Heart Failure Imaging: Where Are We Now?

Approximately 6.2 million people in the United States had heart failure (HF) between 2013 and 2016, and prevalence of the condition continues to increase over time as the population ages. Ischemic heart disease is one of the leading contributors to HF. Thanks to technologic advances in cardiac imaging, multimodality studies provide insight into the pathophysiology of both ischemic and nonischemic cardiomyopathy. In this overview based on the latest research, we discuss the integral role of comprehensive imaging studies, particularly transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), in differentiating potential causes of HF and diagnosing various cardiomyopathies.

TTE and CMR: The Basics

Transthoracic echocardiography, the most widely available initial standard of care test for ventricular dysfunction, can help differentiate ischemic and nonischemic etiologies of cardiomyopathies. Two-dimensional (2D), color, and spectral Doppler TTE can characterize left ventricular (LV) size, morphology, and systolic and diastolic function; assess wall motion abnormalities (WMA); and detect valvular heart disease.

Myocardial strain imaginguses speckle-tracking echocardiography to measure tissue deformation through the cardiac cycle. Myocardial strain imaging, a reproducible measure of LV systolic function, can identify subclinical LV dysfunction and patterns that suggest specific cardiomyopathies (eg, ischemic cardiomyopathy, amyloidosis, hypertrophic cardiomyopathy, chemotherapy-induced cardiotoxicity). In addition, LV global longitudinal strain provides important