Multimodality Imaging in Advanced Heart Failure. A Clinical Consensus Statement of the Heart Failure Association of the ESC. Part 1: Multimodality Imaging for the Evaluation of Patients with Advanced Heart Failure
European Journal of Heart Failure, vol. 27, pp. 2544–2556
Abstract
Heart failure (HF) represents a significant global health burden, with approximately 10% of patients progressing to advanced stages characterized by severe symptoms and recurrent hospitalizations despite conventional treatments such as guideline-directed medical therapy, devices, and surgery. This clinical consensus statement from the Heart Failure Association of the European Society of Cardiology discusses the applications of imaging modalities in patients with advanced HF. Transthoracic echocardiography remains the cornerstone for initial diagnosis and monitoring, providing critical insights into cardiac volumes, function, and valvular integrity, as well as congestion status. Transoesophageal echocardiography offers detailed evaluations of valve pathology, essential for surgical or transcatheter planning. Cardiovascular magnetic resonance provides comprehensive assessments of biventricular size and function, tissue characterization, and flow dynamics, proving particularly useful for diagnosing specific HF aetiologies. Computed tomography offers valuable insights into pulmonary artery diameter, right ventricular volume, and valvular anatomy, which are crucial for guiding percutaneous procedures. Nuclear imaging techniques allow assessing viability and diagnosing non-ischaemic HF conditions, guiding revascularization decisions. Advanced imaging techniques have expanded the understanding and management of right ventricular dysfunction. The integration of these advanced imaging modalities enhances diagnostic accuracy, risk stratification, and therapeutic decision-making, ultimately improving the prognosis and quality of life for patients with advanced HF. This clinical consensus statement highlights the critical role of various imaging modalities in managing patients with advanced HF, excluding those needing mechanical circulatory support or heart transplantation, emphasizing the multifaceted approach required for effective management.
Authors 21
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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
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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
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Affiliation as printed
Heart Failure and Heart Transplant Units, Onassis Hospital , Athens ,
Heart Failure and Heart Transplant Units, Onassis Hospital, Athens, Greece
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Affiliation as printed
Heart Failure and Heart Transplant Units, Onassis Hospital , Athens ,
Heart Failure and Heart Transplant Units, Onassis Hospital, Athens, Greece
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Affiliation as printed
Department of Cardiology, Mersin University, Faculty of Medicine , Mersin ,
Department of Cardiology, Mersin University, Faculty of Medicine, Mersin, Turkey
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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
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University Hospital Centre Zagreb · University of Zagreb
Affiliation as printed
University of Zagreb School of Medicine, Department of Cardiovascular Diseases, University Hospital Centre Zagreb , Zagreb ,
University of Zagreb School of Medicine, Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
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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 ,
Department of Cardiology Hospital Universitario A Coruña (CHUAC), CIBERCV Spain
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University Medical Center Groningen · University of Groningen
Affiliation as printed
University of Groningen, Department of Cardiology, University Medical Center Groningen , Groningen ,
University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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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
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Affiliation as printed
Cardiology Department, Centre Cardiologique du Nord , Saint-Denis ,
Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
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Copenhagen University Hospital · Rigshospitalet
Affiliation as printed
Rigshospitalet Copenhagen University Hospital , Copenhagen ,
Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Affiliation as printed
Royal Brompton Hospital , London ,
Royal Brompton Hospital, London, UK
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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
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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
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Affiliation as printed
Ege University , Izmir ,
Ege University, Izmir, Turkey
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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
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Affiliation as printed
Heart Valve Center , Mainz ,
Heart Valve Center, Mainz, Germany
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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
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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
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Affiliation as printed
Armed Forces Hospital, Porto, and Faculty of Medicine of the University of Porto , Porto ,
Armed Forces Hospital, Porto, and Faculty of Medicine of the University of Porto, Porto, Portugal
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