MRI Heart In addition to the evaluation of cardiac structure and function by rest-only MRI, myocardial perfusion, viability, and fibrosis imaging can assist in identification of etiology and assess prognosis [41,58]. There is no evidence to support the use of rest and stress MRI. CTA Coronary Arteries There is limited evidence to support the use of cardiac CTA as initial imaging for the evaluation of patients with newly suspected or potential HF. Arteriography Coronary The invasive nature of coronary angiography limits its use for the assessment of patients with newly suspected or potential HF. Suspected New-Onset and Known Nonacute Heart Failure is confounded by the following [1]: (1) in most symptomatic HF patients, variable balances of systolic and diastolic dysfunction coexist; and (2) derived LVEF values are dependent on the imaging modality used, method of analysis, and operator performance. Radiography Chest While radiography may play a role in diagnosing HF, there is no evidence to support the use of chest radiographs for differentiating HFrEF from HFpEF. US Echocardiography Transthoracic Resting and Stress At the time of presentation of patients to the ED with new-onset symptomatic HF, the differentiation between HFpEF and HFrEF using TTE has prognostic significance, with HFpEF having higher noncardiovascular mortality but lower cardiovascular mortality compared to HFrEF [62]. Beyond conventional 2-D TTE or TEE evaluations, the use of new more sensitive and more specific technologies, such as tissue Doppler imaging (TDI), strain rate, speckle tracking, or 3-D imaging, has facilitated the identification of other high-risk parameters associated with adverse outcomes, which are useful in guiding therapy and follow-up management of HFrEF patients [63].
Suspected New Onset and Known Nonacute Heart Failure. MRI Heart In addition to the evaluation of cardiac structure and function by rest-only MRI, myocardial perfusion, viability, and fibrosis imaging can assist in identification of etiology and assess prognosis [41,58]. There is no evidence to support the use of rest and stress MRI. CTA Coronary Arteries There is limited evidence to support the use of cardiac CTA as initial imaging for the evaluation of patients with newly suspected or potential HF. Arteriography Coronary The invasive nature of coronary angiography limits its use for the assessment of patients with newly suspected or potential HF. Suspected New-Onset and Known Nonacute Heart Failure is confounded by the following [1]: (1) in most symptomatic HF patients, variable balances of systolic and diastolic dysfunction coexist; and (2) derived LVEF values are dependent on the imaging modality used, method of analysis, and operator performance. Radiography Chest While radiography may play a role in diagnosing HF, there is no evidence to support the use of chest radiographs for differentiating HFrEF from HFpEF. US Echocardiography Transthoracic Resting and Stress At the time of presentation of patients to the ED with new-onset symptomatic HF, the differentiation between HFpEF and HFrEF using TTE has prognostic significance, with HFpEF having higher noncardiovascular mortality but lower cardiovascular mortality compared to HFrEF [62]. Beyond conventional 2-D TTE or TEE evaluations, the use of new more sensitive and more specific technologies, such as tissue Doppler imaging (TDI), strain rate, speckle tracking, or 3-D imaging, has facilitated the identification of other high-risk parameters associated with adverse outcomes, which are useful in guiding therapy and follow-up management of HFrEF patients [63].