Congestive heart failure cardiac MRI

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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD[3]

Overview

Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), T1 mapping, and extracellular volume may diagnosis myocardial fibrosis/scar in subendocardial area for patients with ischaemic heart disease (IHD) and scar in mid-wall area for dilated cardiomyopathy (DCM). Moreover, CMR may identify myocardial characterization including myocarditis, amyloidosis, sarcoidosis, Chagas disease, Fabry disease, LV non-compaction cardiomyopathy, haemochromatosis, and arrhythmogenic cardiomyopathy.

=2021 European Society of Cardiology (ESC) Guidelines

Class I

CMR is recommended for the assessment of myocardial structure and function in patients with poor echocardiogram acoustic windows (Level of Evidence: C) CMR is recommended for the evaluation of myocardial tissue in suspicion of infiltrative disease, Fabry disease, inflammatory disease (myocarditis), LV non-compaction,amyloid, sarcoidosis, iron overload/hemochromatosis(Level of Evidence: C)

Class IIa

CMR with LGE should be considered in DCM to differentiate between ischemic and non-ischemic myocardial damage(Level of Evidence: C)

The above table adopted from 2021 ESC Guideline

Computed tomography coronary angiography (CTCA)

• Computed tomography coronary angiography (CTCA) may be considered in patients with a low to intermediate pre-test probability ofCAD, or equivocal result of

non-invasive stress tests in order to exclude the diagnosis of CAD.

Class IIa

"Coronary CT angiography should be considered in patients with a low to intermediate pre-test probability of CAD or those with equivocal non-invasive stress tests in order to rule out coronary artery stenosis.(Level of Evidence: C) "

The above table adopted from 2021 ESC Guideline

Class IIa

"Endomyocardial biopsy should be considered in patients with rapidly progressive HF despite standard therapy when there is a probability of a specific diagnosis, which can be confirmed only in myocardial samples.(Level of Evidence: C) "

The above table adopted from 2021 ESC Guideline