Cardiovascular magnetic resonance and the evaluation of heart failure

Cardiovascular magnetic resonance (CMR) has established itself as probably the single best way of phenotyping the failing heart. It is the accepted gold standard for measuring cardiac function, volumes, and mass, but within the same scan session additional techniques are available for greater definition. Tissue characterization with the contrast agent gadolinium is well validated and allows the precise visualization and quantification of myocardial infarction. This can be used for viability assessment and to determine heart failure etiology. Dobutamine stress CMR and CMR perfusion hold advantages over conventional techniques. The new frontiers of CMR in heart failure hold the promise of unique insights quantifying myocardial iron, nonischemic fibrosis, microvascular perfusion, plaque characterization, and CMR-targeted intervention. The development and validation of these techniques represent major research challenges for the future. From a clinical perspective, an equal challenge is in increasing the availability of the modality for patients and physicians.