The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 2: Clinical Applications

Received July 29, 2008; accepted July 29, 2008. Part 1 of these articles focused on the targets of the imaging examination in heart failure (HF) and also reviewed the individual techniques that might be used to address these features.1 This article will concentrate on specific clinical situations. Despite improvements in outcomes related to new treatments for HF, the prognosis of this condition remains poor. The guidelines of the American College of Cardiology and the American Heart Association have emphasized the importance of the detection of early disease in patients at risk (stage A) and those with asymptomatic evidence of left ventricular (LV) damage (stage B).2 The identification of these entities should lead to the initiation of prophylactic therapy. In those already on therapy (eg, antihypertensive drugs), the detection of target organ disease (eg, LV hypertrophy) may justify more intensive therapy. ### Early Detection of HF Despite interest in biomarkers, imaging seems to be the optimal strategy for HF screening. It is likely that this will be performed in the community and it is probable (because of cost and availability considerations) that the test of choice will remain echocardiography.3 The increasing workload provided by the HF epidemic may alter the workflow, with an increasing role for imaging in primary care. Although the wider use of echocardiography by noncardiologists will bring challenges with respect to training, this process will be facilitated by progressive miniaturization and automation, which will allow better quantification and reduced subjectivity. The subjective assessment of echocardiography is a well-recognized limitation that has been improved, but not avoided, by modern technical developments. The availability of a simple quantitative parameter to support the clinician’s interpretation of resting echocardiographic images may be provided by the assessment of 2D myocardial strain, based on speckle tracking, although it remains to be shown to what extent the …