Endothelial dysfunction as assessed with magnetic resonance imaging - A major determinant in chronic heart failure

Chronic heart failure (CHF) is a clinical syndrome resulting from interaction of different structure and functional disturbances leading to decreased heart ability to ensure adequate supply of oxygenized blood to tissues and ensure adequate metabolic needs in the cases of normal or increased afterload. Endothelial dysfunction (ED) is a pathological condition characterized by general imbalance of all major endothelial mechanisms with key role in development and progression of atherosclerotic disease. ED has been associated with most cardiovascular risk factors. There is increasing interest in assessing endothelial function non-invasively, leading to development and evaluation of new diagnostic methods. We suggest that MRI is safe and reliable test that offers important advantages over ultrasound for the detection of ED and monitoring of the expected therapeutic effect. We believe that ED plays a pivotal role in chronic heart failure development and progression, regardless of its etiology, and that MRI should be introduced as a "gold standard" in diagnostic procedure and treatment.