Advancing Diagnosis and Management of Cardiomyopathies Through Functional Imaging

Cardiovascular imaging represents a cornerstone in the field of myocardial disease research, with cardiomyopathies posing particular diagnostic and therapeutic challenges. These diverse myocardial disorders—including hypertrophic, dilated, arrhythmogenic, restrictive, and infiltrative types such as amyloidosis and Anderson–Fabry disease—are frequently associated with overlapping clinical and imaging phenotypes. The limitations of conventional structural imaging underscore the critical need for functional modalities capable of delineating subtle pathophysiological processes, quantifying myocardial mechanics, and predicting disease course before the onset of overt symptoms. Recent research highlights how modalities such as strain echocardiography, quantitative cardiac magnetic resonance (CMR), nuclear techniques, and emerging analytic platforms are transforming clinical pathways, yet significant gaps persist in standardization, multicenter reproducibility, and consensus on their additive prognostic value. Current questions in the field revolve around optimal application, comparative utility, and integration of these technologies to sharpen diagnosis, risk assessment, and therapeutic guidance.Multiple studies have demonstrated that advanced functional imaging provides superior sensitivity for detecting subclinical myocardial dysfunction and distinguishing between etiologies with similar morphology. Developments in CMR tissue mapping, PET-guided assessment of microvascular and inflammatory processes, and computational analytics such as radiomics and machine learning have broadened our understanding of disease mechanisms and heterogeneity. Key breakthroughs include improved quantification of diffuse myocardial injury, mapping of arrhythmogenic substrates, and identification of imaging biomarkers that correlate with clinical outcomes and inform precision therapy. Despite these advances, further investigation is required to clarify best practices in acquisition and analysis, as well as to expand access to these tools worldwide.This Research Topic aims to clarify and expand the role of functional imaging in the continuum of cardiomyopathy care, highlighting the mechanistic pathways, diagnostic improvements, and clinical decision-making advantages conferred by these emerging techniques. We seek to foster insights on whether, and how, functional imaging leads to earlier detection, enhanced etiological differentiation, improved risk stratification for arrhythmic and heart failure outcomes, and more precise tailoring of disease-modifying and advanced therapies. By gathering evidence on standardization, multidisciplinary integration, and advances in artificial intelligence, this research topic pursues a unified vision of mechanistic-driven and patient-centered management across the entire spectrum of cardiomyopathies.The scope of this Research Topic includes original and multidisciplinary studies focused on the functional imaging of diverse cardiomyopathies, with emphasis on dynamic myocardial assessment techniques that directly inform clinical care. Submissions should center on imaging-driven mechanistic understanding, risk stratification, and therapy management, rather than solely structural evaluation.To gather further insights in the realm of non-invasive functional imaging for cardiomyopathies, we welcome articles addressing, but not limited to, the following themes:o Myocardial strain, deformation, and mechanical dispersion in phenotyping and risk predictiono Application of CMR mapping, perfusion, and 4D flow in myocardial tissue characterizationo Nuclear and hybrid imaging for inflammation, amyloidosis, sarcoidosis, and microvascular diseaseo Integration of functional imaging with physiological testing and advanced analyticso Standardization, harmonization, and multicenter reproducibility in functional imaging protocolso Clinical implementation science for imaging-guided management and tele-imaging approacheso Illustrative case reports of clinically meaningful impact of functional imagingAppendix: Article TypesWe encourage Original Research, Systematic Reviews, Mini-Reviews, Clinical Trial Protocols, Perspectives, and Opinion papers for submission to this Research Topic. Topic editors: Geza Halasz, Guido Giacalone, Francesco Bianco Source: https://www.frontiersin.org/research-topics/74375/advancing-diagnosis-and-management-of-cardiomyopathies-through-functional-imaging