Cardiac Imaging in Heart Failure with Comorbidities

The Emerging Role of Combined Brain/Heart Magnetic Resonance Imaging for the Evaluation of Brain/Heart Interaction in Heart Failure

Heart failure (HF) patients frequently develop brain deficits that lead to cognitive dysfunction (CD), which may ultimately also affect survival. There is an important interaction between brain and heart that becomes crucial for survival in patients with HF. Our aim was to review the brain/heart interactions in HF and discuss the emerging role of combined brain/heart magnetic resonance imaging (MRI) evaluation. A scoping review of published literature was conducted in the PubMed EMBASE (OVID), Web of Science, Scopus and PsycInfo databases. Keywords for searches included heart failure, brain lesion, brain, cognitive, cognitive dysfunction, magnetic resonance imaging cardiovascular magnetic resonance imaging electroencephalogram, positron emission tomography and echocardiography. CD testing, the most commonly used diagnostic approach, can identify neither subclinical cases nor the pathophysiologic background of CD. A combined brain/heart MRI has the capability of diagnosing brain/heart lesions at an early stage and potentially facilitates treatment. Additionally, valuable information about edema, fibrosis and cardiac remodeling, provided with the use of cardiovascular magnetic resonance, can improve HF risk stratification and treatment modification. However, availability, familiarity with this modality and cost should be taken under consideration before final conclusions can be drawn. Abnormal CD testing in HF patients is a strong motivating factor for applying a combined brain/heart MRI to identify early brain/heart lesions and modify risk stratification accordingly.

Diagnostic Value and Clinical Performance of Cardiac Ultrasound in Patients with Chronic Heart Failure with Hypertension

Objective

To assess the diagnostic value and clinical performance of cardiac ultrasound in patients with chronic heart failure and hypertension.

Methods

In this prospective study, between August 2017 and January 2020, 50 patients with chronic heart failure and hypertension were recruited and assigned to the study group and 50 healthy individuals during the same period after physical examinations were included in the control group. Cardiac ultrasound examinations were performed on the participants, and the results were compared and analyzed.

Results

The study group had a higher left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), and late diastolic peak flow velocity (A wave) and showed lower early diastolic peak flow velocity (E wave) and late diastolic peak flow velocity/lower early diastolic peak flow velocity (E/A) ratio levels than in the control group. The study group had 15 patients with grade I cardiac function (ultrasound detection rate of 100%), 18 patients with grade II cardiac function (ultrasound detection rate of 100%), and 17 patients with grade III cardiac function (ultrasound detection rate of 100%). Grade I cardiac function patients showed the lowest LVEDD, LVESD, and E/A and the highest LVEF than grade II patients, followed by grade III patients. The study group showed higher LVEF and echocardiographic estimation of the pulmonary arterial systolic pressure (PASP) and lower right ventricular lateral wall systolic excursion velocity and tricuspid annular plane systolic excursion (TAPSE) than the control group. Chronic heart failure with hypertension was associated with high levels of right atrial total emptying volume (RAVIt), right atrial passive emptying volume (RAVIp), right atrial active emptying volume (RAVIa), and right atrial active emptying fraction (RAVIaEF) and low levels of right atrial total emptying fraction (RAVItEF) and right atrial passive emptying fraction (RAVIpEF) versus the healthy status (all P < 0.05).

Conclusion

Cardiac ultrasound is a noninvasive operation with low cost, high repeatability, and accurate detection, which can identify right heart function impairment at an early stage, assist clinical treatment, and improve patient prognosis, so it is worthy of promotion and application.

Cardiovascular Magnetic Resonance Imaging: A Prospective Modality in the Diagnosis and Prognostication of Heart Failure

Heart failure (HF) is a clinical syndrome resulting from structural cardiac remodeling and altered function that impairs tissue perfusion. This article aimed to highlight the current diagnostic and prognostic value of cardiac magnetic resonance (CMR) in the management of HF and prospective future applications. Reviewed are the physics associated with CMR, its use in ischemic and non-ischemic causes of HF, and its role in quantifying left ventricular ejection fraction. It also emphasized that CMR allows for noninvasive morphologic and functional assessment, tissue characterization, blood flow, and perfusion evaluation in patients with suspected or diagnosed HF. CMR has become a crucial instrument for the diagnosis, prognosis, and therapy planning in patients with HF and cardiomyopathy due to its accuracy in quantifying cardiac volumes and ejection fraction (considered the gold standard) as well as native and post-contrast myocardial tissue characterization.

Clinical Phenotypes of Cardiovascular and Heart Failure Diseases Can Be Reversed? The Holistic Principle of Systems Biology in Multifaceted Heart Diseases

Recent advances in cardiology and biological sciences have improved quality of life in patients with complex cardiovascular diseases (CVDs) or heart failure (HF). Regardless of medical progress, complex cardiac diseases continue to have a prolonged clinical course with high morbidity and mortality. Interventional coronary techniques together with drug therapy improve quality and future prospects of life, but do not reverse the course of the atherosclerotic process that remains relentlessly progressive. The probability of CVDs and HF phenotypes to reverse can be supported by the advances made on the medical holistic principle of systems biology (SB) and on artificial intelligence (AI). Studies on clinical phenotypes reversal should be based on the research performed in large populations of patients following gathering and analyzing large amounts of relative data that embrace the concept of complexity. To decipher the complexity conundrum, a multiomics approach is needed with network analysis of the biological data. Only by understanding the complexity of chronic heart diseases and explaining the interrelationship between different interconnected biological networks can the probability for clinical phenotypes reversal be increased.