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How to Use Imaging: Cardiac Magnetic Resonance Imaging in Heart Failure With Preserved Ejection Fraction: a Stepwise
Thiago Quinaglia1, Syed Bukhari2, Daniel S Kikuchi2
1Discipline of Cardiology, Department of Medicine, School of Medical Science, University of Campinas, SP, Brazil (T.Q., A.A.B., C.N.G.M., O.R.C.-F.).
Circulation. Cardiovascular Imaging
|January 21, 2026
Summary
Heart failure with preserved ejection fraction (HFpEF) diagnosis is challenging. Advanced imaging like cardiac MRI enhances accuracy and guides new therapies for this growing condition.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Disease
Background:
- Heart failure with preserved ejection fraction (HFpEF) is a complex and increasingly prevalent condition.
- Diagnostic challenges arise from diverse causes and overlapping symptoms with other diseases.
- Aging populations and comorbidities like obesity, diabetes, and hypertension contribute to HFpEF's rise.
Purpose of the Study:
- To review the diagnostic imaging features of HFpEF.
- To explore the role of imaging in HFpEF follow-up.
- To propose a practical diagnostic workflow for suspected HFpEF.
Main Methods:
- Echocardiography as a primary screening and diagnostic tool.
- Cardiac magnetic resonance (CMR) for enhanced accuracy and follow-up.
- CMR tissue characterization techniques including T1/T2 mapping, LGE, ECV, MFR, and strain analysis.
Main Results:
- Echocardiography provides comprehensive cardiac assessment.
- CMR tissue characterization aids in identifying specific underlying conditions causing HFpEF.
- Distinguishing HFpEF causes is crucial for selecting emerging targeted therapies.
Conclusions:
- Advanced imaging, particularly CMR, plays a vital role in diagnosing and managing HFpEF.
- CMR facilitates precise therapy selection by clarifying HFpEF etiology.
- A structured imaging-based workflow can improve clinical practice for suspected HFpEF.
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