Imaging in the management of patients with heart failure

Many imaging techniques are available nowadays in the management of patients with heart failure. The simple chest X-ray examination gives information concerning the cardiac silhouette and the pulmonary vascular distribution, identifing patients with asymptornatic pulmonary congestion. Morphological and global assessment of the left ventricle is easily realized by the application of traditional 2D-echo that could even identify the underlying cause of HE In the last few years the introduction of magnetic resonance imaging (MRI) and three-dimensional echocardiography allows a more quantitative analysis of the morpho-functional parameters. New imaging technologies such as Automatic Boundary Detection, Color Kinesis and Tissue Doppler Imaging (TDI) were developed to study regional wall motion, overcoming the operator-dependent analysis of traditional 2D-echo. MRI reliably assesses the transmurality of myocardial necrosis and ventricular remodeling, even when perfusion abnormalities are confined to the subendocardial layer. MRI allows a more accurate study of myocardial perfusion and microcirculation than echocontrastography. All the imaging tecniques described above, expecially traditional echo, are useful tools in monitoring the cardioprotective effect of therapy. In this setting, TDI is an innovative technique that evaluates wall motion asynchrony, thus allowing an appropriate biventricular pacing resyncronization therapy.