Pattern of delayed myocardial enhancement: A key to differentiate ischemic and non-ischemic cardiomyopathies

Objective

Our objective is to find out if the pattern of delayed myocardial enhancement can be used as a key to diagnose and specify different types of cardiomyopathies.

Patients and methods

Fifty-four patients with suspected cardiomyopathy were enrolled in this study. Patients’ age ranged from 3 to 68 years. All patients were subjected to history taking, laboratory investigations, 2D echocardiography and cardiac magnetic resonance. Images were evaluated for presence, distribution, pattern and site of delayed myocardial enhancement.

Results

Seven types of cardiomyopathies were diagnosed in this study. Each type had a characteristic pattern of myocardial enhancement. Ischemic cardiomyopathy showed subendocardial up to transmural enhancement within the territory of the coronary arteries. Dilated cardiomyopathy showed midwall linear enhancement, hypertrophic cardiomyopathy showed patchy midwall enhancement and restrictive cardiomyopathy showed subendocardial circumferential enhancement. Arrythmogenic right ventricular dysplasia showed enhancement of the dilated right ventricle. Non-compaction showed enhancement of the non-compacted area. Sarcoidosis showed midwall patchy enhancement while Behcet’s disease showed right ventricular subendocardial enhancement.

Conclusion

The pattern of myocardial enhancement can be used as a key to diagnose all types of cardiomyopathies. The use of cardiac magnetic resonance in cardiomyopathy is important to quantify myocardial fibrosis as this has prognostic implications.