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Alessia Gimelli, Patrizio Lancellotti, Luigi P. Badano, Massimo Lombardi, Bernhard Gerber, Sven Plein, Danilo Neglia, Thor Edvardsen, Anastasia Kitsiou, Arthur J.H.A. Scholte, Stephen Schröder, Bernard Cosyns, Paola Gargiulo, Jose Luis Zamorano, Pasquale Perrone-Filardi, Non-invasive cardiac imaging evaluation of patients with chronic systolic heart failure: a report from the European Association of Cardiovascular Imaging (EACVI), European Heart Journal, Volume 35, Issue 48, 21 December 2014, Pages 3417–3425, https://doi.org/10.1093/eurheartj/ehu433
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Introduction
In patients with heart failure (HF) and reduced ejection fraction (EF), non-invasive cardiac imaging provides diagnostic, prognostic, and therapeutic information and assists decision-making. The aim of this consensus paper is to provide an overview of the clinical applications of non-invasive cardiac imaging in the management of HF patients with systolic dysfunction, mostly focusing on impact on clinical decision-making (Figure 1).
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Diagnosis
In patients with suspected HF, an electrocardiogram, chest X-ray, and brain natriuretic peptide (BNP or NT-proBNP) assay should be performed before non-invasive cardiac imaging,1 but in particular clinical situations with high likelihood of the disease, i.e. symptoms of HF in patients with previous myocardial infarction, cardiac imaging might be directly performed without previous BNP assay.
Left ventricular (LV) systolic dysfunction, conventionally identified when EF at rest is <50%, is detected in ∼50% of patients with HF. However, EF does not accurately reflect the contractile status of the myocardium as it is influenced by loading conditions. In addition, EF does not reflect cardiac output that can be preserved in patients with low EF but large left ventricle, or decreased in patients with normal EF but reduced LV chamber size or impaired diastolic function or severe mitral regurgitation. Additional parameters that are usually abnormal in patients with systolic HF include increased end-diastolic diameter and volume (LV diameter >60 mm or 32 mm/m2 with LV volume >97 mL/m2) and end-systolic diameter and volume (LV diameter >45 mm or 25 mm/m2 with LV volume >43 mL/m2).
