Table 3.

Selected examples of potential applications of cardiac MR fingerprinting and needed technical developments (in increasing order according to anticipated level of technical development)

Application	Pathophysiology	CMRF added information	Needed developments
Infiltrative Cardiomyopathy	Myocardial deposition of misfolded protein (amyloidosis), lipids (Fabry), and iron (hemochromatosis)	Tissue characterization of associated protein deposition, lipid content, and iron	Validation of current cMRF metrics (T1, T2, fat proton density) in clinical populations, (Long-term: quantification of additional relaxometry parameters, e.g. T1ρ, MT, T2*)
Inflammatory Cardiomyopathy (myocarditis, pericarditis, sarcoidosis)	Inflammatory cell infiltration into the myocardium or pericardium	Tissue characterization including edema, inflammatory cell infiltration, longitudinal assessment of convalescent phase or response to therapy	Clinical validation by endomyocardial biopsy, improved resolution for imaging of pericardium
Heart transplant assessment	Graft rejection and coronary vasculopathy due to progressive immune /inflammatory processes; arrhythmia and graft failure due to progressive myocardial scarring and myocyte dysfunction	Tissue characterization of inflammation (edema with/without inflammatory cells), fibrosis, extracellular volume, microvascular dysfunction	Clinical validation in post-transplant patients with comparison to reference MR, endomyocardial biopsy, or serum biomarkers
Ischemic Cardiomyopathy	Coronary artery disease with hemodynamically significant stenosis; progressive myocardial scarring in ischemic/infarcted areas	Rest-stress cMRF for T1 reactivity	Stress cMRF imaging protocol, clinical validation in coronary artery disease patients
Right ventricular assessment (pulmonary hypertension, HFpEF, ARVD)	Diffuse fibrosis or fibrofatty replacement of tissue	Tissue characterization in right ventricle of fibrosis and fat content	Improved spatial resolution, fat fraction in right ventricle
Left atrial assessment (atrial fibrillation, HFpEF, diastolic dysfunction)	Fibrosis, inflammation, edema	Tissue characterization of the atria	Improved spatial resolution and arrhythmia insensitive imaging
Reducing contrast administration	Impaired kidney function, contrast sensitivity	Native cMRF to replace late gadolinium enhancement assessment	Clinical validation with established methods, e.g. late gadolinium enhancement
Electrophysiology (VT and AF ablation)	Fibrosis, electrical conduction abnormalities	Tissue characterization including fibrosis, fat infiltration, edema	Correlation with electrical conductivity mapping, ablation outcomes, arrhythmia insensitive imaging
Imaging of patients with implanted devices (ICD, pacemaker)	Devices to regulate cardiac electrical function	Tissue characterization, longitudinal monitoring	Compatibility with devices, imaging in heterogeneous magnetic fields