REVIEW
Cardiac Magnetic Resonance Imaging and Coronary Computed Tomography Angiography in Cardiomyopathy: Diagnostic and Prognostic Insights
Yasmin Hanfi,
Corresponding Author
Yasmin Hanfi
Department of Cardiology, Dallah Hospital, Riyadh, Saudi Arabia
Search for more papers by this authorYasmin Hanfi,
Corresponding Author
Yasmin Hanfi
Department of Cardiology, Dallah Hospital, Riyadh, Saudi Arabia
Search for more papers by this authorFirst published: 22 April 2025
ABSTRACT
This review focuses on the key noninvasive cardiac imaging techniques, including coronary computed tomographic angiography (CCTA) and cardiac magnetic resonance imaging (CMR). It highlights essential publications pertinent to clinicians managing ischemic and nonischemic cardiomyopathy. CCTA provides an anatomical assessment that offers superior diagnostic accuracy compared to functional tests. It is a valuable tool for understanding the impact of nonobstructive coronary artery disease on patient outcomes. Additionally, CCTA is beneficial in defining the morphology of vulnerable plaque, which closely aligns with IVUS findings. It also demonstrates safety advantages, including reduced contrast volume and radiation dose and a lower risk of contrast-induced nephropathy when used in post-CABG besides conventional coronary angiograms. CMR provides invaluable insight into MI size and microvascular obstruction, critical for understanding a patient's prognosis. The assessment of scar tissue with CMR has become an essential tool for risk stratification and informs therapeutic decisions regarding the implantation of ICD.
References
- 1L. H. Nielsen, N. Ortner, B. L. Nørgaard, S. Achenbach, J. Leipsic, and J. Abdulla, “The Diagnostic Accuracy and Outcomes After Coronary Computed Tomography Angiography vs. Conventional Functional Testing in Patients With Stable Angina Pectoris: A Systematic Review and Meta-Analysis,” European Heart Journal - Cardiovascular Imaging 15, no. 9 (2014): 961–971, https://doi.org/10.1093/ehjci/jeu027. (in eng).
- 2M. M. Julie, C. E. Rochitte, M. Deweyet, et al., “Diagnostic Performance of Coronary Angiography by 64-Row CT,” New England Journal of Medicine 359, no. 22 (2008): 2324–2336, https://doi.org/10.1056/NEJMoa0806576.
- 3G. Mowatt, E. Cummins, N. Waugh, et al., “ Systematic Review of the Clinical Effectiveness and Cost-Effectiveness of 64-Slice or Higher Computed Tomography Angiography as an Alternative to Invasive Coronary Angiography in the Investigation of Coronary Artery Disease,” (in eng), no. 1366–5278 (Print).
- 4H. I. Litt, C. Gatsonis, B. Snyder, et al., “CT Angiography for Safe Discharge of Patients With Possible Acute Coronary Syndromes,” New England Journal of Medicine 366, no. 15 (2012): 1393–1403, https://doi.org/10.1056/NEJMoa1201163.
- 5E. Hulten, C. Pickett, and M. S. Bittencourt, et al., “Outcomes After Coronary Computed Tomography Angiography in the Emergency Department,” Journal of the American College of Cardiology 61, no. 8 (2013): 880–892, https://doi.org/10.1016/j.jacc.2012.11.061.
- 6 SCOT-HEART Investigators, “CT Coronary Angiography in Patients With Suspected Angina due to Coronary Heart Disease (SCOT-HEART): An Open-Label, Parallel-Group, Multicentre Trial,” Lancet vol. 385, no. 9985 (2015), pp. 2383–2391, https://doi.org/10.1016/S0140-6736(15)60291-4.
- 7D. E. Newby, P. D. Adamson, C. Berry, et al., “Coronary CT Angiography and 5-Year Risk of Myocardial Infarction,” New England Journal of Medicine 379, no. 10 (2018): 924–933, https://doi.org/10.1056/NEJMoa1805971.
- 8H. R. Reynolds, L. J. Shaw, J. K. Min, et al., “Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity,” Circulation 144, no. 13 (2021): 1024–1038, https://doi.org/10.1161/CIRCULATIONAHA.120.049755.
- 9A. R. van Rosendael, A. M. Bax, J. M. Smit, et al., “Clinical Risk Factors and Atherosclerotic Plaque Extent to Define Risk for Major Events in Patients Without Obstructive Coronary Artery Disease: The Long-Term Coronary Computed Tomography Angiography CONFIRM Registry,” European Heart Journal—Cardiovascular Imaging 21, no. 5 (2020): 479–488, https://doi.org/10.1093/ehjci/jez322.
- 10E. A. Hulten, S. Carbonaro, S. P. Petrillo, J. D. Mitchell, and T. C. Villines, “Prognostic Value of Cardiac Computed Tomography Angiography: A Systematic Review and Meta-Analysis,” Journal of the American College of Cardiology 57, no. 10 (2011): 1237–1247, https://doi.org/10.1016/j.jacc.2010.10.011.
- 11J. Narula, M. Nakano, R. Virmani, et al., “Histopathologic Characteristics of Atherosclerotic Coronary Disease and Implications of the Findings for the Invasive and Noninvasive Detection of Vulnerable Plaques,” Journal of the American College of Cardiology 61, no. 10 (2013): 1041–1051, https://doi.org/10.1016/j.jacc.2012.10.054.
- 12T. Yonetsu, T. Kakuta, T. Lee, et al., “In Vivo Critical Fibrous Cap Thickness for Rupture-Prone Coronary Plaques Assessed by Optical Coherence Tomography,” European Heart Journal 32, no. 10 (2011): 1251–1259, https://doi.org/10.1093/eurheartj/ehq518.
- 13L. P. Dawson and J. Layland, “High-Risk Coronary Plaque Features: A Narrative Review,” Cardiology and Therapy 11, no. 3 (2022): 319–335, https://doi.org/10.1007/s40119-022-00271-9. (in eng).
- 14M. J. Budoff, S. Lakshmanan, P. P. Toth, et al., “Cardiac CT Angiography in Current Practice: An American Society for Preventive Cardiology Clinical Practice Statement(★),” American Journal of Preventive Cardiology 9 (2022): 100318, https://doi.org/10.1016/j.ajpc.2022.100318. (in eng).
- 15M. C. Williams, A. J. Moss, M. Dweck, et al., “Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study,” Journal of the American College of Cardiology 73, no. 3 (2019): 291–301, https://doi.org/10.1016/j.jacc.2018.10.066. (in eng).
- 16F. Mach, C. Baigent, A. L. Catapano, et al., “2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS),” European Heart Journal 41, no. 1 (2019): 111–188, https://doi.org/10.1093/eurheartj/ehz455.
- 17D. K. Arnett, R. S. Blumenthal, M. A. Albert, et al., “2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” Journal of the American College of Cardiology 74, no. 10 (2019): e177–e232, https://doi.org/10.1016/j.jacc.2019.03.010.
- 18Y. Kataoka, K. Wolski, C. Balog, et al., “Progression of Coronary Atherosclerosis in Stable Patients With Ultrasonic Features of High-Risk Plaques,” European Heart Journal—Cardiovascular Imaging 15, no. 9 (2014): 1035–1041, https://doi.org/10.1093/ehjci/jeu065.
- 19S. Lee, H. J. Chang, J. M. Sung, et al., “Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study,” JACC: Cardiovascular Imaging 11, no. 10 (2018): 1475–1484, https://doi.org/10.1016/j.jcmg.2018.04.015.
- 20S. J. Nicholls, R. Puri, T. Anderson, et al., “Effect of Evolocumab on Coronary Plaque Composition,” Journal of the American College of Cardiology 72, no. 17 (2018): 2012–2021, https://doi.org/10.1016/j.jacc.2018.06.078.
- 21C. Zanchin, K. C. Koskinas, Y. Ueki, et al., “Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction: A Serial, Multivessel, Intravascular Ultrasound, Near-Infrared Spectroscopy and Optical Coherence Tomography Imaging Study–Rationale and Design of the PACMAN-AMI Trial,” American Heart Journal 238 (2021): 33–44, https://doi.org/10.1016/j.ahj.2021.04.006.
- 22U. Barbero, M. Iannaccone, F. d'Ascenzo, et al., “64 Slice-Coronary Computed Tomography Sensitivity and Specificity in the Evaluation of Coronary Artery Bypass Graft Stenosis: A Meta-Analysis,” International Journal of Cardiology 216 (2016): 52–57, https://doi.org/10.1016/j.ijcard.2016.04.156.
- 23D. A. Jones, E. V. Castle, A. Beirne, et al., “Computed Tomography Cardiac Angiography for Planning Invasive Angiographic Procedures in Patients With Previous Coronary Artery Bypass Grafting,” EuroIntervention 15, no. 15 (2020): e1351–e1357.
- 24D. A. Jones, A. Beirne, M. Kelham, et al., “Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial,” Circulation 148, no. 18 (2023): 1371–1380, https://doi.org/10.1161/CIRCULATIONAHA.123.064465.
- 25E. K. Oikonomou, M. Marwan, M. Y. Desai, et al., “Non-Invasive Detection of Coronary Inflammation Using Computed Tomography and Prediction of Residual Cardiovascular Risk (the CRISP CT Study): A Post-Hoc Analysis of Prospective Outcome Data,” Lancet 392, no. 10151 (2018): 929–939.
- 26J. S. Lawton, J. E. Tamis-Holland, S. Bangalore, et al., “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines,” Circulation 145, no. 3 (2022): e18–e114, https://doi.org/10.1161/CIR.0000000000001038.
- 27A. Papanastasiou Christos, P. N. Kampaktsis, M. A. Bazmpani, et al., “Diagnostic Accuracy of CMR With Late Gadolinium Enhancement for Ischemic Cardiomyopathy,” JACC: Cardiovascular Imaging 16, no. 3 (2023): 399–401, https://doi.org/10.1016/j.jcmg.2022.12.024.
- 28G. W. Stone, H. P. Selker, H. Thiele, et al., “Relationship Between Infarct Size and Outcomes Following Primary PCI: Patient-Level Analysis From 10 Randomized Trials,” Journal of the American College of Cardiology 67, no. 14 (2016): 1674–1683, https://doi.org/10.1016/j.jacc.2016.01.069.
- 29H. Bulluck, M. Hammond-Haley, S. Weinmann, R. Martinez-Macias, and D. J. Hausenloy, “Myocardial Infarct Size by CMR in Clinical Cardioprotection Studies: Insights From Randomized Controlled Trials,” JACC: Cardiovascular Imaging 10, no. 3 (2017): 230–240, https://doi.org/10.1016/j.jcmg.2017.01.008.
- 30S. de Waha, M. R. Patel, C. B. Granger, et al., “Relationship Between Microvascular Obstruction and Adverse Events Following Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: An Individual Patient Data Pooled Analysis From Seven Randomized Trials,” European Heart Journal 38, no. 47 (2017): 3502–3510, https://doi.org/10.1093/eurheartj/ehx414.
- 31D. J. Shah, H. W. Kim, O. James, et al., “ Prevalence of Regional Myocardial Thinning and Relationship With Myocardial Scarring in Patients With Coronary Artery Disease,” (in eng), no. 1538–3598 (Electronic).
- 32M. Izquierdo, R. Ruiz-Granell, C. Bonanad, et al., “Value of Early Cardiovascular Magnetic Resonance for the Prediction of Adverse Arrhythmic Cardiac Events After a First Noncomplicated ST-Segment–Elevation Myocardial Infarction,” Circulation: Cardiovascular Imaging 6, no. 5 (2013): 755–761, https://doi.org/10.1161/CIRCIMAGING.113.000702.
- 33I. Klem, J. W. Weinsaft, T. D. Bahnson, et al., “Assessment of Myocardial Scarring Improves Risk Stratification in Patients Evaluated for Cardiac Defibrillator Implantation,” Journal of the American College of Cardiology 60, no. 5 (2012): 408–420, https://doi.org/10.1016/j.jacc.2012.02.070. (in eng).
- 34S. R. Ommen, C. Y. Ho, I. M. Asif, et al., “2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines,” Circulation 149, no. 23 (2024): e1239–e1311, https://doi.org/10.1161/CIR.0000000000001250.
- 35R. H. Chan, B. J. Maron, I. Olivotto, et al., “Prognostic Value of Quantitative Contrast-Enhanced Cardiovascular Magnetic Resonance for the Evaluation of Sudden Death Risk in Patients With Hypertrophic Cardiomyopathy,” Circulation 130, no. 6 (2014): 484–495, https://doi.org/10.1161/CIRCULATIONAHA.113.007094.
- 36E. Arbelo, A. Protonotarios, J. R. Gimeno, et al., “2023 ESC Guidelines for the Management of Cardiomyopathies: Developed by the Task Force on the Management of Cardiomyopathies of the European Society of Cardiology (ESC),” European Heart Journal 44, no. 37 (2023): 3503–3626, https://doi.org/10.1093/eurheartj/ehad194.
- 37B. P. Halliday, A. J. Baksi, A. Gulati, et al., “Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement,” JACC: Cardiovascular Imaging 12, no. 8 (2019): 1645–1655, https://doi.org/10.1016/j.jcmg.2018.07.015. Part 2.
- 38W. Bai, M. Sinclair, G. Tarroni, et al., “Automated Cardiovascular Magnetic Resonance Image Analysis With Fully Convolutional Networks,” Journal of Cardiovascular Magnetic Resonance 20, no. 1 (2018): 65.
- 39Y. Gao, Z. Zhou, B. Zhang, et al., “Deep Learning-Based Prognostic Model Using Non-Enhanced Cardiac Cine MRI for Outcome Prediction in Patients With Heart Failure,” European Radiology 33, no. 11 (2023): 8203–8213, https://doi.org/10.1007/s00330-023-09785-9.
- 40A. Schuster, T. Lange, S. J. Backhaus, et al., “Fully Automated Cardiac Assessment for Diagnostic and Prognostic Stratification Following Myocardial Infarction,” Journal of the American Heart Association 9, no. 18 (2020): e016612.
- 41S. J. Backhaus, H. Aldehayat, J. T. Kowallick, et al., “Artificial Intelligence Fully Automated Myocardial Strain Quantification for Risk Stratification Following Acute Myocardial Infarction,” Scientific Reports 12, no. 1 (2022): 12220, https://doi.org/10.1038/s41598-022-16228-w.
- 42A. Satriano, Y. Afzal, M. Sarim Afzal, et al., “Neural-Network-Based Diagnosis Using 3-Dimensional Myocardial Architecture and Deformation: Demonstration for the Differentiation of Hypertrophic Cardiomyopathy,” Frontiers in Cardiovascular Medicine 7 (2020): 584727.
