The Role of Cardiac Magnetic Resonance in Patients with Dilated Cardiomiopathy

Dilated cardiomyopathy (DCM) has an increased risk of heart failure, malignant ventricular arrhythmias, including sudden cardiac death, being the most common cause of heart transplantation. Cardiac magnetic resonance imaging (CMR) is the gold standard technique for assessing left and right ventricular function; the major advantage of CMR is the possibility of tissue characterization, highlighting the replacement of myocardial fibrosis (late gadolinium enhancement - LGE technique) and the interstitial and perivascular reactive fibrosis (mapping techniques - T1 mapping, T2-mapping, T2 * -mapping). Myocardial fibrosis pattern helps to establish the DCM aetiology and has prognostic and therapeutic implications. LGE presence is associated with a weaker therapeutic response and an increased risk of complex ventricular arrhythmias. At the same time, LGE absence associated with the presence of reactive fibrosis quantified by mapping techniques and especially by increasing myocardial extracellular volume, identifies patients with potentially favourable response to optimal drug therapy and cardiac resynchronization therapy.