Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging

Smiseth, Otto A.; Morris, Daniel; Cardim, Nuno; Čikeš, Maja; Delgado, Victoria; Donal, Erwan; Flachskampf, Frank A.; Galderisi, Maurizio; Gerber, Bernhard; Gimelli, Alessia; Klein, Allan L.; Knuuti, Juhani; Lancellotti, Patrizio; Mascherbauer, Julia; Miličić, Davor; Seferović, Petar; Solomon, Scott D.; Edvardsen, Thor; Popescu, Bogdan A; Bertrand, Philippe; Dweck, Marc R; Haugaa, Kristina H; Sade, Leyla Elif; Stanković, Ivan; Ha, Jong‐Won; Nagueh, Sherif F.; Oh, Jae K.; Ohte, Nobuyuki; Cosyns, Bernard

doi:10.1093/ehjci/jeab154

Cited by 161 publications

(154 citation statements)

References 125 publications

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“…Recently, the European Association of Cardiovascular Imaging (EACVI) has published an expert consensus document about the importance of multimodality imaging in patients affected by HFpEF, since it can be very helpful to determine specific etiologies ( 45 , 46 ). CAD, HCM, cardiac amyloidosis, Fabry disease, and sarcoidosis are the main identified etiologies of patients with HFpEF, and it is important to highlight in these setting, the possibility of prescribing established and specific therapies.…”

Section: Diagnosis Of Hfpefmentioning

confidence: 99%

“…Other Doppler measurements that can be applied include peak acceleration rate of mitral E velocity (≥1.90 cm/s 2 ), isovolumic relaxation time (IVRT) ( ≤ 65 ms), DT of pulmonary venous diastolic velocity ( ≤ 220 ms), E/mitral Vp (E/Vp; ≥1.4), and E/e′ ratio (≥11) ( 55 , 57 , 58 ). At present, the two most important criteria to determine elevated LV filling pressures in patients with AF are septal E/e' ≥ 11 and/or TR > 2.8 m/s ( 15 , 46 ).…”

Section: Echocardiographymentioning

confidence: 99%

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Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction

Torto

Guaricci²,

Pomarico³

et al. 2022

Front. Cardiovasc. Med.

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Heart failure with preserved ejection fraction (HFpEF) is a syndrome defined by the presence of heart failure symptoms and increased levels of circulating natriuretic peptide (NP) in patients with preserved left ventricular ejection fraction and various degrees of diastolic dysfunction (DD). HFpEF is a complex condition that encompasses a wide range of different etiologies. Cardiovascular imaging plays a pivotal role in diagnosing HFpEF, in identifying specific underlying etiologies, in prognostic stratification, and in therapeutic individualization. Echocardiography is the first line imaging modality with its wide availability; it has high spatial and temporal resolution and can reliably assess systolic and diastolic function. Cardiovascular magnetic resonance (CMR) is the gold standard for cardiac morphology and function assessment, and has superior contrast resolution to look in depth into tissue changes and help to identify specific HFpEF etiologies. Differently, the most important role of nuclear imaging [i.e., planar scintigraphy and/or single photon emission CT (SPECT)] consists in the screening and diagnosis of cardiac transthyretin amyloidosis (ATTR) in patients with HFpEF. Cardiac CT can accurately evaluate coronary artery disease both from an anatomical and functional point of view, but tissue characterization methods have also been developed. The aim of this review is to critically summarize the current uses and future perspectives of echocardiography, nuclear imaging, CT, and CMR in patients with HFpEF.

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Section: Diagnosis Of Hfpefmentioning

confidence: 99%

Section: Echocardiographymentioning

confidence: 99%

Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction

Torto

Guaricci²,

Pomarico³

et al. 2022

Front. Cardiovasc. Med.

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“…LAS r decreases in a linear fashion as LV diastolic dysfunction progresses [ 23 ]. In line with this, the latest EACVI document [ 24 ] encourages the use of LA strain in the assessment of diastolic function and filling pressures in HFpEF, however LAS r should not be used in patients with atrial fibrillation [ 25 ]. We previously showed a relationship between increased coronary microvascular resistance and reduced LAS r , that seemed to precede conventional measures of LV diastolic dysfunction [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Left atrial reservoir strain as a predictor of cardiac outcome in patients with heart failure: the HaFaC cohort study

Bouwmeester

Stam

Loon

et al. 2022

BMC Cardiovasc Disord

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Background The left atrium (LA) is a key player in the pathophysiology of systolic and diastolic heart failure (HF). Speckle tracking derived LA reservoir strain (LASr) can be used as a prognostic surrogate for elevated left ventricular filling pressure similar to NT-proBNP. The aim of the study is to investigate the correlation between LASr and NT-proBNP and its prognostic value with regards to the composite endpoint of HF hospitalization and all-cause mortality within 1 year. Methods Outpatients, sent to the echocardiography core lab because of HF, were enrolled into this study. Patients underwent a transthoracic echocardiographic examination, commercially available software was used to measure LASr. Blood samples were collected directly after the echocardiographic examination to determine NT-proBNP. Results We included 174 HF patients, 43% with reduced, 36% with mildly reduced, and 21% with preserved ejection fraction. The study population showed a strong inverse correlation between LASr and log-transformed NT-proBNP (r = − 0.75, p < 0.01). Compared to NT-proBNP, LASr predicts the endpoint with a comparable specificity (83% vs. 84%), however with a lower sensitivity (70% vs. 61%). Conclusion LASr is inversely correlated with NT-proBNP and a good echocardiographic predictor for the composite endpoint of hospitalization and all-cause mortality in patients with HF. Trial registration:https://www.trialregister.nl/trial/7268

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“…PALS is an early index of LA fibrosis caused by maladaptive remodelling in chronic HF, even in non‐dilated atria, 4 and a superior predictor of LV filling pressures than E/e' ratio in HF. 5 , 32 Its prognostic role has been well‐established in chronic HF with different grades of LVEF reduction, with influence on clinical outcome and exercise capacity 6 , 33 ; moreover, it has also shown to be a useful index of response to HF therapy. 2 , 34 Even though in previous studies investigating PALS prognostic value in HFpEF the derived cut‐off values were considerably higher than our (>30%), cut‐off values found in cohorts with HFrEF were 15%, 33 15.5%, 35 and 17%, 6 very similar to our ROC‐curves‐derived cut‐off (15%).…”

Section: Discussionmentioning

confidence: 99%

New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

et al. 2021

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Aims The present study investigated the prognostic impact of either isolated left atrial (LA) impairment, or its association with right ventricular (RV) failure, in heart failure (HF) with reduced ejection fraction (HFrEF), using basic and speckle tracking echocardiography (STE). Methods and results One hundred and six outpatients with HFrEF were enrolled in this prospective observational study. Patients with primary lung diseases, non‐sinus rhythm, previous cardiac surgery, and poor acoustic window were excluded. After clinical examination and basic echocardiography, STE was used to measure peak atrial longitudinal strain (PALS) and a new marker of RV performance and pulmonary circulation relation: free‐wall RV longitudinal strain (fwRVLS)/systolic pulmonary artery pressure (sPAP). Patients were followed for all‐cause/cardiovascular death and HF hospitalization. Of 84 eligible patients (60.1 ± 11.5 years; 82% male patients), 48 reached the combined endpoint (cardiovascular death and/or HF hospitalization). Population was divided into three groups: Group 1 (PALS ≥ 15 and fwRVLS/sPAP ≤ −0.5), Group 2 (PALS ≤ 15 and fwRVLS/sPAP ≤ −0.5), and Group 3 (PALS ≤ 15 and fwRVLS/sPAP > −0.5). Mean follow up was 3.5 ± 0.3 years. The higher severity groups were associated with higher LA volume index (P < 0.0001), New York Heart Association class (P = 0.02), mitral regurgitation (P = 0.0004) and tricuspid regurgitation grades (P < 0.0001), lower left ventricular (LV) ejection fraction (P = 0.0003), LV global longitudinal strain (P < 0.0001), PALS (P < 0.0001), tricuspid annular plane systolic excursion (P < 0.007), sPAP (P < 0.0001), and RV strain (P < 0.0001). Reduced PALS and fwRVLS/sPAP were independent predictors of the combined endpoint with adjusted Cox models (hazard ratio = 9.54; 95% confidence interval = 2.95–30.92; P = 0.0002 for Group 3 vs. Group 1). Kaplan–Meier curves showed early and persistent divergence between the three groups for the prediction of the combined endpoint and of all‐cause death (P < 0.0001). Conclusions The combination of LA and right heart damage entails worse prognosis in patients with HFrEF. The evaluation of PALS and fwRVLS/sPAP could aid risk stratification of HFrEF patients to provide them early treatment.

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Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging

Cited by 161 publications

References 125 publications

Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction

Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction

Left atrial reservoir strain as a predictor of cardiac outcome in patients with heart failure: the HaFaC cohort study

New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

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