Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Abstract

Acute heart failure is one of the main diagnostic and therapeutic challenges in clinical practice due to a non‐specific clinical manifestation and the urgent need for timely and tailored management at the same time. In this position statement, the Heart Failure Association aims to systematize the use of various imaging methods in accordance with the timeline of acute heart failure care proposed in the recent guidelines of the European Society of Cardiology. During the first hours of admission the point‐of‐care focused cardiac and lung ultrasound examination is an invaluable tool for rapid differential diagnosis of acute dyspnoea, which is highly feasible and relatively easy to learn. Several portable and stationary imaging modalities are being increasingly used for the evaluation of cardiac structure and function, haemodynamic and volume status, precipitating myocardial ischaemia or valvular abnormalities, and systemic and pulmonary congestion. This paper emphasizes the central role of the full echocardiographic examination in the identification of heart failure aetiology, severity of cardiac dysfunction, indications for specific heart failure therapy, and risk stratification. Correct evaluation of cardiac filling pressures and accurate prognostication may help to prevent unscheduled short‐term readmission. Alternative advanced imaging modalities should be considered to assist patient management in the pre‐ and post‐discharge phase, including cardiac magnetic resonance, computed tomography, nuclear studies, and coronary angiography. The Heart Failure Association addresses this paper to the wide spectrum of acute care and heart failure specialists, highlighting the value of all available imaging techniques at specific stages and in common clinical scenarios of acute heart failure.

Cardiovascular magnetic resonance native T2 and T2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis

“…Electrocardiography (ECG) is also used in the first assessment of HF, and although an abnormal ECG increases the probability of HF, it has low specificity and provides little information to distinguish between cardiac diseases [8]. Transthoracic echocardiography was suggested as primary imaging test in the diagnostic pathway of HF because of its wide availability and low costs, and its cardiac function assessment enables fast decision making [8,10], it however has limitations in distinguishing between underlying diseases [11]. Cardiovascular magnetic resonance (CMR) is the golden standard to detect cardiac remodelling by assessing the global cardiac function, it allows for regional function assessment with strain analysis and furthermore enables the assessment of myocardial fibrosis with late gadolinium enhancement (LGE) [8,[12][13][14], whereas computed tomography is recommended to either exclude or to diagnose coronary artery disease [8].…”

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

“…The European Society of Cardiology (ESC) Heart Failure Association (HFA) has recently highlighted in a position statement the central role of full echocardiographic examination in patients admitted for acute heart failure (AHF). 12 Once the patient is stabilized, the added value of routine cardiac magnetic resonance (CMR) over echocardiography alone to help diagnose the causes of HF not related to ischaemic heart disease has been questioned. 13 Selective rather than routine CMR for identifying specific HF aetiologies is more cost effective.…”

“…Nastupilo je znatno poboljšanje vrijednosti NT-proBNP-a, ali ne i zaduhe (prikazano na HFA Discoveries, nije objavljeno). Niz preporuka stručnih društava rezimiralo je ulogu slikovnih metoda 12 in HF is the lower proportion of female authors in HF practice guidelines and trials, ranging between 11% and 24% only, with modest increases over time in European and US guidelines references but not in HF trials. Importantly, HF trials with a woman first or senior author are associated with a higher proportion of enrolled female participants.…”

SepsEast and COVID-19: Time to Make a Difference

“…In addition to laboratory biomarkers, tissue sampling and storage in biobanks, genetic aspects to get insight into pathogenesis and mechanistic pathways are of pivotal importance [24][25][26][27]. Heart and lung imaging by echocardiography and magnetic resonance could also provide extremely important information [28][29][30][31][32], which may provide pivotal importance in COVID-19 patients' management on the ICU. To date, only a few trials in COVID-19 patients have been published, sadly with no definite advancement in the field [33].…”