This session organized by EACVI Club 35 was devoted to the most recent evidence on prognostic stratification using cardiac imaging modalities.
Dr. Shkolnik (Russia) adressed the prognostic markers in heart failure, as well as the discrepancy between guidelines and every day practice. A very promising prognostic marker is global 2D longitudinal strain (GLS) for either left or right ventricular function. However, simpler parameters (ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), left atrial volume index etc) still represent the mainstay for predicting outcome in heart failure patients.
Dr.Mimoun (France) presented novel prognostic markers in asymptomatic patients with severe aortic stenosis, such as global longitudinal strain, exercise-induced changes in mean gradient or myocardial fibrosis on cardiac magnetic resonance imaging. The prognosis of patients with paradoxical low-flow low-gradient severe aortic stenosis remains controversial. For asymptomatic organic mitral regurgitation, left atrial size, contractile reserve and exercise-induced changes in pulmonary pressure and regurgitation, severity can be used for risk stratification.
Dr. Cesana (Italy) discussed automated carotid intima-media thickness measurements or pulsed-wave velocity as prognostic indices in preclinical atherosclerosis. Multiple non-invasive markers could reliably predict the presence of significant coronary artery disease.
Dr. Gonçalves (Portugal) underlined the value of cardiac magnetic resonance imaging and global longitudinal strain for assessing myocardial fibrosis burden as a predictor of events in patients with hypertrophic cardiomyopathy (HCM). Myocardial crypts could be a novel cardiac magnetic resonance imaging marker, encountered in genotype +/phenotype – HCM patients. “Apical sparing” on 2D longitudinal strain analysis appears to be a highly specific marker for differentiating cardiac amyloidosis from other causes of LV hypertrophy, while its preservation in basal segments may help in the diagnosis of non-compaction cardiomyopathy.
Although uncertainties persist and there is much work still to be done, there is a growing recognition of the ability of non-invasive imaging modalities to improve outcome prediction.