The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 1

Abstract

Radiographic, ultrasound, nuclear, and magnetic resonance methods have become indispensable in the management of heart failure (HF). Imaging is widely used in decision making in HF, not only in relation to left ventricular (LV) systolic and diastolic function but also in the selection of medical, device, and surgical therapy in HF and valvular heart disease. Future developments in the care of advanced heart disease, including stem cell therapy, device therapy to control remodeling, and percutaneous valve interventions, as well as the need to identify subclinical heart disease, are likely to expand this use. Moreover, the epidemic of diabesity (diabetes and obesity) will augment the existing epidemic of HF just when it appeared to have peaked.1 Large numbers of patients will need information from imaging to guide clinical decision making (Table 1). The sources of this information will need to be expeditious, inexpensive, and preferably objective and quantitative.2 View this table: Table 1. Established HF: What the Clinician Needs Although some of the measurements in HF patients are structural (LV mass and geometry), the main components of an imaging assessment in HF will continue to be primarily functional (LV ejection fraction, size, filling pressures, filling characteristics, and right ventricular [RV] function). A number of new technologies will enhance the future accuracy and reliability of these measures. ### LV Volumes and Ejection Fraction Routine techniques (contrast ventriculography, 2D echocardiography) provide real-time imaging in standard imaging planes. The only traditional method that has escaped this limitation has been radionuclide ventriculography, in which the ejection fraction is calculated from scintigraphic counts, but this introduces the separate potential problems of attenuation and overlying chambers. #### Limitations of 2D Imaging Two-dimensional imaging approaches require expert acquisition and observers and have limited reliability in obtaining appropriate cut planes in sequential studies. The limitation of requiring imaging planes in the correct axis is particularly an issue for 2D echocardiography, which …