https://orcid.org/0000-0003-3005-9954
Heart failure (HF) is one of the most prevalent cardiovascular diseases and is associated with significant morbidity and a poor prognosis. Since the 1980s, HF phenotyping was based mainly on clinical symptoms and signs and on measurement of left ventricular ejection fraction (EF). There is increasing awareness that this simplified diagnostic approach has significant limitations. A large fraction of HF patients has entirely normal EF, and for some of the phenotypes correct diagnosis depends on assessment of regional myocardial function, wall structure, perfusion, and metabolism. Furthermore, implementation of medical genetics in combination with imaging has revealed phenotypes that were previously not recognized, and therefore, in some cases genetic testing is needed in the diagnostic workup. Introduction of novel drugs for some of the cardiomyopathies, which cause HF, has strengthened the motivation for refined phenotyping.
This focus issue on cardiovascular imaging in personalized medicine, reviews how novel and advanced cardiac imaging tools may be used to improve HF diagnostics and to identify phenotypes which should be managed by specific therapies. In addition, the role of genetic testing is addressed in a separate state of the art article.1
Echocardiography, cardiac magnetic resonance imaging, and nuclear imaging have undergone important developments over the last several years, and when used alone or in combination, they can image cardiac function, macro- and microstructure, myocardial perfusion, and metabolism (Figure 1). Furthermore, nuclear imaging with molecule-targeted radiopharmaceuticals provides essential diagnostic information for several cardiomyopathies. Separate state of the art articles addresses the utility of each of these modalities.2,3,4 An additional article reviews methods to use when implementing clinical practice guidelines for management of HF.5 Due to recent developments in therapy for HF with preserved EF, a separate state of the art article addresses use of imaging to guide treatment choices in these patients.6
We hope this comprehensive collection of articles about imaging in HF will be helpful in the daily clinical work with cardiac patients. The issue also contains several original articles on the HF topic.
Imaging in heart failure. Upper and lower left and lower middle panels adapted from reference (2), upper middle and right panels from (3) and lower right panel from (4).2–4
Funding
None declared.
Data availability
No new data were generated or analysed in support of this research.
References
Author notes
The opinions expressed in this article are not necessarily those of the Editors of EHJCI, the European Heart Rhythm Association or the European Society of Cardiology.
Conflicts of interest: O.A.S. is co-inventor of ‘Method for myocardial segment work analysis’, has filed patent on ‘Estimation of blood pressure in the heart’, and has received one speaker honorarium from GE Healthcare.
