Synopsis
Select CMR, SPECT or PET for ventricular function, tissue characterisation, perfusion, viability and infiltrative disease while managing contrast, device and radiation constraints.
- CMR provides accurate biventricular volumes, function and tissue characterisation without ionising radiation.
- Late gadolinium enhancement pattern helps distinguish ischaemic scar from many non-ischaemic cardiomyopathies but is not a diagnosis in isolation.
- Stress CMR, SPECT and PET can demonstrate inducible perfusion abnormality; PET can quantify myocardial blood flow in specialist practice.
Key red flags
Large inducible burden, marked biventricular dysfunction or a mechanical complication requires prompt specialist action.
Investigation priorities
Quantify chamber volumes, mass and biventricular ejection fraction.
Management branches
Unexplained ventricular dysfunction, arrhythmia or myocardial injury
- Obtain ECG, biomarkers and comprehensive echocardiography and address acute instability.
- Use CMR when tissue characterisation or accurate biventricular assessment will change diagnosis or management.