Innovative imaging methods in heart failure: a shifting paradigm in cardiac assessment. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Abstract

Myriad advances in all fields of cardiac imaging have stimulated and reflected new understanding of cardiac performance, myocardial damage and the mechanisms of heart failure. In this paper, the Heart Failure Association assesses the potential usefulness of innovative imaging modalities in enabling more precise diagnostic and prognostic evaluation, as well as in guiding treatment strategies. Many new methods have gradually penetrated clinical practice and are on their way to becoming a part of routine evaluation. This paper focuses on myocardial deformation and three‐dimensional ultrasound imaging; stress tests for the evaluation of contractile and filling function; the progress of magnetic resonance techniques; molecular imaging and other sound innovations.The Heart Failure Association aims to highlight the ways in which paradigms have shifted in several areas of cardiac assessment. These include reassessing of the simplified concept of ejection fraction and implementation of the new parameters of cardiac performance applicable to all heart failure phenotypes; switching from two‐dimensional to more accurate and reproducible three‐dimensional ultrasound volumetric evaluation; greater tissue characterization via recently developed magnetic resonance modalities; moving from assessing cardiac function and congestion at rest to assessing it during stress; from invasive to novel non‐invasive hybrid techniques depicting coronary anatomy and myocardial perfusion; as well as from morphometry to the imaging of pathophysiologic processes such as inflammation and apoptosis. This position paper examines the specific benefits of imaging innovations for practitioners dealing with heart failure aetiology, risk stratification and monitoring, and, in addition, for scientists involved in the development of future research.

Towards better definition, quantification and treatment of fibrosis in heart failure. A scientific roadmap by the Committee of Translational Research of the Heart Failure Association (HFA) of the European Society of Cardiology

“…A recent HFA position paper discusses in detail the (fast) developments in imaging techniques. 59 Furthermore, the presence and the extent of MRI-proven fibrosis have been related to poor clinical outcomes. 5 Collectively, different imaging (MRI) techniques may be applied as surrogate measures for the presence and extent of myocardial fibrosis.…”

Heart failure with mid‐range ejection fraction: pro and cons of the new classification of Heart Failure by European Society of Cardiology guidelines

“…The assessment of myocardial deformation, such as the strain and strain rate, through the tissue Doppler or global longitudinal strain (GLS) or on gated single‐photon emission computed tomography myocardial perfusion imaging could be alternative methods to classify HF patients . The GLS is measured on the basis of the LV longitudinal shortening in systole, and it is an index of systolic function . It may become abnormal at an earlier stage before a decrease in LVEF .…”

“…The CMR allows an accurate study of myocardial extracellular volume (ECV) and the detection of fibrosis, interstitial oedema, or deposition of proteins, lipids, or iron. It is a superior imaging method for the identification of the right underlying aetiology of HF . The correlation between the ECV and the echocardiographic parameters, such as LVEF, LV volumes, peak ejection, and peak filling rate, is clearer for the HFpEF group but has not been demonstrated for patients with reduced EF .…”

“…It is a superior imaging method for the identification of the right underlying aetiology of HF . The correlation between the ECV and the echocardiographic parameters, such as LVEF, LV volumes, peak ejection, and peak filling rate, is clearer for the HFpEF group but has not been demonstrated for patients with reduced EF . Moreover, the ECV expansion is significantly linked with higher rates of mortality and worsening of HF .…”

June 2019 at a glance: from genetics to haemodynamics, biomarkers and imaging for the prediction of outcomes

“…Lung ultrasound plays a major role in the assessment of patients with acute and chronic HF . Pivetta et al .…”