From the Guidelines
Noninvasive methods for assessing heart failure include transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and other imaging modalities. These methods are used to evaluate myocardial structure and function, assess left ventricular ejection fraction (LVEF), and identify patients with heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), or heart failure with preserved ejection fraction (HFpEF) 1.
Noninvasive Imaging Modalities
- Transthoracic echocardiography (TTE): recommended for the assessment of myocardial structure and function, LVEF, and valve disease 1
- Cardiac magnetic resonance (CMR): recommended for the assessment of myocardial structure and function, including right heart, in patients with poor acoustic window or complex congenital heart diseases 1
- Other imaging modalities: such as systolic tissue Doppler velocities, deformation indices (strain and strain rate), and non-invasive stress imaging (CMR, stress echocardiography, SPECT, PET) may be considered in specific clinical scenarios 1
Clinical Applications
- Diagnosis of heart failure: noninvasive imaging modalities can provide information about cardiac anatomy, LV or RV function, volumes, geometry, wall motion, or valvular function, and other findings supporting the diagnosis and etiology of heart failure 1
- Assessment of LVEF: TTE is recommended to assess LVEF and identify patients with HFrEF who may be suitable for evidence-based pharmacological and device treatment 1
- Evaluation of myocardial dysfunction: noninvasive imaging modalities can identify myocardial dysfunction at the preclinical stage, and reassessment of myocardial structure and function is recommended in patients with worsening heart failure symptoms or after evidence-based pharmacotherapy 1
From the Research
Noninvasive Methods for Assessing Heart Failure
The following noninvasive methods are used to assess heart failure:
- Echocardiography: a common investigation used to quantify left ventricular function, which is an important prognostic marker in heart failure 2
- Cardiac magnetic resonance imaging: used to identify potential reversible causes and underlying causes of heart failure when other modalities fail to do so 2
- Computed tomography coronary angiography: recommended for patients presenting with typical or atypical anginal symptoms, and is diagnostically comparable to invasive coronary angiography 2
- Eulerian video magnification: a novel noninvasive method that uses video recordings of the neck veins to assess jugular venous pressure, which can be used for remote monitoring of heart failure patients 3
- N-terminal pro-B-type natriuretic peptide (NT-proBNP): a biomarker used to assess left ventricular filling pressure and predict adverse outcomes in patients with heart failure 4
- Bioimpedance cardiography: a noninvasive method that uses alternating current to assess hemodynamics, including stroke volume, cardiac output, and thoracic fluid content 5
- Cardiopulmonary exercise testing: used to assess exercise capacity, which is a predictor of adverse outcomes in patients with heart failure 4
- Two-dimensional speckle tracking echocardiography: used to assess left atrial remodelling and predict adverse outcomes in patients with heart failure 4
Combination of Noninvasive Methods
Combining multiple noninvasive methods can provide a more comprehensive assessment of cardiac performance and predict adverse outcomes in patients with heart failure 4. For example, combining NT-proBNP, echocardiography, and cardiopulmonary exercise testing can provide a synergistic effect and improve prognostication 4.