MRI In addition to the evaluation of cardiac structure and function using rest-only MRI, myocardial focal fibrosis quantified by late gadolinium enhanced (LGE)-MRI in patients with HFpEF is an independent predictor of future events after the adjustment for prognostic factors (ie, age, diabetes mellitus, New York Heart Association classification, history of HF hospitalization, and LVEF) previously identified in the Irbesartan in Heart Failure with Preserved Ejection Fraction study [85]. CTA Coronary Arteries There is limited evidence to support the use of cardiac CTA for the differentiating patients with HFrEF from HFpEF. Arteriography Coronary While echocardiography is commonly used to diagnose and stage diastolic dysfunction, uncertainty in characterizing borderline cases may persist, and direct hemodynamic measurements may still be needed to establish a definitive diagnosis of HFpEF [86-88]. However, such invasive hemodynamic assessment is made without the need for concurrent coronary angiography or contrast LV ventriculography. Suspected New-Onset and Known Nonacute Heart Failure Variant 3: Confirmed new-onset heart failure with reduced ejection fraction of uncertain etiology: ischemic versus nonischemic. Because of reversible or irreversible ischemic injury to the LV myocardium, CAD with or without a history of antecedent myocardial infarction remains a major source of HFrEF nationally [1]. Prompt differentiation of ischemic HFrEF from nonischemic HFrEF is important because patients with ischemic cardiomyopathy can potentially have dramatic improvement with specific therapy, including revascularization [14,89]. Thus, in the setting of new-onset nonacute HFrEF, it is important to distinguish between ischemic and nonischemic (eg, remote diffuse myocarditis, alcoholic cardiomyopathy) etiologies in order to guide further evaluation and treatment [15].
Suspected New Onset and Known Nonacute Heart Failure. MRI In addition to the evaluation of cardiac structure and function using rest-only MRI, myocardial focal fibrosis quantified by late gadolinium enhanced (LGE)-MRI in patients with HFpEF is an independent predictor of future events after the adjustment for prognostic factors (ie, age, diabetes mellitus, New York Heart Association classification, history of HF hospitalization, and LVEF) previously identified in the Irbesartan in Heart Failure with Preserved Ejection Fraction study [85]. CTA Coronary Arteries There is limited evidence to support the use of cardiac CTA for the differentiating patients with HFrEF from HFpEF. Arteriography Coronary While echocardiography is commonly used to diagnose and stage diastolic dysfunction, uncertainty in characterizing borderline cases may persist, and direct hemodynamic measurements may still be needed to establish a definitive diagnosis of HFpEF [86-88]. However, such invasive hemodynamic assessment is made without the need for concurrent coronary angiography or contrast LV ventriculography. Suspected New-Onset and Known Nonacute Heart Failure Variant 3: Confirmed new-onset heart failure with reduced ejection fraction of uncertain etiology: ischemic versus nonischemic. Because of reversible or irreversible ischemic injury to the LV myocardium, CAD with or without a history of antecedent myocardial infarction remains a major source of HFrEF nationally [1]. Prompt differentiation of ischemic HFrEF from nonischemic HFrEF is important because patients with ischemic cardiomyopathy can potentially have dramatic improvement with specific therapy, including revascularization [14,89]. Thus, in the setting of new-onset nonacute HFrEF, it is important to distinguish between ischemic and nonischemic (eg, remote diffuse myocarditis, alcoholic cardiomyopathy) etiologies in order to guide further evaluation and treatment [15].