In addition, the assessment of longitudinal systolic and diastolic LV and RV function during a submaximal exercise stress TTE can confirm LV dysfunction related to HFpEF and might be used as a diagnostic test for difficult clinical situations [79]. In addition, it is known that within individual HFpEF cases, TTE with Doppler indexes of LV filling pressures (ie, early diastolic mitral annular velocity and E/Vp) do not reliably track directly measured filling pressures as these pressures vary, precluding the use of these techniques in the titration of medical therapy for HFpEF [80,81]. In HFpEF patients, global LV longitudinal strain measured using TTE with speckle tracking can help predict readmission within 30 days [51]. While global longitudinal strain is abnormal in HFpEF and is associated with a worse prognosis, it is not a powerful independent predictor of outcome [82]. However, exercise TTE may contribute to the identification of HFpEF patients, especially high-risk ones [83], and abnormal indices of LA mechanics, especially LA reservoir strain, are powerful clinical and prognostic factors in HFpEF [84]. Nuclear Medicine Ventriculography Because RNV can be performed to assess LVEF and volumes [41], it has potential in differentiating between HFrEF and HFpEF. SPECT or SPECT/CT MPI Rest and Stress While there is no evidence to support the use of rest and stress SPECT/CT specifically for differentiating between HFrEF and HFpEF, gated SPECT/CT has potential in differentiating between these forms of HF. FDG-PET/CT Heart and Rb-82 PET/CT Heart While there is no evidence to support the use of PET/CT specifically for differentiating between HFrEF and HFpEF, cardiac gated PET/CT has potential in differentiating between these forms of HF.
Suspected New Onset and Known Nonacute Heart Failure. In addition, the assessment of longitudinal systolic and diastolic LV and RV function during a submaximal exercise stress TTE can confirm LV dysfunction related to HFpEF and might be used as a diagnostic test for difficult clinical situations [79]. In addition, it is known that within individual HFpEF cases, TTE with Doppler indexes of LV filling pressures (ie, early diastolic mitral annular velocity and E/Vp) do not reliably track directly measured filling pressures as these pressures vary, precluding the use of these techniques in the titration of medical therapy for HFpEF [80,81]. In HFpEF patients, global LV longitudinal strain measured using TTE with speckle tracking can help predict readmission within 30 days [51]. While global longitudinal strain is abnormal in HFpEF and is associated with a worse prognosis, it is not a powerful independent predictor of outcome [82]. However, exercise TTE may contribute to the identification of HFpEF patients, especially high-risk ones [83], and abnormal indices of LA mechanics, especially LA reservoir strain, are powerful clinical and prognostic factors in HFpEF [84]. Nuclear Medicine Ventriculography Because RNV can be performed to assess LVEF and volumes [41], it has potential in differentiating between HFrEF and HFpEF. SPECT or SPECT/CT MPI Rest and Stress While there is no evidence to support the use of rest and stress SPECT/CT specifically for differentiating between HFrEF and HFpEF, gated SPECT/CT has potential in differentiating between these forms of HF. FDG-PET/CT Heart and Rb-82 PET/CT Heart While there is no evidence to support the use of PET/CT specifically for differentiating between HFrEF and HFpEF, cardiac gated PET/CT has potential in differentiating between these forms of HF.