Radiography Chest While radiography may play a role in diagnosing HF, there is no evidence to support the use of chest radiography for differentiating ischemic versus nonischemic etiology of HF. US Echocardiography Transthoracic Resting and Stress Several studies have demonstrated the utility of stress echocardiography to identify both resting and poststress systolic wall motion abnormalities [90-92]. Additionally, these findings correlate to clinical outcomes. SPECT or SPECT/CT MPI Rest and Stress With SPECT/CT MPI, sensitivity and negative predictive value are both excellent for detecting CAD in patients with HF with either reduced or preserved LVEF; however, the distinction between ischemic and nonischemic etiologies is more characteristic of the evaluation of HFrEF [93,94]. In dyspneic patients with HFrEF without concomitant chest pain, the nonglobal resting LV dysfunction and high-summed stress MPI-deficiency score on gated rest and stress SPECT serve as independent predictors of an ischemic etiology; although low in sensitivity, specificity is acceptable [95]. While standard MPI (more often performed with SPECT than PET) is often deficient in making that distinction because a nonischemic cardiomyopathy can have focal defects in tracer uptake and CAD with global balanced ischemia can result in a normal-appearing perfusion pattern, new developments in measuring quantitative blood flow have potential to provide a more accurate determination of HFrEF etiology [94]. Nuclear Medicine Ventriculography RNV is used for the evaluation of cardiac function [41]. FDG-PET/CT Heart and Rb-82 PET/CT Heart An advantage of the use of stress MPI with PET is its improved accuracy for the detection of severe, multivessel CAD when compared to SPECT alone. Additionally, PET markers of absolute peak stress LVEF measurements and myocardial perfusion reserve may improve detection of patients with CAD [41,96,97].
Suspected New Onset and Known Nonacute Heart Failure. Radiography Chest While radiography may play a role in diagnosing HF, there is no evidence to support the use of chest radiography for differentiating ischemic versus nonischemic etiology of HF. US Echocardiography Transthoracic Resting and Stress Several studies have demonstrated the utility of stress echocardiography to identify both resting and poststress systolic wall motion abnormalities [90-92]. Additionally, these findings correlate to clinical outcomes. SPECT or SPECT/CT MPI Rest and Stress With SPECT/CT MPI, sensitivity and negative predictive value are both excellent for detecting CAD in patients with HF with either reduced or preserved LVEF; however, the distinction between ischemic and nonischemic etiologies is more characteristic of the evaluation of HFrEF [93,94]. In dyspneic patients with HFrEF without concomitant chest pain, the nonglobal resting LV dysfunction and high-summed stress MPI-deficiency score on gated rest and stress SPECT serve as independent predictors of an ischemic etiology; although low in sensitivity, specificity is acceptable [95]. While standard MPI (more often performed with SPECT than PET) is often deficient in making that distinction because a nonischemic cardiomyopathy can have focal defects in tracer uptake and CAD with global balanced ischemia can result in a normal-appearing perfusion pattern, new developments in measuring quantitative blood flow have potential to provide a more accurate determination of HFrEF etiology [94]. Nuclear Medicine Ventriculography RNV is used for the evaluation of cardiac function [41]. FDG-PET/CT Heart and Rb-82 PET/CT Heart An advantage of the use of stress MPI with PET is its improved accuracy for the detection of severe, multivessel CAD when compared to SPECT alone. Additionally, PET markers of absolute peak stress LVEF measurements and myocardial perfusion reserve may improve detection of patients with CAD [41,96,97].