Vol.:(0123456789) 1 3 La radiologia medica https://doi.org/10.1007/s11547-020-01245-4 CARDIAC RADIOLOGY Multimodality imaging in chronic heart failure Ernesto Di Cesare 1  · Scipione Carerj 2  · Anna Palmisano 3,4  · Maria Ludovica Carerj 5  · Federica Catapano 6  · Davide Vignale 3,4  · Annamaria Di Cesare 7  · Gianluca Milanese 8  · Nicola Sverzellati 8  · Marco Francone 6  · Antonio Esposito 3,4 Received: 7 April 2020 / Accepted: 25 June 2020 © Italian Society of Medical Radiology 2020 Abstract The prevalence of heart failure (HF) is approximately 1–2% of the adult population in developed countries, rising to ≥ 10% among people over 70. The common symptoms of HF include shortness of breath, ankle swelling and fatigue, determined by a reduced cardiac output. Multimodality imaging is crucial to defne HF etiology, determine prognosis and guiding tailored treatments. Echocardiography is the most widely used imaging modality and maintains a pivotal role in the initial diagnos- tic work-up and in the follow-up of HF patients. Cardiac magnetic resonance (CMR) may support the morpho-functional assessment provided by echocardiography when the acoustic window is limited or a gold standard evaluation is required. Furthermore, CMR is frequently used due to the unmatched capability to characterize myocardial structure. Coronary computed tomography angiography has become the non-invasive imaging of choice to diagnose or rule-out coronary artery disease, acquiring remarkable importance in the management of HF patients. Moreover, emerging capabilities of CT-based tissue characterization may be useful, especially when CMR is contraindicated. Finally, chest CT may contribute to precisely defne the framework of HF patients, revealing new insight about cardiopulmonary pathophysiological interactions with potential high prognostic value. Keywords Heart failure · Chronic heart failure · Echocardiography · Computed tomography · Cardiac magnetic resonance Introduction The common symptoms of heart failure (HF) include short- ness of breath, ankle swelling and fatigue, determined by a reduced cardiac output. This defnition excludes the asymp- tomatic structural or functional cardiac abnormalities that anticipate cardiac failure. However, identifcation of cardiac abnormalities before the symptomatic evolution may reduce mortality through establishing targeted treatment at an early stage. The prevalence of HF is approximately 1–2% of the adult population in the developed countries [1, 2]. The proportion of patients with HF and preserved ejection fraction (HFpEF) ranges from 22 to 73%, depending on the defnition applied, the clinical setting, age and sex of the studied population, and previous myocardial infarction. Over the last 30 years, treatment improvements and their implementation have increased survival, reduced the hospitalization rate and the prevalence of HF with reduced EF (HFrEF), although the outcome often remains unsatisfactory [3]. * Antonio Esposito esposito.antonio@hsr.it 1 Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy 2 Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy 3 Experimental Imaging Center, Radiology Unit, IRCCS San Rafaele Scientifc Institute, Milan, Italy 4 School of Medicine, Vita-Salute San Rafaele University, Milan, Italy 5 Department of Biomedical Science, Dental, Morphological and Functional Images, University of Messina, Messina, Italy 6 Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy 7 Department of Medical Sciences, Internal Medicine and Cardiorespiratory Section, University of Ferrara, Ferrara, Italy 8 Department of Clinical Sciences, Section of Diagnostic Imaging, University Hospital of Parma, Parma, Italy