Background: Cardiomyopathies are a diverse group of myocardial disorders broadly classified into ischemic and non-ischemic forms. Differentiating these subtypes is critical for guiding clinical management and prognostication. Cardiac Magnetic Resonance Imaging (CMR) has emerged as a non-invasive imaging modality capable of providing comprehensive myocardial tissue characterization. Objective: To evaluate the role of CMR in differentiating ischemic cardiomyopathy (ICM) from non-ischemic cardiomyopathy (NICM) through Late Gadolinium Enhancement (LGE) patterns, T1 and T2 mapping, and functional assessment. Methods: A prospective observational study was conducted on 75 patients diagnosed with cardiomyopathy, comprising 45 cases of ICM and 30 cases of NICM. CMR imaging was performed, including LGE, T1/T2 mapping, and functional analysis. Statistical comparisons were made using t-tests and chi-square tests, with significance set at p < 0.05. Results: ICM patients exhibited significantly higher prevalence of subendocardial (84.4%) and transmural (44.4%) LGE patterns, while NICM patients predominantly showed mid-wall/epicardial LGE (80%) (p < 0.001). Native T1, T2, and ECV values were significantly elevated in NICM, indicating diffuse fibrosis and myocardial edema (p < 0.001). ICM patients had significantly reduced LV ejection fraction (35.4% vs. 42.6%, p < 0.001) and higher incidence of adverse cardiac events, although these were not statistically significant. Conclusion: CMR effectively differentiates ICM from NICM through distinct LGE patterns and tissue characterization techniques, offering valuable prognostic insights. The integration of T1/T2 mapping further enhances diagnostic accuracy, highlighting the potential of CMR in comprehensive myocardial assessment.

Cardiac Magnetic Resonance Imaging (CMR), Ischemic Cardiomyopathy, Non-Ischemic Cardiomyopathy, Late Gadolinium Enhancement (LGE), Myocardial Fibrosis.