Recent advances in cardiac imaging for patients with heart failure

Transthoracic echocardiography (ECHO) and single-photon emission computed tomography (SPECT) are routine in many heart failure patients. Recently, other imaging tests have emerged in heart failure management: cardiovascular magnetic resonance (CMR), positron emission tomography (PET) and computed tomography (CT). This article reviews recent developments in heart failure imaging.

Longitudinal left ventricular systolic strain on ECHO speckle tracking imaging detects subclinical cardiomyopathy and predicts survival in symptomatic heart failure. Late gadolinium enhancement for myocardial scar is an independent predictor of death or transplantation in ischemic and nonischemic cardiomyopathy. In contrast to earlier reports, both ECHO and CMR contrast have a negligible risk of adverse outcomes. Stress perfusion imaging (SPECT or PET) and PET flow quantification have prognostic value in ischemic cardiomyopathy. F-2-fluoro-2-deoxyglucose (FDG) PET directed management can impact outcome. Abnormal myocardial neuronal activity on I-metaiodobenzylguanidine (MIBG) imaging is associated with increased risk of ventricular arrhythmias and death. Cardiac CT potentially could assess heart failure etiology through coronary angiography and myocardial tissue characterization but its precise role remains undetermined.

There have been several exciting developments in all imaging modalities. Large multicenter trials such as IMAGE heart failure are required to standardize measures and establish benefit before widespread use in heart failure can be recommended.