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A Comprehensive Assessment of Cardiomyopathies through Cardiovascular Magnetic Resonance: Focus on the Pediatric
Francesca Baessato1,2, Cristina Romeo2, Mark G Rabbat3
1Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany.
Insights
Cardiomyopathies (CMPs) in children are rare but serious. Cardiovascular magnetic resonance (CMR) is a key imaging tool for diagnosing pediatric CMPs, assessing severity, and guiding treatment for better outcomes.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Cardiomyopathies (CMPs) are myocardial diseases impacting cardiac function, potentially leading to severe complications like heart failure and sudden cardiac death.
- Pediatric CMPs are uncommon but associated with poorer prognoses.
- Non-invasive cardiac imaging, alongside clinical, genetic, and ECG data, is crucial for diagnosing CMPs and identifying complications.
Purpose of the Study:
- To review the role of advanced cardiovascular magnetic resonance (CMR) imaging in pediatric cardiomyopathies.
- To highlight CMR's utility in diagnosing and characterizing common pediatric CMP phenotypes, including dilated, hypertrophic, and non-compacted forms.
Main Methods:
- This review synthesizes current knowledge on cardiovascular magnetic resonance (CMR) applications in pediatric cardiomyopathies.
- Focuses on CMR's diagnostic and prognostic capabilities compared to other imaging modalities.
Main Results:
- Cardiovascular magnetic resonance (CMR) offers high spatial and temporal resolution, without ionizing radiation, making it a valuable tool complementary to echocardiography.
- CMR enables in vivo myocardial tissue characterization, identifying pathological changes like fibrosis, which are critical predictors of adverse outcomes.
- CMR aids in confirming diagnoses, providing prognostic information, and guiding therapeutic strategies for pediatric CMPs.
Conclusions:
- Cardiovascular magnetic resonance (CMR) is a powerful imaging modality for the comprehensive evaluation of pediatric cardiomyopathies.
- Further large-scale prospective studies are warranted to fully validate CMR's role in childhood CMP management.
- CMR's ability to characterize myocardial tissue is essential for risk stratification and treatment planning in pediatric CMP patients.
Abstract:
Cardiomyopathies (CMPs) are a heterogeneous group of diseases that involve the myocardium and result in systolic or diastolic impairment of the cardiac muscle, potentially leading to heart failure, malignant arrhythmias, or sudden cardiac death. Occurrence in pediatric age is rare but has been associated with worse outcomes. Non-invasive cardiac imaging techniques, integrated with clinical, genetic, and electrocardiographic data, have shown a pivotal role in the clinical work-up of such diseases by defining structural alterations and assessing potential complications. Above all modalities, cardiovascular magnetic resonance (CMR) has emerged as a powerful tool complementary to echocardiography to confirm diagnosis, provide prognostic information and guide therapeutic strategies secondary to its high spatial and temporal resolution, lack of ionizing radiation, and good reproducibility. Moreover, CMR can provide in vivo tissue characterization of the myocardial tissue aiding the identification of structural pathologic changes such as replacement or diffuse fibrosis, which are predictors of worse outcomes. Large prospective randomized studies are needed for further validation of CMR in the context of childhood CMPs. This review aims to highlight the role of advanced imaging with CMR in CMPs with particular reference to the dilated, hypertrophic and non-compacted phenotypes, which are more commonly seen in children.
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