The utility of cardiovascular imaging in heart failure with preserved ejection fraction: diagnosis, biological classific
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The utility of cardiovascular imaging in heart failure with preserved ejection fraction: diagnosis, biological classification and risk stratification Gavin A. Lewis1,2 · Keith Pearce2 · Simon G. Williams2 · Erik B. Schelbert3,4,5 · Anita Macnab2 · Christopher A. Miller1,2,6 Accepted: 19 October 2020 © The Author(s) 2020
Abstract Heart failure with preserved ejection fraction (HFpEF) does not exist as a singular clinical or pathological entity but as a syndrome encompassing a wide range of clinical and biological phenotypes. There is an urgent need to progress from the unsuccessful ‘one-size-fits-all’ approach to more precise disease classification, in order to develop targeted therapies, personalise risk stratification and guide future research. In this regard, this review discusses the current and emerging roles of cardiovascular imaging for the diagnosis of HFpEF, for distilling HFpEF into distinct disease entities according to underlying pathobiology and for risk stratification. Keywords Heart failure with preserved ejection fraction · Cardiovascular imaging · Diagnosis · Disease classification · Risk stratification
Introduction Heart failure with preserved ejection fraction (HFpEF) does not exist as a singular entity but as a syndrome that encompasses a broad cohort of patients with a range of clinical and biological phenotypes [1, 2]. The utility of cardiovascular imaging in HFpEF serves three primary functions: (1) diagnosis: to determine whether patients’ symptoms and signs are due to heart failure (HF) and to identify specific causes of HF in the context of a normal or near normal left ventricular (LV) ejection fraction (EF); (2) biological classification: to characterise the
* Christopher A. Miller [email protected] 1
Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK
2
Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester M23 9LT, UK
3
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
underlying disease mechanisms; and (3) risk stratification: to guide prognosis. The growing prevalence of HFpEF and its poor outcome dictate an urgent need for more precise disease classification in order to develop therapies that target specific pathophysiological mechanisms and to personalise risk stratification. The failure of multiple large phase III trials to identify an effective therapy serves to demonstrate that the “one-size fits all” approach to HFpEF is inadequate. This review discusses the current and emerging roles of cardiac imaging for the diagnosis of HFpEF, for distilling HFpEF into distinct disease entities and for risk stratification.
4
UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA, USA
5
Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
6
Divisio
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