What question did this study set out to answer?

To evaluate whether cardiac magnetic resonance can complement traditional echocardiography to improve diagnostic accuracy, therapeutic decision-making, and clinical outcomes in heart failure with preserved ejection fraction.

December 27, 2022Cardiology in Review

Heart Failure With Preserved Ejection Fraction: Will Cardiac Magnetic Imaging Impact on Diagnosis, Treatment, and Outcomes?: Explaining the Need for Advanced Imaging to Clinical Stakeholders

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Why the study?

Heart failure diagnosis and therapy have historically relied on echocardiography, prompting an evaluation of whether cardiac magnetic resonance has an increasing role in refining diagnostic accuracy and outcomes for HFpEF.

Does cardiac magnetic resonance imaging improve diagnostic accuracy and outcomes compared to echocardiography in patients with HFpEF?

Key Points

To evaluate whether cardiac magnetic resonance can complement traditional echocardiography to improve diagnostic accuracy, therapeutic decision-making, and clinical outcomes in heart failure with preserved ejection fraction.
Reviewed diagnostic paradigms categorizing heart failure by left ventricular ejection fraction, contrasting preserved (HFpEF, LVEF >50%) and reduced (HFrEF, LVEF <40%) phenotypes.
Assessed the historical reliance on echocardiography alongside the expanding role of advanced cardiac magnetic resonance imaging in clinical evaluation.
Relying solely on generalized volume overload symptoms and basic ejection fraction metrics limits the diagnostic precision needed to identify specific myocardial pathologies.
Cardiac magnetic resonance provides complementary diagnostic detail that refines phenotypic understanding and addresses the limitations of standard echocardiography in HFpEF management.

Structured PICO

Does cardiac magnetic resonance imaging improve diagnostic accuracy and outcomes compared to echocardiography in patients with HFpEF?

Population

Patients with heart failure with preserved ejection fraction (HFpEF)

Intervention

Cardiac magnetic resonance imaging (CMR)

Comparator

Echocardiography

Outcome

Diagnostic accuracy, treatment guidance, and outcomes

This review highlights the potential for cardiac magnetic resonance imaging to complement echocardiography in improving the diagnostic precision and management of HFpEF.

Implication

May support complementary CMR use with echocardiography in HFpEF; leaves open whether it improves diagnostic accuracy or outcomes.

Abstract

Clinicians frequently equate symptoms of volume overload to heart failure (HF) but such generalization may preclude diagnostic or etiologic precision essential to optimizing outcomes. HF itself must be specified as the disparate types of cardiac pathology have been traditionally surmised by examination of left ventricular (LV) ejection fraction (EF) as either HF with preserved LVEF (HFpEF-LVEF >50%) or reduced LVEF of (HFrEF-LVEF <40%). More recent data support a third, potentially transitional HF subtype, but therapy, assessment, and prognosis have been historically dictated within the corresponding LV metrics determined by echocardiography. The present effort asks whether this historically dominant role of echocardiography is now shifting slightly, becoming instead a shared if not complimentary test. Will there be a gradual increasing profile for cardiac magnetic resonance as the attempt to further refine our understanding, diagnostic accuracy, and outcomes for HFpEF is attempted?