Key result
Decision-centered multimodality HF framework prioritizes 91 studies to guide test selection and reassessment.
Why the study?
Heart failure severity cannot be inferred from LVEF alone, as loading conditions, rhythm, comorbidities, congestion, and measurement variability can produce discordance between EF categories and clinical status.
This narrative review proposes an explicit, decision-centered framework integrating clinical assessment, biomarkers, and multimodality imaging to guide test selection and longitudinal reassessment in heart failure beyond static LVEF.
Answers are grounded in this paper and cite their sources.
LVEF alone inadequately captures HF severity; leaves open prospective validation of integrated decision frameworks.
Heart failure (HF) is a clinical syndrome whose severity cannot be inferred from left ventricular ejection fraction (LVEF) alone. Loading conditions, rhythm, comorbidities, congestion, and measurement variability can produce discordance between EF categories and clinical status. This narrative review proposes a decision-centered framework integrating clinical assessment and biomarkers with relatively stable traits, dynamic physiological states, and longitudinal treatment responses. A new focused PubMed search through 16 October 2026 retrieved 543 unique records; 91 were prioritized for an evidence map, supplemented by the original bibliography and targeted source checking. Application-specific judgments distinguish technical validity, diagnostic or prognostic information, clinical actionability, and demonstrated outcome benefit. Representative pathways address unexplained dyspnea, cardiomyopathic substrate, amyloidosis, right-sided dysfunction, and worsening HF. Conventional echocardiography, natriuretic peptides, clinical risk factors, and congestion assessment anchor these pathways; advanced testing is selected when results could change management. Illustrative scenarios show how positive, negative, and indeterminate findings affect the next step. The proposed framework has not been prospectively validated; its incremental value over guideline-based multimodality assessment, including effects on outcomes, efficiency, and cost, remains hypothetical. Its contribution is an explicit structure for choosing tests and planning reassessment, with evidence boundaries made visible.
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Xia et al. (2026) conducted a review in Heart Failure. Decision-centered multimodality and longitudinal phenotyping framework vs. Guideline-based multimodality assessment was evaluated. A proposed decision-centered framework for multimodality heart failure phenotyping prioritized 91 of 543 retrieved records to guide test selection and longitudinal reassessment.
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