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01.11.2018 | Imaging (Q Truong, Section Editor) | Ausgabe 11/2018

Current Treatment Options in Cardiovascular Medicine 11/2018

Imaging and Management of Heart Failure and Preserved Ejection Fraction

Zeitschrift:
Current Treatment Options in Cardiovascular Medicine > Ausgabe 11/2018
Autoren:
MD Fernando Telles, MD, PhD, MPH Thomas H. Marwick
Wichtige Hinweise
This article is part of the Topical Collection on Imaging

Abstract

Purpose of review

The prevalence of heart failure with preserved ejection fraction (HFpEF) is rising and in some places, it is already the most prevalent form of heart failure. The usual treatments of HF do not improve mortality or outcomes in HFpEF, suggesting a distinct pathophysiology that remains poorly characterized. The neutrality of clinical trial results is also attributable to the heterogeneity of patient profiles, and by poor characterization offered by classical echocardiography parameters. Emerging imaging modalities may overcome this problem. We therefore aimed to summarize recent advances offered by cardiovascular imaging in disease characterization, and the implication of findings to new phenotype-specific treatment options.

Recent findings

Novel cardiovascular imaging techniques such as LV global longitudinal strain, left atrial strain, tissue characterization by magnetic resonance T1 time, as well as incorporation of systolic and diastolic stress testing offer greatly improved characterization, diagnosis, and stratification of disease pathogenesis. These techniques offer insight into identification of HFpEF sub-phenotypes that are resistant to, or responsive to therapies.

Summary

There is a growing body of evidence that novel cardiovascular imaging modalities are able to characterize HFpEF patients with much greater accuracy than current guideline-driven parameters. Whether this information can be synthesized to adequately stratify patients into sub-phenotypes with clearer disease pathogenesis amenable to targeted intervention will be of particular future interest.

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