Diagnostic Value of Cardiac MRI in the Evaluation of Arrhythmia and Cardiomyopathy

This prospective observational study enrolled 100 patients referred for cardiac MRI to evaluate suspected cardiomyopathy or arrhythmia, assessing CMR’s diagnostic yield and its impact on clinical decision-making.

CMR identified cardiomyopathy in 75% and arrhythmia-associated structural abnormalities in 25% of patients, with positive predictive values for specific diagnoses (dilated, hypertrophic, ischemic, and non-ischemic cardiomyopathy) demonstrating clinical utility across multiple phenotypes. The late gadolinium enhancement (LGE) pattern — subendocardial for ischemic, mid-wall for non-ischemic — was the primary discriminating feature for etiology.

The diagnostic value of cardiac MRI in cardiomyopathy and arrhythmia evaluation is well established in the literature and reflected in guidelines. This single-center Indian study confirms that finding in a distinct patient population context, with cardiomyopathy representing the dominant indication (75%). The study does not add to the fundamental evidence base but provides real-world validation data.

For CAD-specific evaluation, cardiac MRI’s role is most important in distinguishing ischemic from non-ischemic cardiomyopathy when echo is insufficient — the LGE pattern is the definitive discriminating test. CMR is also increasingly used to characterize plaque and assess microvascular disease.

We rate the evidence limited. A small single-center prospective study confirming established cardiac MRI diagnostic utility in cardiomyopathy and arrhythmia — providing real-world validation rather than novel evidence.