• Acute coronary syndrome
• Pathology—valves
• pathology
• arrhythmic right ventricular dyplasia
• hypertrophic cardiomyopathy
• acute ischaemic syndromes
• acute myocardial infarction
• cardiomyopathy

The role of cardiac magnetic resonance (CMR) for detection of myocardial injury in asymptomatic subjects has been tested so far only in selected healthy or unhealthy populations, such as competitive athletes and patients with liver cirrhosis.1 2 Aquaro et al should be congratulated for their original study, which is the first to assess the prevalence of myocardial tissue abnormalities by CMR in asymptomatic cocaine addicts who were studied ≥48 h after drug withdrawal, with no history of cardiac disease.3 Although biohumoral markers of cardiac involvement were negative in all but one and a stress test was always negative for ischaemia, evidence of myocardial damage was found in the majority (83%), including delayed enhancement (DE, 73%) and oedema (47%).

According to pathology and clinical studies, acute and chronic cocaine abuse has been associated with both vascular and myocardial abnormalities.4–6 Myocardial damage in cocaine abusers includes cardiac hypertrophy, acute myocardial infarction, dilated cardiomyopathy and myocarditis. In contrast to myocardial oedema, which is potentially reversible, myocardial DE detected by CMR imaging is viewed as a surrogate of fibrosis—that is, an irreversible myocardial injury, and was found in 73% of asymptomatic cocaine addicts, either with …