Cardiovascular magnetic resonance (CMR) is a unique diagnostic imaging tool for the assessment of cardiomyopathies, allowing a non-invasive detection of the most common diseases of the heart muscle. In the real world, patients with suspected cardiomyopathies who show signs and symptoms of heart failure should undergo a thorough diagnostic evaluation. Besides clinical and echocardiographic assessment, coronary angiography is the most important and common examination performed to detect or rule out coronary artery disease. This approach is relevant for the clinical decision-making, as it may obviate the need for further diagnostic evaluation of the heart structure and muscle function. CMR can reliably detect a variety of heart muscle diseases without requiring bioptic confirmation of the diagnosis. In addition, CMR provides anatomo-functional information that possesses incremental and independent prognostic value. This represents a new paradigm shift as it moves the attention from the coronary arteries to the heart muscle. CMR is useful in establishing the correct diagnosis of several clinical conditions and cardiomyopathies, thus guiding therapeutic strategies and influencing patient prognosis.