Novel Imaging Techniques for Heart Failure

Abstract

Heart failure (HF) is an epidemic with an increasing prevalence and an absolute mortality rate of approximately 50 % within 5 years of diagnosis. Imaging plays a main role in HF diagnosis, assessment of aetiology and treatment guidance. This article reviews current HF applications for all the available non-invasive imaging modalities: echocardiography, cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT). Echocardiography, with its recent developments, such as 3D echo, is the main imaging test used in the evaluation of HF patients, given its availability and reliability in assessing cardiac structure and function. CMR allows the characterisation of myocardial tissue, in addition to providing information on the structure and cardiac function, so it is a great help in the determination of HF aetiology and may predict patient outcomes. Nuclear imaging can detect ischaemia and viability and can obtain additional prognostic data. Cardiac CT is EchocardiographyAlthough echocardiography is a relatively 'ancient' technique, its versatility makes it unique in the provision of volumes, function, haemodynamics or valvular regurgitation. In addition, because of its availability, safety and low cost, echocardiography is the first and most widely used test for the diagnosis, selection of appropriate treatment and prognosis of HF.1 Echocardiography is also the most used imaging method in the reassessment of HF patients. It remains unclear when to repeat echocardiographic exams, but it is deemed appropriate at least in patients with worsening symptoms. Systolic FunctionGlobal left ventricular (LV) function is of paramount importance regarding therapeutic decisions. Visual estimation of ejection fraction (EF), the Teichholz and Simpson methods, have been widely validated. 2,3However, in 2D imaging, because of its operator-dependent nature, repeated testing has a high probability of producing variable volume and EF results.The apparition of 3D fully sampled matrix transthoracic echocardiography has enabled easier acquisition of images, 4 simplifying its routinary application. There have been many studies comparing 2D and 3D echocardiography (2DE and 3DE) and a 'reference' standard (generally CMR). A recent meta-analysis of all 3DE studies evaluating LV volumes and EF demonstrated that 3DE generally underestimated volumes, but not as significantly as 2DE. There was also less variability than 2D compared with CMR.5 Nonetheless, 3DE echocardiography may be challenging and not practical in patients with low image quality (e.g. critical patients), in whom 2DE measures are more realiable. 3DE is also a less standardised techique than 2DE, and because of this reason most laboratories use the more universally applicable 2DE measurements in clinical practice. Only recently, large analyses of LV parameters using 3DE in large cohorts of healthy individuals have been published to establish race, age and gender-specific ...

Preditores de prognóstico da insuficiência cardíaca através de exames de imagem

“…Além disso, a deformação longitudinal global (GLS, do inglês: Global Longitudinal Strain) adiciona valor prognóstico tanto na insuficiência cardíaca com fração de ejeção preservada (ICFEp) como na insuficiência cardíaca com fração de ejeção reduzida (ICFEr), contribuindo de forma mais idônea na ICFEp. Devido à sua ampla disponibilidade, ao baixo custo e à confiabilidade na avaliação não só da estrutura como também da função cardíaca esquerda e direita, a ecocardiografia é considerada como exame de primeira linha na IC, exercendo um papel fundamental no diagnóstico, seleção do tratamento e no prognóstico dos pacientes (Melero-Ferrer et al, 2016;Paterson et al, 2013).…”

“…A literatura tem relatado que a análise do ventrículo direito também pode ser importante para o prognóstico dos pacientes, e a ecocardiografia 3D permite avaliá-lo com acurácia comparável à ressonância magnética cardíaca (RMC) na maioria dos pacientes. Em indivíduos com baixa qualidade de imagem, porém, são mais confiáveis as medidas 2D (Cesare et al, 2020;Melero-Ferrer et al, 2016;Zhou et al, 2019).…”

“…Nesse contexto, a TC exerce papel relevante, uma vez que a angiotomografia computadorizada coronariana é um procedimento capaz de avaliar a permeabilidade e a carga aterosclerótica coronariana. Além disso, por meio da quantificação da calcificação coronária, permite a estratificação do risco cardiovascular (Flachskampf et al, 2020;Melero-Ferrer et al, 2016).…”

Current issues in evaluation of the right ventricle condition: Role of gender and ethnic features and exercise

“…Так, например, в трех последних исследованиях данные отношения ранне-го и позднего диастолического движения фиброзного кольца трикуспидального клапана e't / a't у лиц старше 60 лет составляли 0,7±0,2, 0,89±0,2 и 0,86±0,06 соот-ветственно [31][32][33]. Однако данные систолической части спектра тканевой допплерометрии фиброзного кольца трикуспидального клапана s't во втором иссле-довании, проведенном в Италии, достоверно снижа-лись до 11,7±2,2 см / сек в старшей возрастной груп-пе (р<0,0001), чего не наблюдалось у исследуемых в России и Швеции, где значения этого показателя были в пределах 13,5 (11,(8)(9)(10)(11)(12)(13)(14)(15)8) и 14,9±2,2 см / сек соответ-ственно и не отличались от данных других возрастных групп [31][32][33]. Возможно, в данном случае имели место климатические или широтные особенности.…”

Foreword

“…The natriuretic peptides are increasingly blurring the distinction between diagnostic test and therapeutic agent. 17,18 There is also an excellent review on the prognostic value of cardiac magnetic resonance (CMR), which is indeed creeping ever more frequently into routine practice, despite the expense of the equipment, [19][20][21][22] challenging the once uncontested role of advanced echocardiography, a review of 3D applications of which is also covered in this issue.…”