Clinical application of cardiac computed tomography in cardiomyopathy

Cardiomyopathies are a heterogeneous group of myocardial disorders characterized by mechanical and/or electrical dysfunction, typically occurring without significant coronary artery disease, hypertension, valvular, or congenital heart disease. According to current ESC guidelines, cardiovascular magnetic resonance (CMR) is a class I recommendation for the initial evaluation of patients with suspected cardiomyopathy, given its ability to provide comprehensive morphological and tissue characterization. CMR, however, may be precluded in patients owing to device incompatibility, claustrophobia, or arrhythmia- and motion-related image degradation. In this context, cardiac computed tomography (CCT), traditionally used for assessing coronary artery disease, has emerged as a valuable alternative. Technological advancements have enabled CCT to deliver not only detailed anatomical information but also functional and tissue-specific insights. The recent consensus document from the European Association of Cardiovascular Imaging underscore the expanding clinical applications of CCT, highlighting its potential role in the diagnostic work-up and phenotypic classification of cardiomyopathies. In this review, we summarize the current evidence supporting the use of CCT in patients with suspected cardiomyopathy, outline its clinical strengths and limitations, and discuss emerging developments such as artificial intelligence and radiomics, which could further enhance its diagnostic and prognostic value.