Author + information
- Received October 2, 2018
- Revision received June 24, 2019
- Accepted June 28, 2019
- Published online May 4, 2020.
- Theodoros D. Karamitsos, MD, PhDa,∗ (, )
- Alexandra Arvanitaki, MDa,
- Haralambos Karvounis, MD, PhDa,
- Stefan Neubauer, MDb and
- Vanessa M. Ferreira, MD, DPhilb
- a1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
- bOxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- ↵∗Address for correspondence:
Dr. Theodoros Karamitsos, 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece.
• Tissue composition changes such as fibrosis, edema, or infiltration are frequent features in myocardial diseases.
• Cardiac imaging modalities offer the ability to characterize myocardial tissue to varying extent.
• Cardiovascular magnetic resonance offers comprehensive myocardial tissue characterization by providing various diagnostic and prognostic imaging biomarkers.
• Advanced cardiac imaging is expected to become an integral part in risk stratification and personalized medicine.
Myocardial fibrosis, either focal or diffuse, is a common feature of many cardiac diseases and is associated with a poor prognosis for major adverse cardiovascular events. Although histological analysis remains the gold standard for confirming the presence of myocardial fibrosis, endomyocardial biopsy is invasive, has sampling errors, and is not practical in the routine clinical setting. Cardiac imaging modalities offer noninvasive surrogate biomarkers not only for fibrosis but also for myocardial edema and infiltration to varying degrees, and have important roles in the diagnosis and management of cardiac diseases. This review summarizes important pathophysiological features in the development of commonly encountered cardiac diseases, and the principles, advantages, and disadvantages of various cardiac imaging modalities (echocardiography, single-photon emission computer tomography, positron emission tomography, multidetector computer tomography, and cardiac magnetic resonance) for myocardial tissue characterization, with an emphasis on imaging focal and diffuse myocardial fibrosis.
Drs. Neubauer and Ferreira are supported by the NIHR Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence. Dr. Ferreira is supported by the British Heart Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received October 2, 2018.
- Revision received June 24, 2019.
- Accepted June 28, 2019.
- 2020 American College of Cardiology Foundation
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