Role of cardiac imaging in management of heart failure

Abstract

The significant advancement in cardiac imaging in recent years led to improved diagnostic accuracy in identifying the specific causes of heart failure and also provided physicians with guidelines for appropriately managing patients with heart failure. Diseases that were once considered rare are now more easily detected with the aid of cardiac imaging. Various cardiac imaging techniques are used to evaluate patients with heart failure, and each technique plays a distinct yet complementary role. This review aimed to discuss the comprehensive role of different types of cardiac imaging in the management of heart failure.

Keywords: Cardiac imaging techniques; Echocardiography; Etiology; Heart failure; Prognosis; Therapy.

Figure 1.

Grades of diastolic dysfunction in four patients with preserved ejection fraction. From top to bottom: first line, a 40-year-old man with a left ventricular mass index (LVMI) of 76 g/m² and left atrial volume index (LAVI) of 31 mL/m² exhibits normal left ventricular diastolic function. Second line, a 72-year-old man with an LVMI of 73 g/m² and LAVI of 25 mL/m², who complained of chest pain, displays relaxation abnormality. Third line, a 70-year-old woman diagnosed with Fabry disease, with an LVMI of 280 g/m² and LAVI of 63 mL/m², exhibits a pseudo-normalization pattern. Last line, a 67-year-old woman who underwent kidney transplantation, with an LVMI of 104 g/m² and LAVI of 78 mL/m², demonstrates restrictive physiology. A4C, apical four-chamber view; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; TR, tricuspid regurgitation.

Figure 2.

Representative peak longitudinal strain echocardiographic bull’s eye maps from patients with various cardiomyopathies. (A) Normal. (B) Apical hypertrophic cardiomyopathy, with reduced strain in the apical segments. (C) Hypertrophic cardiomyopathy involving the septal wall. (D) Cardiac amyloidosis shows severely reduced strain in the basal and midventricular segments with preservation of the apical segments (cherry on top). GLS, global longitudinal strain.

Figure 3.

Different patterns of late gadolinium enhancement (LGE) according to different etiologies of heart failure. (A) Dilated cardiomyopathy shows diffuse mid-wall LGE, often localized to the inferoseptal wall. (B) Hypertrophic cardiomyopathy shows intramural LGE of hypertrophied segments. (C) Cardiac amyloidosis shows the global subendocardial distribution of LGE. (D) Sarcoidosis shows multiple patchy LGE in basal interventricular septum and mid-wall of both ventricles.

Figure 4.

Different applications of computed tomography (CT) in the management of heart failure. (A) Transmural infarction of basal inferoseptal and anterior wall is seen as a thin wall and low attenuation on CT (red arrowheads). (B) Mediastinal lymphadenopathies in cardiac sarcoidosis. (C) Pericardial calcification in chronic constrictive pericarditis.

Figure 5.

The use of nuclear imaging in identifying etiologies of heart failure and disease activity. (A) Scintigraphy with technetium-labeled bisphosphonates shows grade 3 radiotracer uptake in the myocardium, indicating transthyretin cardiac amyloid deposits (red arrowheads). (B) Hypermetabolic mediastinal lymphadenopathies in active sarcoidosis (yellow arrows). (C) Hypermetabolism along the left and right ventricular myocardium in active cardiac sarcoidosis (yellow arrowheads).

Figure 6.

The role of cardiac imaging in the management of heart failure. CMD, coronary microvascular dysfunction; CT, computed tomography; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; IHD, ischemic heart disease; LV, left ventricle; MR, magnetic resonance; PTE, pulmonary thromboembolism; RV, right ventricle; VHD, valvular heart disease.