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Imaging and Management of Heart Failure and Preserved Ejection Fraction

  • Imaging (Q Truong, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

The prevalence of heart failure with preserved ejection fraction (HFpEF) is rising and in some places, it is already the most prevalent form of heart failure. The usual treatments of HF do not improve mortality or outcomes in HFpEF, suggesting a distinct pathophysiology that remains poorly characterized. The neutrality of clinical trial results is also attributable to the heterogeneity of patient profiles, and by poor characterization offered by classical echocardiography parameters. Emerging imaging modalities may overcome this problem. We therefore aimed to summarize recent advances offered by cardiovascular imaging in disease characterization, and the implication of findings to new phenotype-specific treatment options.

Recent findings

Novel cardiovascular imaging techniques such as LV global longitudinal strain, left atrial strain, tissue characterization by magnetic resonance T1 time, as well as incorporation of systolic and diastolic stress testing offer greatly improved characterization, diagnosis, and stratification of disease pathogenesis. These techniques offer insight into identification of HFpEF sub-phenotypes that are resistant to, or responsive to therapies.

Summary

There is a growing body of evidence that novel cardiovascular imaging modalities are able to characterize HFpEF patients with much greater accuracy than current guideline-driven parameters. Whether this information can be synthesized to adequately stratify patients into sub-phenotypes with clearer disease pathogenesis amenable to targeted intervention will be of particular future interest.

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Abbreviations

HFpEF:

Heart failure with preserved ejection fraction

AHA:

American Heart Association

ACC:

American College of Cardiology

HFSA:

Heart Failure Society of America

ESC:

European Society of Cardiology

LAVI:

Left atrial volume index

LVMI:

Left ventricular mass index

e′:

Early diastolic mitral annular velocity

E/e′:

Ratio of early diastolic trans-mitral to mitral annular velocities

BNP:

Brain natriuretic peptide

NT:

ProBNP N-terminal pro-B-type natriuretic peptide

PCWP:

Pulmonary capillary wedge pressures

GLS:

Global longitudinal strain

ECV:

Myocardial extracellular volume

References and Recommended Readings

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Cardiovascular Imaging Research Group, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia

    Fernando Telles MD & Thomas H. Marwick MD, PhD, MPH

  2. Royal Prince Alfred Hospital, Sydney, Australia

    Fernando Telles MD

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Telles, F., Marwick, T.H. Imaging and Management of Heart Failure and Preserved Ejection Fraction. Curr Treat Options Cardio Med 20, 90 (2018). https://doi.org/10.1007/s11936-018-0689-9

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