Other imaging modalities
Other imaging techniques can be helpful.1,21
Cardiac catheterisation and coronary angiography
This is indicated in the following clinical scenarios:
- heart failure caused by systolic dysfunction in association with angina with regional wall motion abnormalities and/or scintigraphic evidence of reversible myocardial ischaemia when revascularisation is being considered
- ‘work-up’ for cardiac transplantation
- heart failure secondary to complications of MI such as ventricular aneurysm.
Nuclear imaging, including ECG-gated myocardial perfusion imaging can be used to assess heart function and damage in heart failure. ECG-gated single-photon emission CT (SPECT) can be used to assess global LVEF, regional wall motion abnormalities, and regional wall thickening. If coronary artery disease is suspected CT (SPECT) can also assess for ischaemia and myocardial viability.
Cardiac computed tomography (CT) scanning of the heart is not usually required in the routine diagnosis and management of heart failure. Multidetector CT (MDCT) scanning is useful in delineating congenital and valvular abnormalities; however, echocardiography and CMR may provide similar information without exposing the patient to ionising radiation.
Positron emission tomography (PET) (alone or with CT) may also be used to assess ischaemia and viability,but lack of availability, radiation exposure, and wide availability of cheaper alternatives limit its’ use.
Imaging summary statement
Appropriate and timely imaging is crucial in a patient with suspected heart failure; it can make a diagnosis, reveal an underlying cause, guide therapy and predict outcome.
Echocardiography remains the primary investigation due to its widespread availability, low cost and wealth of clinical experience. CMR, however, is also a powerful imaging modality in heart failure which may give more information as to the aetiology of the condition.
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