Abstract
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.
Highlights
IntroductionHeart failure with preserved ejection fraction (HFpEF) is diagnosed by identifying the HF symptoms (e.g., breathlessness, ankle swelling, and fatigue) and signs (e.g., pulmonary crackles and peripheral edema) in patients with left ventricular ejection fraction (LVEF) ≥ 50%, increased plasma natriuretic peptide (NP) levels, and specific structural alterations or diastolic dysfunction (DD) [1]
Heart failure with preserved ejection fraction (HFpEF) is diagnosed by identifying the HF symptoms and signs in patients with left ventricular ejection fraction (LVEF) ≥ 50%, increased plasma natriuretic peptide (NP) levels, and specific structural alterations or diastolic dysfunction (DD) [1]
Heart failure with preserved ejection fraction represents a challenging clinical syndrome despite the fact that considerable progress is being made in its overall framing
Summary
Heart failure with preserved ejection fraction (HFpEF) is diagnosed by identifying the HF symptoms (e.g., breathlessness, ankle swelling, and fatigue) and signs (e.g., pulmonary crackles and peripheral edema) in patients with left ventricular ejection fraction (LVEF) ≥ 50%, increased plasma natriuretic peptide (NP) levels, and specific structural alterations or diastolic dysfunction (DD) [1]. Multimodality Imaging in HFpEF common form of HF in patients aged ≥ 65 years [2]. Epidemiological data revealed that the prevalence of HFpEF relative to heart failure with reduced ejection fraction (HFrEF) is increasing at a rate of 1% per year. The patients affected by HFpEF are women and older with risk factors and comorbidities (such as obesity, hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease) [4, 5]. Data obtained from different imaging modalities can be used to guide prognosis stratification
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