Independent of and incremental to basic parameters (eg, LV mass, left atrial [LA] size, and mitral regurgitation) provided by TTE, the following insights can be gained from more advanced echocardiographic techniques in the setting of suddenly decompensated ventricular function: (1) need for HF hospitalization based on LV global longitudinal strain derived using speckle-tracking technology [51]; (2) risk of all-cause 1-year mortality based on Doppler-determined transmitral to mitral annular early diastolic velocity ratio reflecting LV filling pressure [52]; and (3) risk for in-hospital mortality, rehospitalization, and cardiovascular mortality by early mitral inflow velocity to early diastolic mitral annular velocity reflecting LV filling pressure estimated with Doppler [53]. Cardiac filling pressures can be estimated from physical examination with modest accuracy, and exposure to echocardiographic data may not significantly enhance accuracy beyond bedside examination alone, both for left- heart and right-heart pressures [54]. However, in ambulatory patients being evaluated in the community for suspected of nonacute new-onset HF using standardized diagnostic evaluation, TTE was shown to not make a significant diagnostic contribution [40]. Nuclear Medicine Ventriculography Radionuclide ventriculography (RNV) is an additional alternative that may be applied to the evaluation of cardiac function [41]. One of its benefits is its significant reproducibility, which has been used to track the efficacy of a variety of therapeutic interventions for patients with HF [41,55-57]. SPECT or SPECT/CT MPI Rest and Stress There is no evidence to support the use of rest and stress SPECT/CT MPI as an initial imaging modality for suspected new-onset nonacute HF. FDG-PET/CT Heart and Rb-82 PET/CT Heart There are only minimal data on the use of PET/CT for evaluation of newly suspected or potential HF [23-25].
Suspected New Onset and Known Nonacute Heart Failure. Independent of and incremental to basic parameters (eg, LV mass, left atrial [LA] size, and mitral regurgitation) provided by TTE, the following insights can be gained from more advanced echocardiographic techniques in the setting of suddenly decompensated ventricular function: (1) need for HF hospitalization based on LV global longitudinal strain derived using speckle-tracking technology [51]; (2) risk of all-cause 1-year mortality based on Doppler-determined transmitral to mitral annular early diastolic velocity ratio reflecting LV filling pressure [52]; and (3) risk for in-hospital mortality, rehospitalization, and cardiovascular mortality by early mitral inflow velocity to early diastolic mitral annular velocity reflecting LV filling pressure estimated with Doppler [53]. Cardiac filling pressures can be estimated from physical examination with modest accuracy, and exposure to echocardiographic data may not significantly enhance accuracy beyond bedside examination alone, both for left- heart and right-heart pressures [54]. However, in ambulatory patients being evaluated in the community for suspected of nonacute new-onset HF using standardized diagnostic evaluation, TTE was shown to not make a significant diagnostic contribution [40]. Nuclear Medicine Ventriculography Radionuclide ventriculography (RNV) is an additional alternative that may be applied to the evaluation of cardiac function [41]. One of its benefits is its significant reproducibility, which has been used to track the efficacy of a variety of therapeutic interventions for patients with HF [41,55-57]. SPECT or SPECT/CT MPI Rest and Stress There is no evidence to support the use of rest and stress SPECT/CT MPI as an initial imaging modality for suspected new-onset nonacute HF. FDG-PET/CT Heart and Rb-82 PET/CT Heart There are only minimal data on the use of PET/CT for evaluation of newly suspected or potential HF [23-25].