Usefulness of Cardiac Magnetic Resonance in Early Assessment of Cardiomyopathies: Myocardial Fibrosis Is a Common Denominator

Myocardial fibrosis is a common denominator in a wide spectrum of cardiomyopathies; it plays a major role in the pathophysiology of structural remodelling and as a predictor of adverse outcome. Quantification of myocardial fibrosis by invasive biopsy is limited in clinical practice due to the commonly scattered tissue distribution and procedural risks. Late gadolinium enhancement by cardiac magnetic resonance has revolutionized the assessment of ischemic cardiomyopathy by visualization of regional scarring after myocardial infarction. The binary (white-black) principle of contrast development and a requirement for well separated layers of healthy and diseased myocardium is straightforward for clinical decision making in ischemic heart disease, but renders this technique less powerful in conditions where the myocardium is affected diffusely. Recently emerged T1 mapping techniques allow for an individualized quantification of global and regional myocardial signal and are promising tools to separate between healthy and diseased. In this article we review the emerging evidence for T1 mapping techniques and outline the necessary future directions for a successful translational pathway.