Syllabus

Cardiovascular Magnetic Resonance (CMR) is not only able to assess cardiac function, but also to visualize small myocardial lesions and to differentiate myocardial tissue changes, e.g. detection and extension of focal and diffuse fibrosis. CMR is meanwhile mentioned in 29 Guidelines of the European Society of Cardiology. In 2016 the new Heart Failure (HF) were published and noninvasive imaging was discussed in detail. In comparison to the last version CMR had a higher impact. It was not only recommended in case of worse ultrasound condition and for the exclusion of Coronary Artery Disease (CAD), but also for the differentiation between ischemic and non-ischemic heart disease. The recommendations are reflecting the unique capability of CMR to differentiate myocardial injury. Interestingly, the characterization of storage diseases, myocardial involvement in systematic disorders as well as the detection of inflammatory disease are mentioned as class I indication. Class I is the highest level of recommendation a method can get. The level is currently “C” – reflecting expert opinion and single center trials. The highest level would be a IA indication, that can be reached only based on successful prospective multi-center trials. Using the capabilities of CMR to assess myocardial tissue composition, CMR is able to detect and differentiate the injury already in preserved ejection fraction. The strong collaboration between physicians and scientists enables the community to provide stable techniques. One of missing pieces are standardized and fast techniques. That would help to establish CMR as an every day technique in every hospital. Whereas echocardiography is a bedside and wide spread technique, CMR is the only technique to verify specific subclinical changes. This information would help to develop a specific personalized therapy.

Acknowledgements

No acknowledgement found.

References

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC European Heart Journal (2016) 37, 2129–2200 doi:10.1093/eurheartj/ehw128