Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies

Table 1 Cardiac magnetic resonance findings in hypertrophic cardiomyopathy and phenocopies

	Morphologic features	Tissue characterization
		LGE	Mapping	ECV
Athlete’s heart	Balanced increase in wall thickness and cavity size	Absent or in RV insertion points	Normal or decreased T1	Normal or decreased
Hypertrophic cardiomyopathy (sarcomeric)	Typically asymmetric LVH, with septal predominance	Mid-mural, patchy, affecting most hypertrophied segments; transmural in advanced stages	Increased native T1, regardless of LGE presence, reflecting interstitial fibrosis	Increased ECV attributed to fibrosis
Amyloidosis	Symmetric or asymmetric LVH	Subendocardial, global, diffuse; transmural in advanced stages. LGE reflects infiltration, not fibrosis; abnormal gadolinium kinetics	Marked increase in native T1 value (AL > ATTR) due to protein accumulation	Markedly increased ECV reflecting protein accumulation
Fabry disease	Concentric LVH, prominent papillary muscles, RV hypertrophy	Mid-mural, basal inferolateral segment	Decreased native T1 values (lipid storage); pseudonormalization in advance stages due to fibrosis. Elevated T2 levels due to inflammation	Normal ECV

ECV: Extracellular volume; LGE: Late gadolinium enhancement; LVH: Left ventricular hypertrophy; RV: Right ventricle.