Jeroen J. Bax
During the session on multimodality imaging in heart failure, different imaging techniques were addressed that can help in the evaluation of these patients. The presentations were oriented around patient examples. Dr. Daniel from Germany started by summarizing the information that is needed in these patients; a structured collection of information will guide the therapeutic decision-making process. Firstly, it is important to differentiate between ischemic and non-ischemic cardiomyopathy. In daily practice, the vast majority of patients presenting with heart failure have underlying coronary artery disease. It is then important to determine the precise LV function (or the LV ejection fraction) and volumes. These are important prognostic variables and also play a role in selection of therapy (eg device therapy). Next, an important issue is whether ischemia is present. The presence of viability is still considered important, although the recent STICH trial did not show the additional value of viability assessment on outcome after revascularization. Finally, assessment of valvular disease, particularly mitral regurgitation, is important in patients with severe heart failure who often present with ischemic mitral regurgitation. Prof. Daniel then discussed the role of echocardiography in this structured analysis, indicating the value of 2D and 3D techniques, and the use of intravenous contrast agents. The next presentation was performed by Dr. Desai from the United States, who elegantly discussed the role of magnetic resonance imaging in patients with heart failure. He emphasized that particularly contrast-enhanced MRI is useful in the differentiation between ischemic and non-ischemic cardiomyopathy. MRI can also assess perfusion and function with high resolution, resulting in a high accuracy to detect ischemia. Considering viability assessment, MRI using contrast has the highest resolution for scar assessment and is currently the only technique that can detect non-transmural scar tissue. Dr. Underwood from the UK addressed the use of nuclear imaging techniques and cardiac CT in the evaluation of patients with heart failure. Nuclear imaging with SPECT or PET is an excellent tool to assess cardiac ischemia. Moreover, PET assessment of glucose utilization is probably the most sensitive detector of residual viability. Cardiac CT, as Dr. Underwood pointed out, is emerging as the non-invasive imaging technique for assessing coronary stenoses or atherosclerosis. From all 3 talks, it was obvious that imaging can provide substantial information in patients with heart failure, that can be used to determine the optimal treatment strategy. It will be important to develop care tracks that aim to systematically obtain the information that is needed to define the best therapeutic possibility in the individual heart failure patient; in this way, imaging can be systematically implemented to derive the information needed.
Multimodality imaging heart failure
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