Role of Cardiac Magnetic Resonance in Heart Failure with Preserved Ejection Fraction
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Purpose of Review
Approximately half of the patients presenting with heart failure have preserved ejection fraction. These patients usually have a combination of underlying etiologies and may profit from individualized treatment. Failure of clinical trials without adequate understanding of the underlying problem highlights the need for an in-depth assessment of this complex clinical syndrome. This review seeks to discuss the role of cardiovascular magnetic resonance imaging (CMR) in improving diagnosis and targeted management of heart failure with preserved ejection fraction (HFpEF).
Technical advances in tissue mapping techniques enable a virtual histopathological perspective to detect myocardial disease processes, such as inflammation, infiltration, and fibrosis. Myocardial perfusion imaging enables separation between regional ischemia due to epicardial coronary artery disease (CAD) and microvascular disease. Finally, computation of aortic pulse wave velocity (PWV) provides insight into the effects of the vascular stiffness on the efficiency of cardiac work.
A comprehensive CMR protocol enables identification of the underlying pathophysiology in patients with HFpEF, allows identification of important differential diagnoses in patients with specific diseases, and may lead to imaging-guided precision medicine in HFpEF.
KeywordsHFpEF Diastolic dysfunction Cardiovascular magnetic resonance T1/T2 mapping Aortic pulse wave velocity
Coronary artery disease
Coronary flow reserve
Cardiovascular magnetic resonance imaging
Heart failure with preserved ejection fraction
Heart failure with reduced ejection fraction
Late gadolinium enhancement
Pulse wave velocity
Right ventricular dysfunction
Compliance with Ethical Standards
Conflict of Interest
Faraz Pathan and Valentina O. Puntmann declare that they have no conflicts of interest.
Eike Nagel reports non-financial support from Bayer Healthcare, non-financial support from Siemens Healthcare, non-financial support from TOMTEC, non-financial support from CVI42, non-financial support from MEDIS, grants from Deutsches Zentrum für Herz- Kreislauf-Forschung e.V. (DZHK), and grants from German Research Foundation (DFG), during the conduct of the study. He also reports grants and personal fees from Bayer Healthcare and personal fees from Siemens Healthcare, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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