From Acquisition to Prognosis: The Role of AI in Cardiac Magnetic Resonance Imaging Evaluation of Ischemic Cardiomyopathy.

Journal: Echocardiography (Mount Kisco, N.Y.)
Published Date: Jun 1, 2025

Abstract

Acute and chronic ischemic cardiomyopathy (ICM) still represents a leading cause of morbidity and mortality. Cardiac magnetic resonance (CMR) imaging plays a central role in the diagnosis and management of ICM, offering detailed visualization of cardiac structures and function. The evolving role of artificial intelligence (AI) in enhancing CMR exams, from acquisition to prognosis, is rapidly expanding in clinical practice, particularly in CMR of patients with ICM, emphasizing the integration of AI algorithms to optimize imaging workflows in standard protocols. Advanced AI models enable more efficient and faster image acquisition, reducing artifacts and enhancing accuracy, even offering free-breathing sequences. In post-processing, AI allows for the segmentation and quantification of cardiac parameters, facilitating precise assessment of volumes, myocardial scarring, and perfusion abnormalities, which are critical parameters in ICM. Moreover, AI-driven analysis provides robust prognostic insights by predicting adverse outcomes, such as heart failure and arrhythmias, through comprehensive data integration and pattern recognition. Looking forward, the future of AI in CMR promises further advancements in personalized medicine, with AI algorithms continually improving in accuracy and clinical applicability. This review will analyze the role of AI in increasing diagnostic accuracy, optimizing workflows, and improving prognosis in patients with ICM.

Authors

  • Giuseppe Muscogiuri
    Clinical Cardiology Unit and Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Nicola Pegoraro
    Department of Translational Medicine - Section of Radiology, University of Ferrara, Ferrara, Italy.
  • Alberto Cossu
    Child Neuropsychiatry Unit, Department of Children and Maternal Health, AOUI Verona, full member of European Reference Network EpiCARE, Verona, Italy.
  • Alessandro Caruso
    School of Medicine, University of Milano-Bicocca, Milan, Italy.
  • Davide Casartelli
    School of Medicine, University of Milano-Bicocca, Milan, Italy.
  • Francesco Severi
    School of Medicine, University of Milano-Bicocca, Milan, Italy.
  • Gabrielle Gershon
    Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA. Electronic address: https://twitter.com/gabbygershon.
  • Marly van Assen
    Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.).
  • Carlo N De Cecco
    Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.).
  • Marco Guglielmo
    Centro Cardiologico Monzino, IRCCS, Milan, Italy.
  • Tommaso D'Angelo
    Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
  • Luca Saba
    Department of Radiology, A.O.U., Italy.
  • Riccardo Cau
    Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Cagliari.
  • Paolo Marra
    Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Aldo Carnevale
    Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
  • Melchiore Giganti
    Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
  • Sandro Sironi
    School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

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