therefore, multimodality cardiac imaging aims to correctly identify DCM from the wider pool of patients with reduced ejection fraction (EF).

The prevalence of DCM in the general population remains undefined but it is considered to be the most common cardiomyopathy worldwide,w1 with an estimated incidence of 4.5/100 000/year.w2 A broad spectrum of entities may cause DCM. Traditionally, familial and genetic causes were thought to account for a small percentage of cases but are now increasingly recognised.w3 The other aetiologies are grouped into non-familial DCM, that comprises …

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