Heart failure with preserved ejection fraction: the missing pieces in diagnostic imaging

Area of Science:

• Cardiology
• Medical Imaging
• Pathophysiology

Background:

• Heart failure with preserved ejection fraction (HFpEF) affects over half of heart failure patients.
• Current diagnostic criteria for HFpEF rely on identifying diastolic dysfunction, a late-stage indicator.
• The lack of effective therapies and clear diagnostic guidelines contributes to delayed diagnosis and treatment.

Purpose of the Study:

• To review current imaging modalities for assessing HFpEF.
• To explore the pathophysiological basis of HFpEF, focusing on systemic inflammation.
• To recommend novel imaging targets for early and accurate HFpEF diagnosis.

Main Methods:

• Review of existing literature on HFpEF diagnosis and imaging.
• Analysis of current understanding of HFpEF pathophysiology, including the role of comorbidities and inflammation.
• Proposal of new imaging strategies extending beyond cardiac assessment.

Main Results:

• HFpEF diagnosis is difficult due to normal ejection fraction and non-specific symptoms.
• Diastolic dysfunction, a key diagnostic criterion, represents advanced disease.
• Systemic inflammation, driven by comorbidities, is implicated as an initiator of HFpEF.

Conclusions:

• Early diagnosis of HFpEF remains a significant clinical challenge.
• A shift towards understanding extramyocardial factors, like systemic inflammation, is crucial.
• Novel imaging targets beyond the heart are needed for timely HFpEF detection and intervention.