The role of imaging in the selection of patients for HFpEF therapy

Figures

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  Figure 1. Illustrative example of HFpEF patient in whom evaluation by DPD scintigraphy (left and upper right) revealed ATTR amyloidosis, reproduced with permission from.1 Lower right, echocardiographic parasternal long-axis view showing concentric hypertrophy of the left ventricle (septal and posterior wall thickness, both 15 mm). See text for further details.

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  Figure 2. Schematic overview of diseases covered by the “umbrella concept” of HFpEF. Imaging plays a crucial role for their identification and identification of therapeutic option. Rare cardiomyopathies and valvular heart disease have been omitted for the sake of clarity.

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  Figure 3. Example of HFpEF due to coronary microvascular dysfunction. Patient with heart failure symptoms and newly diagnosed left ventricular hypertrophy on echocardiography and CMR (panel 1). Panel 2 shows a thin circumferential subendocardial perfusion defect, suggestive for microvascular dysfunction. Microvascular dysfunction is clearly demonstrated by quantitative perfusion CMR (1.5 T): panel 3 shows normal perfusion at rest (green, rest myocardial blood flow 1.0 mL/g/min), while stress perfusion shows generalized impaired maximal perfusion (green-yellow; maximal myocardial blood flow 1.5 mL/g/min), resulting in a myocardial perfusion reserve of 1.5 (normal > 2.4).

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  Figure 4. Regression of wild-type ATTR amyloidosis under tafamidis therapy. Visualization of response to tafamidis treatment (61 mg once daily) by nuclear imaging. Planar whole-body DPD-scintigraphy in the upper panels and axial 99mTc-DPD-SPECT in the lower panels, with baseline findings on the left (upper left panel, Perugini grade 3, lower left panel, clear tracer uptake in the left ventricular walls; peak cardiac standardized uptake value: 12.40 g/mL) and follow-up findings after approximately 9 months on the right (upper right panel, Perugini grade 2, lower right panel, decreased myocardial uptake, peak cardiac standardized uptake value: 8.56 g/mL). Reproduced from.22