In heart failure evaluation, what is the role of Cardiac MRI?

• A. Replaces ECG
• B. Assess ventricular volumes, function, viability, and fibrosis; helps differential diagnosis beyond echo
• C. Not useful in HF
• D. Only measures ejection fraction

Answer: (B)

Cardiac MRI provides a comprehensive view of the heart that echo cannot fully cover. It can precisely quantify ventricular volumes, chambers’ function, and ejection fraction, which is essential for staging and tracking heart failure. Beyond that, it characterizes the myocardium itself: late gadolinium enhancement reveals scar and fibrosis, which informs prognosis and helps predict whether myocardium may regain function after interventions. This tissue characterization also aids in distinguishing ischemic from nonischemic cardiomyopathy and can identify other causes of heart failure, such as infiltrative diseases. Because of these capabilities, MRI offers more than just EF measurement and complements or surpasses echo in many aspects of HF evaluation, while not replacing ECG.