CMR in the Evaluation of Diastolic Dysfunction and Phenotyping of HFpEF: Current Role and Future Perspectives

JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 2):283-296. doi: 10.1016/j.jcmg.2019.02.031. Epub 2019 Jun 12.

Abstract

Heart failure with preserved ejection fraction presents a challenging diagnosis given a heterogeneous patient population and limited therapeutic options. Diastolic function assessment using echocardiography has been a cornerstone in the work-up and is as important as systolic functional assessment. There has been increased awareness to the potential utility of cardiac magnetic resonance (CMR) imaging over the past decade as a promising, radiation-free, robust imaging modality providing an unrestricted field of view and high-resolution images for global and regional functional assessment. CMR provides early markers for detecting myocardial disease using tissue characterization imaging, which might prove useful to improve diagnosis and management. Over the years, several studies have examined CMR-derived diastolic functional indices, including transmitral and pulmonary venous velocities, left ventricular and left atrial strain using myocardial tagging, and, more recently, feature tracking. The relevance of imaging-based diastolic function indices and their clinical application across different modalities is increasingly recognized.

Keywords: T1 mapping; cardiac magnetic resonance; extracellular volume map; feature-tracking CMR imaging; phase-contrast imaging.

Publication types

  • Review

MeSH terms

  • Atrial Function, Left
  • Diastole
  • Heart Failure / diagnostic imaging*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Humans
  • Magnetic Resonance Imaging, Cine*
  • Phenotype
  • Predictive Value of Tests
  • Prognosis
  • Stroke Volume*
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Dysfunction, Left / therapy
  • Ventricular Function, Left*