Established and emerging cardiovascular magnetic resonance techniques for prognostication and guiding therapy in heart failure

Abstract

The syndrome of heart failure is prevalent and a cause of significant morbidity and mortality. Cardiovascular magnetic resonance (CMR) offers a unique method to quantify the extent of left ventricular dysfunction and also characterize the myocardium, particularly according to the presence and distribution of late gadolinium enhancement. The prognostic value of late gadolinium enhancement in various etiologies of heart failure has been demonstrated. Newer techniques that non-invasively assess the extracellular volume may also add to the prognostic value of CMR in heart failure. Management decisions in patients with heart failure can often be complex. CMR can provide useful information when planning cardiac device therapy and the CMR assessment of viability is key when planning revascularization.

Keywords::

• cardiac magnetic resonance
• extracellular volume
• heart failure
• late gadolinium enhancement
• prognosis
• T1 mapping

Financial & competing interests disclosure

PP Swoboda is funded by a British Heart Foundation clinical research training fellowship. S Plein has an unrestricted educational grant from Philips Healthcare, and is funded by a British Heart Foundation Senior Clinical Research Fellowship. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The syndrome of heart failure is a common cause of mortality and morbidity.

• Cardiovascular magnetic resonance adds to prognostic assessment in heart failure by accurate assessment of ejection fraction.

• The presence of late gadolinium enhancement in many etiologies of heart failure (particularly ischemic cardiomyopathy, dilated cardiomyopathy, myocarditis and sarcoidosis) confers a significant risk of mortality.

• T1 and extracellular volume mapping are emerging techniques that may add further prognostic value.

• Cardiovascular magnetic resonance techniques can add further information which may be useful when making complex treatment plans including implantable cardioverter-defibrillator, cardiac resynchronization therapy and revascularization in patients with heart failure.

Notes