Cardiac CT for the Assessment of Ischemic Cardiomyopathy.

Ischemic cardiomyopathy is a major cause of heart failure, and the accurate assessment of myocardial ischemia, infarction, and tissue characteristics is essential for therapeutic decision-making. Cardiac CT provides integrated structural and functional information by enabling coronary anatomical evaluation, as well as assessment of left ventricular volume, ejection fraction, and regional wall motion. CT myocardial perfusion imaging enables the evaluation of hemodynamically significant ischemia, whereas late iodine enhancement CT directly visualizes myocardial infarction and fibrosis. Dual-energy CT improves contrast resolution and quantitative analysis, supporting enhanced myocardial tissue characterization such as extracellular volume estimation. CT-derived fractional flow reserve complements the physiological assessment of coronary stenosis, and integrating these findings with perfusion, scarring, tissue composition, and functional parameters improves the differentiation between ischemic and non-ischemic cardiomyopathies. With these advances, cardiac CT has evolved into a multiparametric platform for myocardial evaluation. This review summarizes its role in ischemic cardiomyopathy.