Cardiac Magnetic Resonance to Reclassify Diagnosis and Detect Cardiomyopathies in Hospitalized Patients with Acute Presentation

Background: Cardiomyopathies are a significant cause of heart failure, arrhythmia and cardiac morbidity in the general population/ Cardiovascular magnetic resonance (CMR) is valuable tool for the diagnostic work-up of patients with acute cardiac events. Objectives: This study evaluated the diagnostic value of CMR and the yield of cardiomyopathies in hospitalized cardiac patients with acute presentation. Methods A retrospective analysis was conducted in 535 consecutive hospitalized patients who underwent CMR at Hippokration Hospital, Athens, Greece, to identify a subset of scans performed at an urgent basis of hospitalized patients. Demographic data, cause of admission, CMR findings, and plasma cardiac biomarkers (hs-Troponin I, NT-proBNP, CRP) were systematically recorded. Results Out of the initial 535 CMR scans evaluated, further analysis was conducted on 104 patients who were in-hospital and underwent CMR on an urgent basis. From the total population of hospitalized patients, 33% had CMR findings indicative of an underlying cardiomyopathy, with dilated cardiomyopathy being the most common subtype (36%) followed by arrhythmogenic cardiomyopathy (27%), hypertrophic cardiomyopathy (15%) or other subtypes (e.g., cardiac amyloidosis, sarcoidosis, endomyocardial fibrosis, EGPA, or unclassified). CMR led to reclassification of the initial diagnosis into that of an underlying cardiomyopathy in 32% of cases. The highest reclassification rate was observed within the subgroup with heart failure (71%), followed by that of acute myocardial infarction/ischemic heart disease (24%) and myocarditis (22%). Conclusions CMR imaging effectively contributed to the differential diagnosis of hospitalized patients with acute cardiac events that remained without a definitive diagnosis after their initial work-up and uncovered underlying cardiomyopathy in almost one-third of this cohort.