Multidimensional cardiac functional phenotyping beyond ejection fraction: a multimodality imaging framework for...

Area of Science:

• Cardiovascular imaging
• Cardiac physiology
• Multimodality assessment

Background:

• Left ventricular ejection fraction (LVEF) is a limited measure of cardiac function.
• Cardiac physiology is complex and requires multidimensional assessment.
• Contemporary imaging offers evaluation across five domains: pump function, deformation, diastolic function, flow, and tissue characterization.

Purpose of the Study:

• To propose a five-dimensional, phenotype-oriented multimodality imaging framework for cardiovascular care.
• To refine disease characterization and risk stratification in various cardiac conditions.
• To guide selective, stepwise escalation of imaging modalities based on clinical indication.

Main Methods:

• Review of contemporary multimodality imaging techniques.
• Proposal of a five-dimensional framework integrating pump function, myocardial deformation, diastolic function, flow dynamics, and tissue characterization.
• Emphasis on a stepwise escalation strategy from echocardiography to advanced imaging like CMR and 4D flow MRI.

Main Results:

• Multimodality imaging provides a more comprehensive pathophysiological interpretation of cardiac dysfunction than LVEF alone.
• This multidimensional phenotyping can refine risk stratification in heart failure with preserved ejection fraction, cardiomyopathies, and valvular heart disease.
• A selective, stepwise approach to imaging is recommended for clinically actionable interpretation.

Conclusions:

• A five-dimensional imaging framework enhances cardiac functional assessment beyond LVEF.
• This approach supports refined disease characterization and risk stratification.
• Implementation requires addressing barriers like cost, workflow, standardization, and AI integration.