The Role of Novel Cardiac Imaging for Contemporary Management of Heart Failure

Figures

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  Figure 1. Left atrial strain by speckle tracking echocardiography. Upper panel: echocardiographic image (apical four-chamber view) showing the left ventricle (LV) and left atrium (LA) with blue coded region of interest for LA strain tracking. Lower panel: LA strain trace along with ECG. Reservoir strain (41%) is indicated by the blue arrow.

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  Figure 2. Current algorithm of the European Association of Cardiovascular Imaging for echocardiographic assessment of left ventricular filling pressure in patients with suspected heart failure with preserved ejection fraction. Note that this algorithm integrates left atrial reservoir strain, with a cut-off of 18%, as a reserve parameter if one of the classic parameters, LA volume, E/e’, or systolic pulmonary arterial pressure, cannot be obtained with confidence. Reproduced, with permission, from [8].

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  Figure 3. Schematic drawing of externally stimulated shear wave imaging. The shear wave is initiated by an external stimulus, and then visualized by very-high-framerate imaging. This allows imaging the propagation of the shear wave, and to obtain shear wave speed. From shear wave speed, under simplifying assumptions, the stiffness of a tissue can be calculated. UF ultrafast. Adapted with permission from [14].

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  Figure 4. CMR images with late gadolinium enhancement (LGE) in non-ischemic cardiomyopathies. Top left: cardiac sarcoidosis, with patchy distribution of LGE (arrows) in lateral wall and septum. Top right: septal mid-wall “stripe” pattern of LGE (arrows) in dilated cardiomyopathy. Middle left: patchy epicardial and mid-wall LGE (arrows) in the lateral wall in myocarditis. Middle right: midventricular short-axis view in a patient with pulmonary hypertension, right ventricular dilatation, and hypertrophy (star). Note LGE (arrows) at the right ventricular insertion points. Bottom left: cardiac amyloid. The LV blood pool is nulled (star) and there is subtle circumferential subendocardial LGE throughout the LV, most pronounced at the base (arrow). Bottom right: midventricular short-axis view of patient with hypertrophic cardiomyopathy and septal hypertrophy showing extensive mid-wall LGE (arrows). Reproduced, with permission, from [38].

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  Figure 5. Tissue characterization using native T1 and extracellular volume fraction (ECV). For the purpose of comparability, only studies using 1.5 T scanners were considered in this figure. AM, acute myocarditis; DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; MI, myocardial infarction; RA, rheumatoid arthritis; TC, takotsubo cardiomyopathy; SS, systemic sclerosis. Reproduced according to the Creative Commons CC BY license from [39].

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  Figure 6. Examples of summed PET images taken 10–20 min after injection of 11C-PIB (see below for abbreviations). The signal represents myocardium/blood SUV ratio, and the color scale ranges from black (SUV ratio 0) to white (SUV ratio 4.0). Transaxial and coronal view of (A) a patient with AL amyloidosis and high degree of 11C-PIB uptake in the left ventricle wall and septum; (B) a patient with ATTR amyloidosis and moderate degree of 11C-PIB uptake in the cardiac walls, most apparent in the septum; and (C) a healthy volunteer with no myocardial 11C-PIB uptake. All subjects show high signal in the liver, which is due to normal metabolization of 11C-PIB, and in the lungs, which is most likely caused by tracer lipophilicity. ATTR, transthyretin amyloidosis; PET, positron emission tomography; PIB, Pittsburgh compound B; SUV, standardized uptake value. Reproduced, with permission, from [50].