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Who Gets Better With Dilated Cardiomyopathy?: The Evolving Role of Cardiac Magnetic Resonance Imaging.

Significant left ventricular (LV) reverse remodeling (LVRR) in patients with dilated cardiomyopathies is a commonly encountered clinical phenomenon after treatment with guideline directed medical therapy (GDMT).1 A degree of myocardial recovery is generally assumed in light of concomitant improvements in survival, decreases in hospitalizations and better functional status. Yet, what is perhaps most striking is the spectrum of both myocardial and clinical responses of patients to GDMT. Moreover, the mechanisms behind this heterogeneity remain poorly understood. Although multiple retrospective cross-sectional studies have defined clinical characteristics associated with significant myocardial recovery, more detailed prospective longitudinal insights into myocardial structural and tissue changes that define myocardial recovery are limited. While T1 mapping and the absence of late gadolinium enhancement (LGE) are predictors of remodeling and improved outcomes,2,3 less is known about their relationship to GDMT. Additionally, the utility of cardiac magnetic resonance imaging (CMR) after some degree of LVRR or recovery has occurred also remains largely unexplored.