Structural and myocardial dysfunction in heart failure beyond ejection fraction

Area of Science:

• Cardiology and Cardiovascular Imaging
• Multisystemic Disease Pathophysiology

Background:

• Heart failure (HF) is a leading cause of mortality, traditionally assessed by left ventricular ejection fraction (LVEF) via echocardiography.
• Limitations of LVEF assessment are increasingly recognized, highlighting the need for a deeper understanding of HF pathophysiology.

Purpose of the Study:

• To advocate for a shift from LVEF-based classification to a comprehensive staging system for heart failure.
• To emphasize the utility of advanced imaging and a holistic approach in managing heart failure.

Main Methods:

• Review of current evidence on the limitations of LVEF in heart failure assessment.
• Introduction of the Heart-Lung-Kidney-Liver (HLM) staging system for comprehensive multiorgan damage evaluation.
• Highlighting the role of multimodality imaging beyond standard echocardiography.

Main Results:

• Current reliance on LVEF for heart failure classification is insufficient due to its inherent limitations.
• Advanced imaging techniques provide superior insights into myocardial abnormalities and systemic involvement in HF.
• The HLM staging system offers a framework for assessing multiorgan damage in heart failure patients.

Conclusions:

• A comprehensive staging system, like HLM, integrating multiorgan status is superior to LVEF-based classification for heart failure.
• Multimodality imaging combined with holistic staging facilitates personalized therapies and improves heart failure management.
• Adopting a systemic perspective is crucial for effectively addressing the complexities of heart failure.