Utility of cardiovascular magnetic resonance imaging with contrast-enhancement: beyond the scope of viability

Chapter 1 gives us a brief technical background including applications of late-gadolinium enhancement (LGE)-CMR imaging in patients with ischemic heart disease and myocarditis. In chapter 2 the long-term effect of successful early revascularization by primary percutaneous coronary intervention (PCI) on LV remodeling and infarcted tissue is investigated. LV dilatation and wall motion abnormalities were less after successful early revascularization. Potential effect of successful primary PCI on scar size was nonsignificant. To get further insight into the impact of a successful early revascularization on relationship between infarcted tissue and LV remodeling, patients were investigated with LGE-CMR >1 month post-MI in chapter 3. Only successful early revascularized patients showed a correlation between infarcted tissue and LV remodeling. In chapter 4 we assessed potential relationships between Framingham Risk Score vs. LV remodeling and infarcted tissue by LGE-CMR. The Framingham Risk Score showed significant relations with LV remodeling but no relation with infarcted tissue. We used in chapter 5 LGE-CMR in ICD recipients to assess potential differences in infarct tissue between patients with prior life-threatening ventricular arrhythmia vs. patients with prophylactic ICD implantation. Applied shocks for ventricular arrhythmias were higher in the secondary prevention group but there were no difference in infarct tissue observed. We investigated in chapter 6 in patients with ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) relationships between MTWA (indicates increased risk of sudden cardiac death) and scar/fibrosis determined by LGE-CMR. No relationship was observed between MTWA and myocardial scar. Chapter 7 reviews the role of CMR for the evaluation of myocarditis and myocarditis-induced cardiomyopathies. CMR-derived information on changes in LV function and myocardial inflammation may be useful to monitor the disease process. Myocardial infection with Epstein-Barr virus or Cytomegalovirus may trigger development of chronic fatigue syndrome (CFS). We described in chapter 8 that CFS patients demonstrated smaller LV dimensions, reduced - function and presence of myocardial fibrosis in some CFS patients compared with age-matched, healthy women. Additional CMR approaches are illustrated in chapter 9. Future perspectives and limitations of novel CMR methods are reviewed, including 3.0T CMR-imaging and the ability to identify diffuse myocardial fibrosis with post-contrast T1-mapping.