Multimodality Imaging in Advanced Heart Failure. A Clinical Consensus Statement of the Heart Failure Association of the ESC. Part 2: Mechanical Circulatory Support and Heart Transplantation

European Journal of Heart Failure, vol. 27, pp. 2557–2570

Abstract

This clinical consensus statement outlines the vital role of multimodality imaging in managing patients with advanced heart failure (HF), particularly those receiving mechanical circulatory support (MCS) and heart transplantation (HT). For both temporary and durable MCS, multimodality imaging, primarily echocardiography, is crucial for selecting candidates, ensuring proper device placement, and monitoring in the post-implantation period. Preoperatively, it helps to identify HF phenotypes, assess ventricular functions, detect intracardiac thrombi, and evaluate valvular conditions. Key measurements include ventricular size, ejection fraction, and cardiac output. Intraoperative imaging ensures optimal device placement and complication detection. Post-implantation echocardiography gives an impression of the interplay between heart and MCS, detects early complications, and evaluates ventricular unloading and right ventricular function. Serial imaging evaluations are essential for the management of the patient and the device and for diagnosing and treatment of complications. In temporary MCS, imaging is vital in the weaning process. Imaging is crucial across various post-transplant phases, from early postoperative monitoring to long-term follow-up. Echocardiography is the first-line technique. Cardiovascular magnetic resonance provides detailed evaluation of cardiac structure and function, offering insights into fibrosis, oedema, and myocardial perfusion. Coronary computed tomography angiography and positron emission tomography are possible alternatives for assessing coronary allograft vasculopathy. Overall, multimodality imaging is pivotal for comprehensive management of patients potentially eligible to or undergoing MCS or HT, enhancing diagnostic accuracy and guiding therapeutic decisions.

Authors 21

1. Laurens F. Tops corresponding Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Leiden ,

   Contributed equally as co-first authors

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

2. Alberto Aimo

   Scuola Superiore Sant'Anna · Fondazione Toscana Gabriele Monasterio

   Affiliation as printed

   Cardiology Division, Fondazione Toscana Gabriele Monasterio , Pisa ,

   Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna , Pisa ,

   Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy

   Contributed equally as co-first authors

   Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy

3. Stamatis N. Adamopoulos
   Affiliation as printed

   Heart Failure and Transplant Units, Onassis Hospital , Athens ,

   Heart Failure and Transplant Units, Onassis Hospital, Athens, Greece

4. Michael J. Bonios
   Affiliation as printed

   Heart Failure and Transplant Units, Onassis Hospital , Athens ,

   Heart Failure and Transplant Units, Onassis Hospital, Athens, Greece

5. Ahmet Çelik

   Mersin Üniversitesi

   Affiliation as printed

   Department of Cardiology, Faculty of Medicine, Mersin University , Mersin ,

   Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey

6. Ovidiu Chioncel

   Carol Davila University of Medicine and Pharmacy · Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu"

   Affiliation as printed

   Emergency Institute for Cardiovascular Diseases ‘C.C. Iliescu’ , Bucharest ,

   University of Medicine Carol Davila , Bucharest ,

   Emergency Institute for Cardiovascular Diseases 'C.C. Iliescu', Bucharest, Romania

   University of Medicine Carol Davila, Bucharest, Romania

7. Maja Čikeš

   University Hospital Centre Zagreb · University of Zagreb

   Affiliation as printed

   Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb , Zagreb ,

   Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

8. Maria G. Crespo‐Leiro

   Centro de Investigación en Red en Enfermedades Cardiovasculares · Complexo Hospitalario Universitario A Coruña

   Affiliation as printed

   Department of Cardiology, Hospital Universitario A Coruña (CHUAC), CIBERCV , A Coruña ,

   Department of Cardiology Hospital Universitario A Coruña (CHUAC), CIBERCV A Coruña Spain

9. Kevin Damman

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen ,

   Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

10. Concetta Di Nora

    Azienda sanitaria universitaria Friuli Centrale

    Affiliation as printed

    Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale , Udine ,

    Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy

11. Julien Dreyfus

    Centre Cardiologique du Nord

    Affiliation as printed

    Cardiology Department, Centre Cardiologique du Nord , Saint-Denis ,

    Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France

12. Finn Gustafsson

    Copenhagen University Hospital · Rigshospitalet

    Affiliation as printed

    Rigshospitalet Copenhagen University Hospital , Copenhagen ,

    Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark

13. Shahrukh Hashmani

    Royal Brompton Hospital

    Affiliation as printed

    Royal Brompton Hospital , London ,

    Royal Brompton Hospital, London, UK

14. Marco Masetti

    IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola

    Affiliation as printed

    Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna , Bologna ,

    Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy

15. Ify R. Mordi

    University of Dundee

    Affiliation as printed

    Division of Cardiovascular Research, School of Medicine, University of Dundee , Dundee ,

    Division of Cardiovascular Research, School of Medicine, University of Dundee, Dundee, UK

16. Sanem Nalbantgil

    Ege University

    Affiliation as printed

    Ege University , Izmir ,

    Ege University, Izmir, Turkey

17. Linda Wilhelmina Van Laake

    Utrecht University · University Medical Center Utrecht

    Affiliation as printed

    Department of Cardiology, University Medical Center Utrecht and Utrecht University , Utrecht ,

    Department of Cardiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands

18. Ralph Stephan von Bardeleben
    Affiliation as printed

    Heart Valve Center , Mainz ,

    Heart Valve Center, Mainz, Germany

19. Marco Metra

    Vita-Salute San Raffaele University · IRCCS Ospedale San Raffaele

    Affiliation as printed

    Cardiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital , Milan ,

    Cardiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy

20. Brenda Moura

    Universidade do Porto

    Affiliation as printed

    Armed Forces Hospital, Faculty of Medicine of the University of Porto , Porto ,

    Armed Forces Hospital, Faculty of Medicine of the University of Porto, Porto, Portugal

21. Tuvia Ben Gal

    Tel Aviv University · Rabin Medical Center

    Affiliation as printed

    Department of Cardiology, Rabin Medical Center , Petah Tikva ,

    Faculty of Medicine, Tel Aviv University , Tel Aviv ,

    Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel

    Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel