Key result
Radionuclide myocardial imaging enables non-invasive quantification of pathological processes for precise HFpEF diagnosis and management.
Why the study?
HFpEF involves complex pathophysiological mechanisms that create diagnostic difficulties and limited treatment options, while conventional imaging has significant limitations in comprehensively evaluating its heterogeneous etiologies.
Radionuclide myocardial imaging offers a transformative approach for the precise diagnosis, molecular phenotyping, and mechanism-targeted therapy of HFpEF.
Does not yet support routine HFpEF imaging pathways; leaves open the need for prospective validation of radionuclide phenotyping.
Heart failure with preserved ejection fraction (HFpEF) represents a major phenotype of heart failure and accounts for over 50% of clinical cases. The complex pathophysiological mechanism involved in HFpEF promotes diagnostic difficulties and limited treatment options, posing a significant challenge in modern cardiology. Conventional imaging methods have significant limitations in comprehensively evaluating the heterogeneous etiologies and key pathological mechanisms of HFpEF. Radionuclide myocardial imaging, through the application of targeted radioactive tracers, enables in vivo, non-invasive quantitative assessment of multiple pathological and physiological processes such as myocardial perfusion, energy metabolism, sympathetic nervous activity, inflammatory responses, and fibrotic progression. Moreover, this technology offers a transformative approach to the precise diagnosis, molecular phenotyping, risk stratification, therapeutic monitoring, and prognostic assessment of HFpEF. Therefore, this review systematically summarizes the latest progress in radionuclide myocardial imaging techniques in diagnosing and treating HFpEF, with a particular focus on analyzing the unique clinical value of this technology in identifying specific etiologies (such as cardiac amyloidosis, cardiac sarcoidosis, and coronary microvascular dysfunction) and elucidating pathological mechanisms (including metabolic remodeling, inflammatory, fibrosis, and alterations in sympathetic innervation). Furthermore, we discuss the future directions of this imaging modality, including the development of novel molecular probes, integration with multimodal imaging techniques, and the application of artificial intelligence-assisted analysis. These innovations are expected to facilitate a paradigm shift from symptom-oriented management to mechanism-targeted therapy, offering new perspectives for the precise classification and clinical management of HFpEF.
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Yu et al. (2025) conducted a review in Heart Failure With Preserved Ejection Fraction (HFpEF). Radionuclide Myocardial Imaging was evaluated. Radionuclide myocardial imaging enables non-invasive quantitative assessment of multiple pathological processes, offering a transformative approach to the precise diagnosis and management of HFpEF.
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