Moderne Bildgebung bei Kardiomyopathien

Zusammenfassung

Während bei ischämischen Kardiomyopathien die Ätiologie durch eine Koronarangiografie normalerweise einfach zu klären ist, stellt die Abklärung nicht ischämischer Kardiomyopathien eine Herausforderung dar. Die Echokardiografie ist dabei diagnostisches Mittel der ersten Wahl. Neben der breiten Verfügbarkeit liegen ihre Stärken in der Quantifizierung systolischer als auch diastolischer Funktionsstörungen sowie in der Erfassung begleitender valvulärer Pathologien. Die CMR ermöglicht eine umfassende funktionelle Darstellung vor allem des rechten Ventrikels mit frei wählbaren Schnittebenen. Insbesondere durch Muster und Ausmaß der Kontrastmittelanreicherung im Myokard (LGE) lassen sich sowohl Aussagen über die vermutliche Ätiologie der CMP als auch über die individuelle Prognose der Patienten treffen. Aufgrund der fehlenden Strahlenbelastung eignet sich die CMR sowohl zur initialen Diagnostik als auch zur Verlaufskontrolle. Die kardiale CT hilft durch die Darstellung der Koronarien, eine relevante KHK als Ursache der kardialen Funktionsstörung auszuschließen.

Abstract

Ischemic cardiomyopathies are usually easily diagnosed by coronary angiography, while the aetiology of non-ischemic CMP may be challenging to differentiate. Echocardiography remains the first diagnostic tool, due to its availability and its potential to quantify systolic and diastolic dysfunction, as well as concomitant valvular pathologies. CMR has become increasingly important in the last years, as it offers not only a comprehensive functional assessment of the left as well as the right ventricle but also different possibilities of tissue characterization. In particular, the pattern and extent of late gadolinium enhancement provides insights into the underlying pathology, and into the individual patientsʼ prognosis. As CMR works without radiation, it is suitable for initial diagnostic as well as repeated follow-up. The main advantage of CT is the excellent visualization of normal coronary arteries which permits excluding coronary artery disease as the cause of cardiac dysfunction.

Schlüsselwörter

Kardiomyopathien - kardiale Magnetresonanztomografie - moderne Bildgebung

Key words

cardiomyopathies - cardiac magnetic resonance - modern imaging

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